A concussion results in a temporary functional disturbance, rather than a structural injury to the brain tissue. This injury occurs when a blow to the head or body causes the brain to move rapidly back and forth within the skull. Following a child’s head injury, many parents experience anxiety regarding whether their child should be allowed to sleep. The initial management of a child’s rest must be balanced with careful monitoring for complications.
The Current Medical Consensus on Sleep
The belief that a child must be woken up every hour after a concussion is outdated and potentially detrimental to recovery. Current medical guidelines state that sleep is beneficial for the injured brain and should be encouraged, provided the child does not exhibit any danger signs. During sleep, the brain restores glucose, which is a primary fuel source needed for the healing processes following the injury. Preventing restful sleep interrupts this recovery period, which may prolong symptoms and delay the return to normal activities. Parents should allow the child to sleep as needed, focusing on a good nighttime routine while limiting excessive daytime napping to maintain sleep hygiene.
Recognizing Immediate Danger Signs
While sleep is generally safe and therapeutic, certain “red flag” symptoms signal a severe traumatic brain injury, such as an intracranial bleed, requiring immediate emergency medical attention. Parents must call emergency services if they observe a severe or worsening headache that does not improve with rest or mild pain relievers, or repeated or forceful vomiting.
Changes in consciousness are concerning, such as the inability to wake the child up or difficulty rousing them from sleep. Neurological deterioration can also manifest as seizures or convulsions, slurred speech, or weakness or numbness in the arms or legs. Unequal pupil size or the presence of clear fluid or blood draining from the ears or nose also requires immediate transport to an emergency department.
How to Monitor a Sleeping Child
If a medical professional has confirmed the child is safe to sleep, parents can monitor them without disrupting their rest. The goal of monitoring is to ensure the child can be easily aroused to a baseline level of consciousness, not to keep them awake. Parents should check on the child periodically, perhaps every few hours, during the first night.
Monitoring involves gently nudging the child or calling their name to elicit a response, such as stirring, opening their eyes, or mumbling a word. The child should respond to this stimulation, even if they immediately fall back asleep. Parents should also observe the child’s breathing pattern to ensure it remains regular and steady, and check that their skin color is normal.
Managing Recovery in the First Two Days
The initial 48 hours following a concussion should focus on relative cognitive and physical rest, which is a shift from the previous recommendation for complete rest or “cocooning” in a dark room. During this period, the child should avoid activities that significantly worsen their symptoms, such as loud noises or bright lights. Light physical activity, like a short walk, is encouraged and may actually help prevent prolonged symptoms.
Cognitive rest is important, meaning strictly limiting activities that require concentration and effort, including schoolwork, reading, and screen time on devices like phones, tablets, and computers. Studies suggest that abstaining from screen time during the first 48 hours can shorten the overall duration of concussion symptoms. If the child experiences a mild headache, acetaminophen is the preferred pain reliever; however, parents should avoid ibuprofen or aspirin in the first 24 to 48 hours due to the potential risk of increased bleeding.