Returning to school after a mild head injury

What symptoms will my child experience?

After a mild brain injury, children may experience many varied, temporary symptoms. These may include headaches, fatigue, noise/light sensitivity and changes in feelings, such as irritability or they may become easily upset. Injured children may also suffer changes in thinking skills, such as decreased concentration and taking longer to process information or think of responses.

For most children, these symptoms resolve within one to three weeks, although some may have symptoms for up to three months post-injury. During this time, it is important for caregivers to ease children back into their normal activities, as doing too much too soon can prolong a child’s recovery. Although children require both physical and cognitive rest, avoiding activities altogether can also result in problems, including low mood and withdrawal from social activities.

When can my child return to school?

It can be challenging to decide when your child should return to school after a mild brain injury. Most guidelines agree that an individualised, graded approach should be used as the child becomes more adept at tolerating challenging tasks without symptoms.

A complete cognitive rest is recommended during the early post-injury period. This means no video/computer games, texting, homework or school work, iPad/iPhone use, reading or strenuous social activities such as going to a restaurant. After 24 hours of rest, gentle exercises can be reintroduced, such as 15 minutes of screen time twice daily, reading five pages of a book, going for a walk or having a friend over.

If your child tolerates this level of activity well, begin introducing more challenging cognitive tasks such as 30 minutes of homework, reading for lengthier periods and social visits to school (even if the child cannot participate in learning). Once your child is able to tolerate one to two hours of homework tasks, you can begin slowly reintroducing them back to school. Start with half days first, before increasing to a full school day.

If your child’s symptoms worsen at any stage, try reducing the level of cognitive activity before re-introducing more complex tasks.

Can my child sit for exams?

Sometimes, children sustain their mild brain injury just before or during important exam periods. Although most children look “well” after a mild brain injury, it’s important to remember that they frequently experience a number of temporary symptoms that can negatively impact on their performance in exams and other formal assessments while they are still recovering. It’s important to ask your child’s school to:

• allow for exams or assessments to be postponed, without penalty, until your child has sufficiently recovered
• provide your child with extensions for outstanding assignments or projects while they are recovering
• allow your child additional time in exams to help manage fatigue. In addition, they should not sit for more than one exam daily.
• allow for rest breaks during exams and assessment in quiet, one-on-one settings
• where possible, avoid assessing the child on concepts they may have missed while injured.

Returning to school advice for older children

In general, older children prefer to be involved in developing their return-to-school plan. This may involve them checking that strategies are socially acceptable, providing feedback on their symptoms and helping to choose which subjects to return to initially.

Older students may require fatigue breaks during double lessons. Parents and carers should also be mindful of which subjects children are returning to. Woodwork, for example, may exacerbate symptoms of noise sensitivity, while subjects such as science may aggravate cognitive symptoms. Be sure to identify a key school contact who can share information with the large number of teachers involved in your child’s care.

Important school strategies to help minimise your child’s symptoms

The following strategies may help to minimise your child’s symptoms while they are recovering from a mild brain injury. Ask your child’s school to do the following.

Help reduce fatigue

• Allow your child plenty of rest breaks during class and school.
• Reduce the amount of work they are expected to complete.
• Provide a quiet area for your child to rest, if needed.
• Alternate activities that are relatively easy with those requiring more effort.
• Allow for a peer note-taker to prevent your child from becoming overly fatigued by listening and taking notes.

Allow for headaches

• Identify and manage factors that aggravate your child’s headaches.
• Allow your child to move to a quiet area or go to sick bay if symptoms persist or worsen.
• Provide them with pain relief as recommended by your child’s treatment medical team.

Care for noise or light sensitivity and visual symptoms

• Allow your child to have lunch in a quieter area of the school grounds.
• Limit or avoid noisy classes such as music, manual arts, physical education and assembly.
• Allow your child to wear sunglasses in school.
• Reduce the brightness of screens on your child’s electronic devices such as iPads, computers, smart boards and others.
• Turn off fluorescent lights, as needed.

Allow for slower thinking and cognition

• Allow your child extra time to complete tasks or have him/her complete tasks at their own rate.
• Provide your child with only one activity to complete at a time.
• Where possible, minimise distractions. For example, ensure the environment is quiet and that your child has everything they need before starting a task.
• Monitor your child’s concentration; they may need breaks or prompts and cues to help stay on track.
• Allow your child to audio record or type drafts of their work.
• Encourage and demonstrate the use of organisation and memory aids, such as diaries, calendars and phone reminders.

Care for your child's feelings

• Provide your child with plenty of opportunity to express their feelings. Anxiety and low moods are frequent after a mild brain injury. Children worry about falling behind at school, the impact of the injury on them socially and may miss sports and physical activities. It is important to provide plenty of reassurance that there will be opportunities to catch up and that they will not be penalised for missed work.
• Where possible, validate your child’s feelings and provide them with reassurance that activity restrictions are only temporary.
• If the child’s feelings are of concern, link them in with an appropriate caregiver such as a guidance officer, Kids Helpline or a local psychologist.

General advice for parents and carers

• Share all relevant medical advice – including information on how to transition your child back to school and activity restrictions – with your child’s school to ensure their safe, successful and timely return to school.
• Consider your child’s access to the school environment and distance between classes. They may require assistance with heavy bags, rest periods for walking long distances or special permission to move to the next class early, depending on their symptoms.
• Work closely with your child’s school to help support clear communication and your child’s return to normal activities.

When to seek help

In an emergency, call Triple Zero (000) and ask for an ambulance.

If you're not sure whether to go to an emergency department, call 13 HEALTH (13 43 25 84) and speak to a registered nurse.

For specific information and advice to help support your child’s recovery and return to learning, it can be helpful to contact your child’s GP or treatment team. Should you have specific concerns about your child’s educational development and progress, it is recommended that you seek support from your child’s class teacher, principal/deputy principal, or year coordinator.

If you or your child are concerned by changes in their feelings or mood, first speak to your GP or school counsellor/guidance officer. Your GP can assist you in linking in with a local psychologist, if needed.

Developed by the Queensland Paediatric Rehabilitation Service, Queensland Children’s Hospital. We acknowledge the input of consumers and carers.

Resource ID: FS218. Reviewed: January 2017.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.