Returning to School After a Concussion: A Guide for Halton Families

School comes before sport

When a student has a concussion, families often focus on when they can play again. Current guidelines put school first: a student should be back to full learning, without symptoms getting worse, before returning to full-contact sport.

That doesn't mean keeping them home until they feel perfect. Research over the past decade has shifted advice away from long periods of rest. After a short period of relative rest in the first day or two, most students do better when they gradually return to school with the right supports than when they stay home in a dark room for a week or more.

The first 24 to 48 hours

In the first day or two, the aim is relative rest, not complete rest:

• light activity around the house and short, easy walks are fine;
• limit screens, reading and anything that clearly makes symptoms worse;
• prioritise sleep;
• avoid sport and any activity with a risk of another hit to the head.

If symptoms are severe or getting worse, or if you see warning signs such as repeated vomiting, worsening headache, increasing confusion or drowsiness, weakness, or slurred speech, go to the emergency department.

A gradual return to learning

Most return-to-learn plans follow a similar progression. Students move forward when the current step doesn't cause a meaningful, lasting increase in symptoms.

1. Light learning at home. Short periods of reading or schoolwork, about 15 to 30 minutes at a time, with breaks in between.
2. Back to school part-time. Half days or a reduced schedule, with accommodations.
3. Full days with accommodations. A normal schedule with supports still in place.
4. Full school without accommodations. Normal workload, including tests.

A mild, short-lived increase in symptoms during an activity is usually acceptable. If symptoms rise noticeably and stay up, the student should drop back a step and try again the next day.

Accommodations that actually help

Schools in Ontario are required to have concussion policies, including return-to-school plans, and both Halton boards have procedures for this. The most useful accommodations are usually practical ones:

• Scheduled breaks in a quiet space, before symptoms build up rather than after.
• Reduced screen time and printed notes or larger fonts where possible.
• Postponed tests and extended deadlines for major assignments.
• A reduced homework load while symptoms are settling.
• Leaving class a few minutes early to avoid crowded, noisy hallways.
• Sitting away from bright windows or noisy areas if light or noise sensitivity is a problem. See light sensitivity after concussion.

Ask the school who coordinates their concussion plan. It is often a guidance counsellor, a vice-principal or the student's homeroom teacher. Agree on how you'll share progress, so accommodations are scaled back as the student improves rather than ending all at once.

Signs the return isn't going well

Some students stall, usually for one of a few reasons:

• Headaches that build through the school day. This can point to a neck component or visual strain, and both are treatable.
• Trouble reading or following the board. Eye-movement problems are common after concussion and respond well to targeted exercises.
• Dizziness in busy hallways or the cafeteria. This can suggest a vestibular problem. See dizziness after concussion.
• Brain fog and slowed thinking that isn't improving week to week. See brain fog after concussion.
• Worry, low mood or avoiding school. Concussion can affect mood directly, and falling behind adds stress. This deserves attention too.

If a student isn't steadily improving after two to four weeks, or if each step back to school sends symptoms up again, that's a good time for a concussion assessment.

How we help students in Burlington

At Burlington Concussion Clinic, we work with students, parents and schools to:

• find out what is limiting school tolerance, whether that's the neck, eyes, balance system or exercise tolerance;
• treat those specific problems instead of simply waiting;
• provide a clear, staged plan the school can follow;
• coordinate the return to sport so it follows a successful return to learning, not the other way round.

If your child is struggling to get back to school after a concussion, book a concussion assessment online or call us at 905-635-5711.

This article is general information and doesn't replace individual medical advice. Follow your physician's guidance and your school board's concussion procedures.