Parent's and Coach's Guide to CDC HEADS UP Concussion Ages 5-17 2025

CDC HEADS UP groups the symptoms a child may report into four types:

NFHS guidance (2023) also lists neck pain, double or blurry vision, and just "not feeling right" or "feeling down".

Symptoms can appear hours or days later, so keep checking in with your child. Share any symptoms with their health care provider, and tell the provider if they get worse.

CDC HEADS UP says to call 911 or go to the nearest emergency department if any of these appear after a bump, blow or jolt to the head or body:

• One pupil larger than the other, or double vision
• A headache that gets worse and does not go away
• Repeated nausea or vomiting
• Convulsions or seizures (shaking or twitching)
• Slurred speech, weakness, numbness or decreased coordination
• Unusual behavior, increased confusion, restlessness or agitation
• Not able to recognize people or places
• Loss of consciousness with increasing drowsiness, or can't wake up or stay awake

NFHS guidance (2023) adds that any loss of consciousness, even brief, should be taken seriously. These signs can mean a dangerous collection of blood is pressing on the brain.

Follow the concussion action plan in NFHS guidance (2023), which is consistent with CDC HEADS UP:

1. Remove the athlete from play right away.
2. Check for danger signs. If any are present, call 911 or get the athlete to the emergency department.
3. Make sure a health care professional evaluates the athlete. Don't try to judge how serious it is yourself.
4. Inform the parents/guardians about the possible concussion and give them concussion information.
5. Don't let the athlete drive.
6. Keep them out of play for the rest of that day, and until a health care professional gives clearance (in writing, under NFHS guidance).

Until they're evaluated, watch the athlete closely and don't leave them alone, because symptoms can develop over a few hours or longer.

No. CDC HEADS UP and NFHS guidance both say an athlete with a suspected concussion must not return to play on the day of the injury, however they feel. They stay out until a health care provider clears them.

• Signs and symptoms can take hours or days to appear, so feeling fine on the sideline doesn't rule out a concussion.
• A second hit before the brain has recovered can slow recovery, increase the chance of long-term problems and, in rare cases, cause fatal brain swelling and bleeding (NFHS).
• Athletes should never "tough out" a concussion, and teammates, coaches and parents should never encourage them to play through symptoms.

When in doubt, sit them out.

A health care provider, not the coach or parent. CDC HEADS UP says the return-to-sports decision is a medical decision that should be made by a health care provider, and an athlete should return to sports only with that provider's approval.

• Don't judge severity yourself. Coaches and parents aren't expected to diagnose a concussion. Their job is to spot it and remove the athlete.
• Get it in writing. NFHS high school guidance (2023) says an athlete diagnosed with a concussion needs written clearance from an appropriate health care professional before any practice or competition. Some state laws also require written clearance.
• Clearance starts the steps; it doesn't skip them. After clearance, the athlete still goes through the step-by-step return-to-sports progression before full play.

Yes. According to the CDC, every state has a youth sports concussion return-to-play law. Washington's Lystedt Law (2009) was the first, requiring removal from play and clearance before return.

The details vary by state, including:

• which programs are covered (some laws cover only school sports, others also cover community leagues),
• which health care professionals can give clearance, and
• whether clearance must be in writing.

The national baseline in CDC HEADS UP and NFHS high school guidance: an athlete suspected of a concussion is removed from play right away, doesn't return the same day, and returns only after clearance from a health care professional. NFHS guidance (2023) calls for written clearance consistent with applicable law. State high school associations may add their own requirements.

Timing: CDC HEADS UP says most children can return to school within 1 to 2 days. Research has found that delaying the return may lead to a longer recovery.

Rest: NFHS guidance (2023) recommends relative rest for the first 24 to 48 hours, meaning everyday activities with reduced screen time, rather than complete rest and isolation. Light activity such as walking is fine if it makes symptoms no more than mildly worse.

Support at school: at first, a student may need

• rest breaks during class,
• help with homework or less homework, and
• extra time for assignments and tests.

These supports can be removed as symptoms ease.

What to do:

• Ask the health care provider to complete the CDC HEADS UP Letter to Schools, which suggests support strategies.
• Talk with teachers, the school nurse and counselors about symptoms so they can provide support and monitor recovery.

Not every student needs academic supports. Students should be fully back to learning before an unrestricted return to sport.

CDC HEADS UP uses a six-step return-to-sports progression. It starts only once the athlete's health care provider gives the go-ahead, and should be done with that provider's approval and supervision. Where the team has a certified athletic trainer, work closely with them.

Rules between steps:

• Each step typically takes at least 24 hours.
• Move up only if no new symptoms appear at the current step.
• Return to sports can run alongside return to school, but the athlete should be back to all regular non-sports activities without accommodations before finishing the progression. NFHS guidance (2023) likewise says to complete return-to-learn before unrestricted return to sport.

For coaches planning practice: an athlete in steps 2 to 4 can do the activity for that step but must not take part in contact drills until step 5.

CDC HEADS UP says new or returning symptoms are a sign the athlete is pushing too hard.

1. Stop the activity right away.
2. Contact the athlete's health care provider.
3. After more rest, once symptoms have gone, the athlete can restart at the previous step.

Parents and coaches should watch for concussion symptoms after each day's activity, not just during it. If any danger sign appears, such as a worsening headache, repeated vomiting, a seizure or increasing confusion, call 911 or go to the emergency department.

According to CDC HEADS UP, most children feel better within 2 to 4 weeks, but some have symptoms for months or longer. Symptoms are usually at their worst right after the injury.

• If symptoms last longer than 2 to 4 weeks, the child's health care provider may refer them to a specialist.
• Contact the provider if symptoms don't go away or get worse after returning to regular activities.
• Contact the provider about anxiety, sadness, hopelessness or other mental health changes that persist or get worse.
• Repeat concussions can mean a longer recovery and raise the risk of long-term health problems, so avoid further head impacts while recovering.

The return-to-sports progression alone can take a week or more, because each of its six steps typically takes at least 24 hours.