Heads Up to Schools: Know Your ABCs — for Teachers, Counselors, and School Professionals

What is a concussion?

A concussion is a type of brain injury that changes the way the brain normally works. A concussion is caused by a bump, blow, or jolt to the head. Concussions can also occur from a fall or blow to the body that causes the head and brain to move rapidly back and forth. Even what seems to be a mild bump to the head can be serious.

Children and adolescents are among those at greatest risk for concussion. The potential for a concussion is greatest during activities where collisions can occur, such as during physical education (PE) class, playground time, or school-based sports activities. However, concussions can happen any time a student’s head comes into contact with a hard object, such as a floor, desk, or another student’s head or body. Proper recognition and response to concussion can prevent further injury and help with recovery.

What are the signs and symptoms of concussion?

The signs and symptoms of concussion can show up right after an injury or may not appear or be noticed until hours or days after the injury. Be alert for any of the following signs or symptoms. Also, watch for changes in how the student is acting or feeling, if symptoms are getting worse, or if the student just “doesn’t feel right.”

Signs observed by teachers and school professionals

• Appears dazed or stunned
• Is confused about events
• Answers questions slowly
• Can’t recall events prior to the hit, bump, or fall
• Can’t recall events after the hit, bump, or fall
• Loses consciousness (even briefly)
• Shows behavior or personality changes
• Forgets class schedule or assignments

Symptoms reported by the student

Thinking/Remembering

• Difficulty thinking clearly
• Difficulty concentrating or remembering
• Feeling more slowed down
• Feeling sluggish, hazy, foggy, or groggy

Physical

• Headache or “pressure” in head
• Nausea of vomiting
• Balance problems or dizziness
• Fatigue or feeling tired
• Blurry or double vision
• Sensitivity to light or noise
• Numbness or tingling
• Does not “feel right”

Emotional

• Irritable
• Sad
• More emotional than usual
• Nervous

Sleep*

• Drowsy
• Sleeps less than normal
• Sleeps more than normal
• Has trouble falling asleep

*Only ask about sleeping symptoms if the injury occurred on a prior day.

What are concussion danger signs?

Be alert for symptoms that worsen over time. The student should be seen in an emergency department right away if s/he has:

• One pupil (the black part in the middle of the eye) larger than the other
• Drowsiness or cannot be awakened
• A headache that gets worse and does not go away
• Weakness, numbness, or decreased coordination
• Repeated vomiting or nausea
• Slurred speech
• Convulsions or seizures
• Difficulty recognizing people or places
• Increasing confusion, restlessness, or agitation
• Unusual behavior
• Loss of consciousness (even a brief loss of consciousness should be taken seriously)

How can I recognized a concussion

Teachers and school counselors may be the first to notice changes in their students. The signs and symptoms can take time to appear and can become evident during concentration and learning activities in the classroom.

Send a student to the school nurse, or another professional designated to address health issues, if you notice or suspect that a student has:

1. Any kind of forceful blow to the head or to the body that results in rapid movement of the head, AND
2. Any change in the student’s behavior, thinking, or physical functioning. (See the signs and symptoms of concussion.)

When do I need to know about my students’ returning to school after a concussion?

Supporting a student recovering from a concussion requires a collaborative approach among school professionals, health care providers, and parents, as s/he may need accommodations during recovery. If symptoms persist, a 504 meeting may be called. Section 504 Plans are implemented when students have a disability (temporary or permanent) that affects their performance in any manner.

Services and accommodations for students may include speech-language therapy, environmental adaptations, curriculum modifications, and behavioral strategies.

Students may need to limit activities while they are recovering from a concussion. Exercising or activities that involve a lot of concentration, such as studying, working on the computer, or playing video games, may cause concussion symptoms (such as headache or tiredness) to reappear or get worse.

Students who return to school after a concussion may need to:

• Take rest breaks as needed,
• Spend fewer hours at school,
• Be given more time to take tests or complete assignments,
• Receive help with schoolwork, and/or
• Reduce time spent on the computer, reading, or writing.

It is normal for students to feel frustrated, sad, and even angry because they cannot return to recreation or sports right away, or cannot keep up with their schoolwork. A student may also feel isolated from peers and social networks. Talk with the student about these issues and offer support and encouragement. As the student’s symptoms decrease, the extra help or support can be removed gradually.

For more information and toolkits for youth sports coaches and high school coaches, visit www.cdc.gov/headsup.