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A Fact Sheet for School Nurses 

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. 

How can I recognize a concussion?

To help you recognize a concussion, ask the injured

student or witnesses of the incident about: 

1. Any kind of forceful blow to the head or to the

body that resulted in rapid movement of the head. 

-and2. Any change in the student’s behavior, thinking, or

physical functioning. (See the signs and

symptoms of concussion.)

The FacTs:

* All concussions are

serious.

* Most concussions occur

without loss of 

consciousness.

* Recognition and proper

response to concussions

when they first occur can

help aid recovery and

prevent further injury, 

or even death.

To download this fact sheet in Spanish, please visit: www.cdc.gov/Concussion.

Para obtener una copia electrónica de esta hoja de información en español, por

favor visite: www.cdc.gov/Concussion. 

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

May 2010
2 Heads Up to Schools: Know Your Concussion ABCs

How can concussions 

happen in schools?

Children and adolescents are among those 

at greatest risk for concussion. Concussions

can result from a fall, or any time a student’s

head comes into contact with a hard object,

such as the floor, a desk, or another student’s

head or body. 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. 

Students may also get a concussion when

doing activities outside of school, but then

come to school when symptoms of the

concussion are presenting. For example,

adolescent drivers are at increased risk for

concussion from motor vehicle crashes. 

Concussions can have a more serious effect 

on a young, developing brain and need to be

addressed correctly. Proper recognition and

response to concussion symptoms in the

school environment can prevent further 

injury and can help with recovery.
What are the signs and symptoms of concussion?

Heads Up to Schools: Know Your Concussion ABCs 3

Students who experience one or more of the signs and symptoms listed below after a bump, blow, or

jolt to the head or body should be referred to a health care professional experienced in evaluating

for concussion. 

There is no one single indicator for concussion. Rather, recognizing a concussion requires a symptom

assessment. The signs and symptoms of concussion can take time to appear and can become more

noticeable during concentration and learning activities in the classroom. For this reason, it is

important to watch for changes in how the student is acting or feeling, if symptoms become worse,

or if the student just “doesn't feel right.”

SIGNS OBSERVED BY SCHOOL NURSES

• Appears dazed or stunned

• Is confused about events

• Answers questions slowly

• Repeats questions

• 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

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 or 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 usual

• Sleeps more than usual

• Has trouble falling asleep

*Only ask about sleep symptoms if the injury occurred on

a prior day.

Remember, you can’t see a concussion and some students may not experience or report symptoms until 

hours or days after the injury. Most young people with a concussion will recover quickly and fully. But for

some, concussion signs and symptoms can last for days, weeks, or longer. 
What are concussion 

danger signs?

In rare cases, a dangerous blood clot may

form on the brain in a person with a

concussion and crowd the brain against the

skull. The student should be taken to an

emergency department right away if s/he

exhibits any of the following danger signs after

a bump, blow, or jolt to the head or body:

• One pupil larger than the other

• Is drowsy 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 

• Cannot recognize people or places 

• Becomes increasingly confused, restless,

or agitated 

• Has unusual behavior 

• Loses consciousness (even a brief 

loss of consciousness should be 

taken seriously)

4 Heads Up to Schools: Know Your Concussion ABCs

For more information and tool kits for

youth sports coaches and high school

coaches, visit www.cdc.gov/Concussion.
What can school nurses and

school professionals do?

Below are steps for you to take when a

student comes to your office after a bump,

blow, or jolt to the head or body.

1. Observe student for signs and

symptoms of concussion for a

minimum of 30 minutes.

2. Complete the Concussion Signs and

Symptoms Checklist and monitor

students consistently during the

observation period. The form includes

an easy-to-use checklist of signs and

symptoms that you can look for when the

student first arrives at your office, fifteen

minutes later, and at the end of 30

minutes, to determine whether any

concussion symptoms appear or change.

3. Notify the student’s parent(s) or

guardian(s) that their child had an

injury to the head. 

> If signs or symptoms are present: refer

the student right away to a health care

professional with experience in

evaluating for concussion. Send a copy

of the Concussion Signs and Symptoms

Checklist with the student for the health

care professional to review. Students

should follow their health care

professional’s guidance about when

they can return to school and to

physical activity.

> If signs or symptoms are not present:

the student may return to class, 

but should not return to sports or

recreation activities on the day of the

injury. Send a copy of the Concussion

Signs and Symptoms Checklist with the

student for their parent(s) or

guardian(s) to review and ask them to

continue to observe the student at

home for any changes. Explain that

signs and symptoms of concussion can

take time to appear. Note that if signs

or symptoms appear, the student

should be seen right away by a health

care professional with experience in

evaluating for concussion. 

Heads Up to Schools: Know Your Concussion ABCs 5

Children and teens with a

concussion should NEVER return

to sports or recreation activities

on the same day the injury

occurred. They should delay

returning to their activities until a

health care professional

experienced in evaluating for

concussion says they are

symptom-free and it’s OK to

return to play. This means, until

permitted, not returning to: 

• Physical Education (PE) class,

• Sports practices or games, or

• Physical activity at recess.
What do I need to know 

about students returning 

to school after a concussion?

