What to Do After Your Child Hits Their Head

A head impact happens fast. Whether it was a fall from the monkey bars, a collision on the soccer field, or a tumble down the stairs, the minutes and hours that follow matter. Parents often feel uncertain about what to do, how serious the injury is, and whether to go to the emergency room or wait and watch. This guide walks through the immediate steps, what to monitor, and when to escalate care.

The most important thing to understand at the outset is that concussion symptoms do not always appear immediately. A child may seem fine in the first few minutes and develop headache, nausea, or confusion over the following hours. Observation in the first 24 hours is as important as the initial response.

Step 1: Stop All Activity Immediately

Remove your child from play, sport, or physical activity the moment a significant head impact occurs. This is not optional and it is not something to reassess based on how the child feels in the moment. The CDC's Heads Up program is explicit on this point: a child should not return to activity on the same day a concussion is suspected. The reasoning is neurological. In the immediate period following a concussion, the brain is in a vulnerable state. A second impact during this window, even a minor one, can cause disproportionately severe injury. That condition, called second impact syndrome, is rare but can be catastrophic and is almost entirely preventable.

Do not let a coach, teammate, or the child themselves talk you out of this. "I feel fine" is not a reliable indicator of brain status immediately after a head impact.

Step 2: Assess for Emergency Symptoms

Before deciding whether to call the pediatrician or go to the emergency room, quickly assess whether your child has any symptoms that require immediate emergency care. Call 911 or go directly to the emergency department if your child has any of the following.

• Loss of consciousness, even briefly
• Vomiting more than once
• A seizure
• Headache that is getting significantly worse rather than staying stable or improving
• Slurred or confused speech
• One pupil that is larger than the other
• Extreme drowsiness or inability to be roused
• Clear fluid from the nose or ears
• Weakness or numbness in the arms or legs
• In infants: a bulging fontanelle (the soft spot on top of the head)

If none of these are present, your child does not require emergency care at this moment, but they do need to be monitored carefully and seen by a pediatrician within one to two days.

Step 3: Create a Low-Stimulation Environment

Bring your child somewhere calm and quiet. Dim the lights if light sensitivity is present. Turn off screens, reduce background noise, and limit visitors. The brain after a concussion is working harder than usual to maintain basic function, and sensory input adds to that load. Rest in the first 24 to 48 hours is not about being overly cautious. It is about giving the brain the conditions it needs to begin recovery.

Screen time, including phones, tablets, video games, and television, has been shown to increase symptom burden in the acute phase of concussion. The American Academy of Pediatrics recommends limiting screen use during the first 48 hours following a concussion. This is often the hardest instruction for children and teenagers to follow, and it helps to explain the reason rather than simply issuing a rule.

Step 4: Monitor Symptoms Through the First Night

A frequently asked question is whether a child with a concussion should be kept awake. Current guidance from the American Academy of Pediatrics states that it is generally safe to let a child sleep after a concussion, provided they were alert and responsive before falling asleep and have none of the emergency symptoms listed above. Sleep supports neurological recovery. Keeping an exhausted child awake is not necessary and may increase agitation and symptom burden.

A reasonable approach is to check on your child once or twice during the night to confirm they can be roused, respond to their name, and are breathing normally. You do not need to wake them fully. If they are difficult to rouse or seem confused when you check, call your pediatrician's after-hours line or go to the emergency room.

In the first 24 hours, track symptoms in writing. Note when they started, how severe they are on a scale of one to ten, and whether they are improving, staying the same, or worsening. That record is useful information for the medical provider who will evaluate your child.

Step 5: Contact Your Pediatrician

Call your child's pediatrician the same day or first thing the following morning. Most pediatric practices will want to see a child with a suspected concussion within 24 to 48 hours of the injury. The evaluation will typically include a review of symptoms, a neurological assessment, and guidance on return to school and activity.

When you call, be prepared to describe how the injury happened, what symptoms appeared and when, whether there was any loss of consciousness, and how your child is presenting at the time of the call. Bringing your written symptom log to the appointment helps the provider build an accurate picture.

Do not give ibuprofen or aspirin for headache in the first 24 hours after a head injury unless specifically directed by a physician. Acetaminophen is generally considered the safer option for pain management in the acute phase because ibuprofen and aspirin affect platelet function, which is relevant when there is any possibility of bleeding. Ask your pediatrician for specific guidance on pain management for your child.

What the First 24 to 48 Hours Should Look Like

Physical and cognitive rest in the early recovery window does not mean complete isolation or lying in a dark room for two days. Current evidence supports relative rest, meaning a significant reduction in activity and stimulation without strict bed rest. Short, calm activities such as light conversation, brief walks, or quiet reading are generally acceptable once acute symptoms begin to stabilize. The goal is to avoid anything that significantly worsens symptoms.

Watch for a pattern of improvement. Symptoms that are gradually decreasing over the first 24 to 48 hours are a positive sign. Symptoms that are staying the same or worsening after 48 hours warrant a follow-up call to the pediatrician. Symptoms that worsen suddenly or dramatically at any point require immediate medical evaluation.

What Comes Next

Most children with a single concussion recover fully within one to four weeks with appropriate rest and a gradual return to activity. The return to school typically comes before return to sport, and both follow a stepwise protocol that your pediatrician or a concussion specialist will guide. Rushing either of those processes increases the risk of prolonged symptoms and delayed recovery.

If your child's symptoms persist beyond two to four weeks, ask for a referral to a pediatric concussion specialist or neurologist. Post-concussion syndrome in children is manageable with the right support, but it requires accurate diagnosis and a structured recovery plan.

Further Reading

• How to Tell If Your Child Has a Concussion
• Return to School After Concussion: What Parents Need to Know
• Concussion and Post-Concussion Syndrome Hub
• Youth Concussion: Resources for Parents and Families
• Post-Concussion Syndrome: What It Is and Why Symptoms Persist

Resources

• CDC Heads Up: Concussion in Youth Sports
• American Academy of Pediatrics: Concussions
• Robbins Nest Alliance: Guides and Printables

References

• Centers for Disease Control and Prevention. (2023). Concussion Facts. U.S. Department of Health and Human Services.
• Halstead, M. E., Walter, K. D., & Moffatt, K. (2018). Sport-related concussion in children and adolescents. Pediatrics, 142(6), e20183074.
• Lumba-Brown, A., Yeates, K. O., Sarmiento, K., et al. (2018). Centers for Disease Control and Prevention guideline on the diagnosis and management of mild traumatic brain injury among children. JAMA Pediatrics, 172(11), e182853.
• Silverberg, N. D., Iaccarino, M. A., Panenka, W. J., et al. (2020). Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Archives of Physical Medicine and Rehabilitation, 101(2), 382–393.
• Cantu, R. C., & Gean, A. D. (2010). Second-impact syndrome and a small subdural hematoma. Journal of Neurotrauma, 27(9), 1557–1564.