Mild Traumatic Brain Injury in Children and Adolescents
Traumatic brain injury (TBI) occurs to the
brain after a blow to the head or a blow to
the body affecting the head. Loss of
consciousness is possible, but only occurs in
about 20% of all head injuries. You can
have a brain injury without any loss of
consciousness, skull fracture, internal
bleeding, or memory loss. Any of these
symptoms are possible, but not necessary for
an injury to have occurred. It is important to
note that a “concussion” is the same thing as
a mild traumatic brain injury. Don’t let the
label “mild” mislead you. Mild TBI (mTBI)
is often called an “Invisible Injury” because
the injury is too small to be seen on a CT
scan or MRI. This does not mean that an
injury is not there, but just that our current
tests may not detect it.
What happens to the brain after a Mild
Traumatic Brain Injury?
After a mTBI, the brain works very hard to
fix itself. This is not easy and uses a lot of
energy. The areas of the brain that help
make and move energy are often damaged.
This means that just when the brain’s need
for energy is high, the energy level is low.
This “mismatch” in energy can make the
brain feel slow.
Which symptoms are most common?
Headaches, fatigue, and dizziness are
common symptoms. Some people have
changes in vision or hearing. Many say they
think slower, have a hard time focusing, or
feel “foggy”. Others complain of having
trouble following directions or feel like they
can’t do more than one thing at a time.
Parents may see changes in emotions such
as being more irritable, sad or worried.
How long will the symptoms last?
Most people (about 80%) recover from a
mTBI in about 10-14 days. However, some
people have symptoms that last much
longer. Students with a history of learning
disabilities, ADHD, depression, or anxiety
may recover more slowly. Medical
conditions such as migraines or other head
injuries can also slow down recovery. Early
on, we cannot tell who will recover quickly
or slowly. Often symptoms will get worse
about 24-48 hours after the injury before
they start to get better.
How do we treat mTBI?
The best way to heal is by resting. This
includes both physical and brain rest;
which means avoiding anything that will
increase your heart rate or requires too much
thought. In the first few days, activities such
as exercise, sports, video games, texting,
emailing, social media, and reading should
be avoided. After 2 or 3 days, these
activities can be restarted slowly. Start with
15-20 minutes, and then increase the time or
the difficulty of the activity as tolerated. In
the first few weeks, an increase in symptoms
means you are doing too much and may
need to slow down. A lot of people like to
be very active in treating injuries, but for
mTBI, slowing down initially and letting the
brain heal is the best way you can recover
faster. Your body is working hard to heal
your brain, and these activities take energy
away from that. When you have symptoms
in the first few weeks, your body is trying
to tell you that you are doing too much.
When should I call the doctor?
After the first few days, symptoms should
start to get better if you follow the
suggestions above. If they get worse, call
your doctor. The doctor may need to order
more tests. Before leaving the hospital, your
team probably told you to follow-up with
the Brain Care Clinic. This is a special
clinic with experts that can help you during
your recovery. It is important that you make
and keep this appointment. These experts
can help you with your recovery and can
also work with your school if help is needed.
What about school?
You should plan to stay home from school
for at least one day, if not 2 or 3. If you
have symptoms while resting at home, they
will likely get worse if you go back to
school immediately. After 3 days, it is
important to try returning to school. If a full
school day is too much, start with a half day.
You can also do some school work at home.
The most important thing is to start school
work slowly. If you speed through things
faster than your brain can handle, the
healing will be much slower. Let your
symptoms guide you to help heal more
quickly. You should not return to work,
sports or other activities until you can
handle a full school day and all your school
work. Most students are able to return to
their full school days in a week or two.
RETURN TO LEARN AND PLAY – A STEPWISE PLAN
STEP SCHOOL PLAY GOAL
1 Complete brain rest. Complete physical rest. Focus on recovery. Avoid
screens, homework, or
2 Start make-up homework
for 5-15 minute sessions.
Light exercise like walking
or swimming (unless not
cleared by doctor).
Gradually start these
activities; should not cause
3 Homework sessions 20-30
More heavy exercise like
skating or running drills; no
Increase endurance by
repeating short periods of
4 Half days at school. Make-
up homework should not be
Add resistance training; no
5 Full days at school. Shorter
may be needed.
Once cleared by doctor,
return to impact drills.
Focus on returning to
6 Full days. Some help may
continue. Catch up with
important missed work.
Return to game or typical
Full return to school and
At home, you can use the following log to track how bad your symptoms are before and after
starting a variety of activities. This includes going to school, taking a shower, playing video
games, or texting. If symptoms worsen after the activity, you may want to reduce your activity
level for a few hours until you feel better. If your symptoms persist for more than 7 days, you
should talk to your doctor about a referral to the Brain Care Clinic (608-263-3301) at the
Waisman Center at UW for additional follow-up.
TBI SYMPTOM LOG
Rate symptoms before and after activities on a scale of 0-10, with 10 being severe
Headache / / / / / / /
Fatigue / / / / / / /
Dizziness / / / / / / /
Nausea / / / / / / /
Sleepy / / / / / / /
/ / / / / / /
/ / / / / / /
Foggy / / / / / / /
Distracted / / / / / / /
Feeling slow / / / / / / /
Forgetful / / / / / / /
Irritability / / / / / / /
Emotional / / / / / / /
Tearful / / / / / / /
/ / / / / / /
ξ Record name and date
ξ Rate all symptoms at time of waking up
ξ Add activities along the top of the graph
ξ Rate each symptom before and after doing an activity
ξ Include activities such as going for a walk, reading, watching TV, therapies (OT, PT,
Speech Therapy), taking a shower, and talking with the doctors.
ξ Rate all symptoms before going to bed
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 5/2017 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6328