Supporting a student recovering from a

concussion requires a collaborative approach

among school professionals, health care

professionals, parents, and students. All

school staff, such as teachers, school nurses,

counselors, administrators, speech-language

pathologists, coaches, and others should be

informed about a returning student’s injury

and symptoms, as they can assist with the

transition process and making accommodations for a student. 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.

Encourage teachers and coaches to monitor

students who return to school after a

concussion. 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. After a concussion,

physical and cognitive activities—such as

concentration and learning—should be

carefully monitored and managed by health

and school professionals.

If a student already had a medical condition

at the time of the concussion (such as

chronic headaches), it may take longer to

6 Heads Up to Schools: Know Your Concussion ABCs

School Policies: 

Students Returning to School after a Concussion

Check with your school administrators to 

see if your district or school has a policy in

place to help students recovering from a

concussion succeed when they return to

school. If not, consider working with your

school administration to develop such a

policy. Policy statements can include the

district’s or school’s commitment to safety, a

brief description of concussion, a plan to help

students ease back into school life (learning,

social activity, etc.), and information on when

students can safely return to physical activity

following a concussion. 
recover from the concussion. Anxiety and

depression may also make it harder to adjust

to the symptoms of a concussion.

School professionals should watch for

students who show increased problems paying

attention, problems remembering or learning

new information, inappropriate or impulsive

behavior during class, greater irritability, less

ability to cope with stress, or difficulty

organizing tasks. 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 a student to feel frustrated, sad,

and even angry because s/he cannot return to

recreation or sports right away, or cannot keep

up with 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 gradually removed.

What can I do to prevent and

prepare for a concussion?

Here are some steps you can take to prevent

concussions in school and ensure the best

outcome for your students: 

Prepare a concussion action plan. To

ensure that concussions are identified early

and managed correctly, have an action plan in

place before the start of the school year. This

plan can be included in your school or district’s

concussion policy. You can use the online

action plan for sports and recreation activities

at: www.cdc.gov/concussion/response/html.

Be sure that other appropriate school and

athletic staff know about the plan and have

been trained to use it.

Educate parents, teachers, coaches, and

students about concussion. Parents,

teachers, and coaches know their students

well and may be the first to notice when a

student is not acting normally. Encourage

teachers, coaches, and students to:

• Learn about the potential long-term

effects of concussion and the dangers of

returning to activity too soon. 

• Look out for the signs and symptoms of

concussion and send students to see you

if they observe any or even suspect that a

concussion has occurred. 

• View videos about concussion online at:

www.cdc.gov/Concussion.

Prevent long-term problems. A repeat

concussion that occurs before the brain

recovers from the previous concussion—

usually within a short period of time (hours,

days, or weeks)—can slow recovery or

increase the likelihood of having long-term

problems. In rare cases, repeat concussions

Heads Up to Schools: Know Your Concussion ABCs 7
can result in edema (brain swelling),

permanent brain damage, and even death.

Keep students with a known or suspected

concussion out of physical activity, sports, or

playground activity on the day of the injury

and until a health care professional with

experience in evaluating for concussion says

they are symptom-free and it is OK for the

student to return to play.

Create safe school environments.

The best way to protect students from

concussions is to prevent concussions from

happening. Make sure your school has

policies and procedures to ensure that the

environment is a safe, healthy place for

students. Talk to all school staff and

administrators and encourage them to keep

the physical space safe, keep stairs and

hallways clear of clutter, secure rugs to the

floor, and check the surfaces of all areas where

students are physically active, such as playing

fields and playgrounds. Playground surfaces

should be made of shock-absorbing material,

such as hardwood mulch or sand, and

maintained to an appropriate depth. Proper

supervision of students is also important.

Monitor the health of your

student athletes. Make

sure to ask whether an

athlete has ever had a

concussion and insist that

your athletes are medically

evaluated and are in good condition to

participate in sports. Keep track of athletes

who sustain concussions during the school

year. This will help in monitoring injured

athletes who participate in multiple sports

throughout the school year. 

Some schools conduct preseason baseline

testing (also known as neurocognitive tests)

to assess brain function—learning and

memory skills, ability to pay attention or

concentrate, and how quickly someone can

think and solve problems. If an athlete has a

concussion, these tests can be used again

during the season to help identify the effects

of the injury. Before the first practice,

determine whether your school would

consider baseline testing. 

For more detailed information 

about concussion diagnosis and

management, please download

Heads Up: Facts for Physicians about

Mild Traumatic Brain Injury from

CDC at: www.cdc.gov/Concussion.

again, remember your

concussion aBcs:

A—Assess the situation

B—Be alert for signs and symptoms

U.S. D C—Contact a health care professional epartment of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention

For more information on concussion and to order additional materials for school

professionals FREE- OF-CHARGE, visit: www.cdc.gov/Concussion.