If a child hits their head in sport and then has headache, dizziness, or fogginess, do not put them back in that day; if they keep vomiting, grow sleepier, or the headache keeps getting worse, go to emergency at once

Children who keep playing after concussion take on average 44 days to recover; those taken out at once about 22 days. If something is off after a head hit, do not play again that day — wait until a doctor says yes. Repeated vomiting, growing sleepiness and not waking, headache getting worse, slurred speech, or seizures are signals to go to emergency at once.

Cost

No money. Take the child out; no more practice or competition that day. The hard part is a tight game, the child saying “I’m fine,” and coaches and parents wanting them back in.

Benefit

Concussion is a temporary disruption of brain function after a head hit; imaging usually shows nothing. A U.S. study followed 69 athletes with sport concussion, mean age about 15. The 35 taken out at once recovered in a mean 22.0 days. The 34 who kept playing with symptoms recovered in a mean 44.4 days (P=0.003; unlikely to be chance). Those who kept playing had 8.80 times the chance of recovery dragging past 21 days versus those taken out. A 2022 Amsterdam international sport-concussion meeting issued a consensus. It says loss of consciousness, seizures, unsteadiness, confusion, behavior change, or inability to remember events means immediate removal. Those people should not return to competition or training that day. The exception is when experienced medical staff check on the spot and confirm it is not from concussion. CDC guidance for parents and coaches is more direct: with suspected symptoms, leave at once, do not return that day, wait until a doctor says return is OK. It also says do not judge severity yourself — only medical staff can assess. It lists signals for emergency care at once: seizures; not recognizing people or places; repeated nausea and vomiting; odd behavior, growing confusion or agitation. Also growing sleepiness after passing out and not waking when called; slurred speech, weak or numb limbs. And headache that keeps getting worse without relief; unequal pupils or double vision (U.S. / multi-country)

Notes

Grade B because the keep-playing and leave groups were not assigned by lot, and numbers are small. Benefit is set large from recovery days roughly halved. The consensus also says less screen time for the first two days, light activity such as walking is OK, and after 24 to 48 hours increase slowly as tolerated. But sports with collision or fall risk wait until a doctor says yes. Helmets for cycling and skiing are in Section 22, item 12 (wear a helmet when mountain biking). Head bumps in elders that show problems only weeks later are in Section 13, item 10 (elder who hit their head). The beneficiary is the child.

Sources · 4

1. Elbin RJ, Sufrinko A, Schatz P, et al. (2016). Removal From Play After Concussion and Recovery Time. Pediatrics, 138(3), e20160910. doi.org/10.1542/peds.2016-0910
2. Patricios JS, Schneider KJ, Dvorak J, et al. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695-711. doi.org/10.1136/bjsports-2023-106898
3. CDC (2025). Signs and Symptoms of Concussion. HEADS UP. cdc.gov/heads-up/signs-symptoms/index.html
4. CDC. How to Respond. HEADS UP. cdc.gov/heads-up/response/index.html