CDC PEDIATRIC mTBI GUIDELINE

Management and Treatment

Recommendations

This handout for healthcare providers provides an overview of the management 

and treatment-related recommendations contained in the CDC Pediatric mTBI Guideline.

Eight sets of management and treatment recommendations are included in the Guideline. 

These recommendations focus on: 

GOAL OF THE CDC mTBI GUIDELINE

The goal of the CDC Pediatric Mild Traumatic Brain Injury (mTBI) 

Guideline is to help healthcare providers take action to improve 

the health of their pediatric patients with mTBI. To do this, the 

Guideline consists of 19 clinical recommendations that cover 

diagnosis, prognosis, and management and treatment. These 

recommendations are applicable to healthcare providers working 

in: inpatient, emergency, primary, and outpatient care settings. 

The Guideline was developed through a rigorous process guided 

by the American Academy of Neurology methodology and 2010 

National Academy of Sciences methodology for the development 

of evidence-based guidelines. An extensive review of scientific 

literature, spanning 25 years of research, formed the basis of 

the Guideline. 

While most have a good recovery, some children experience 

both acute and long-term problems that affect them: 

Physically Cognitively Psychologically

mTBI in children

General areas of treatment 

for patients and families

Symptom and 

problem-specific 

treatments

RECOMMENDATIONS FOR TREATMENT 

AND MANAGEMENT OF mTBI
GENERAL AREAS OF TREATMENT 

FOR PATIENTS AND FAMILIES

Health outcomes can generally be optimized through patient education 

and behavior modification. In addition, evidence suggests that rest, or 

reduction in cognitive and physical activity, is beneficial immediately 

following mTBI. This should be followed shortly after the injury with 

a gradual return to activity.

Patient and Family Education and Reassurance

• In providing education and reassurance to the family, the 

healthcare provider should include the following information:

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- Warning signs indicating a more serious injury

- Expected course of symptoms and recovery

- Instructions on monitoring post-concussive symptoms

- Prevention of further injury

- Management of cognitive and physical activity, or rest

- Instructions regarding return to school and return to 

play or recreation

- Clear healthcare provider follow-up instructions from 

a healthcare provider

CDC PEDIATRIC mTBI GUIDELINE

Management and Treatment Recommendations

CDC PEDIATRIC mTBI GUIDELINE: Management and Treatment Recommendations

Counsel patients to return gradually to 

non-sports activities after no more than 

2-3 days of rest. 

Collaboration among healthcare providers, schools, and families should be coordinated to gradually 

adjust interventions and return the child to full participation without worsening symptoms.

Cognitive and Physical Rest and Aerobic Treatment

• Healthcare providers should counsel patients to observe more restrictive physical and cognitive activity 

during the first several days following mTBI in children. 

• Following these first several days, healthcare providers should counsel patients and families to resume 

a gradual schedule of activity that does not exacerbate symptoms, with close monitoring of symptom 

expression (number, severity).

• Following the successful resumption of a gradually increased schedule of activity, healthcare providers 

should offer an active rehabilitation program of progressive reintroduction of noncontact aerobic activity 

that does not exacerbate symptoms, with close monitoring of symptom expression (number, severity).

• Healthcare providers should counsel patients to return to full activity when they return to premorbid 

performance if they have remained symptom-free at rest, and with increasing levels of physical exertion. 

Return to school and play plans can be found at www.cdc.gov/HEADSUP.
Evidence suggests that social support (both tangible help and 

emotional involvement) contributes to healthy behaviors, and 

improved overall quality of life.

Psychosocial and Emotional Support

Return to School

• Healthcare providers may assess the extent and types of social 

support (e.g., emotional, informational, instrumental, appraisal) 

available for children with mTBI, and emphasize social support 

as a key element in the education of caregivers and educators. 

• To assist children returning to school following mTBI, medical and 

school-based teams should counsel the student and family regarding 

the process of gradually increasing the duration and intensity 

of academic activities as tolerated, with the goal of increasing 

participation without significantly exacerbating symptoms. 

• Return to school protocols should be customized based 

on the severity of postconcussion symptoms in children with 

mTBI as determined jointly by medical and school-based teams. 

• For any student with prolonged symptoms that interfere with 

academic performance, school-based teams should assess the 

educational needs of that student and determine the student’s 

need for additional educational supports, including those 

described under pertinent federal statutes. 

• Postconcussion symptoms and academic progress in school 

should be monitored collaboratively by the student, family, 

healthcare provider, and school teams, who jointly determine 

which modifications or accommodations are needed to maintain an 

academic workload without significantly exacerbating symptoms. 

• The provision of educational supports should be monitored and 

adjusted on an ongoing basis by the school-based team until the 

student’s academic performance has returned to pre-injury levels. 

• For students who demonstrate prolonged symptoms and academic 

difficulties despite an active treatment approach, healthcare 

providers should refer the child for a formal evaluation by a 

specialist in pediatric mTBI. 

CDC PEDIATRIC mTBI GUIDELINE

Management and Treatment Recommendations

CDC PEDIATRIC mTBI GUIDELINE: Management and Treatment Recommendations

of children with mTBI will demonstrate 70 80% functional recovery by 1-3 months.

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SYMPTOM OR PROBLEM–SPECIFIC 

TREATMENT AND MANAGEMENT

Dizziness is another potentially debilitating symptom of mTBI, and limited evidence suggests that early vestibular 

physical therapy may benefit patients experiencing dizziness.

Painful headaches are one of the most common symptoms in 

children after mTBI and may require intervention.

Vestibulo-ocular Motor Dysfunction

Post-traumatic Headache Treatment and Management

• Healthcare providers may refer children with subjective or objective evidence of persistent vestibulo-ocular 

motor dysfunction following mTBI to a program of vestibular rehabilitation. 

• Healthcare providers in the emergency department should

clinically observe and consider obtaining a head CT in 

children presenting with a severe and worsening headache, 

along with other symptoms or risk factors, following mTBI 

to evaluate for ICI requiring further management in 

accordance with validated clinical decision making rules. 

• Children undergoing observation periods for headache 

with acutely-worsening symptoms should undergo 

emergent neuroimaging.

• Healthcare providers and caregivers should offer nonnarcotic analgesia to children with a painful headache 

following acute mTBI, but also provide counseling to 

the family regarding the risks of analgesic overuse, 

including a rebound headache. 

• There is insufficient evidence to recommend the 

administration of 3% hypertonic saline as a treatment for 

an acute headache following mTBI in children. Healthcare 

providers should not administer this medication to children 

with mTBI for treatment of symptoms outside of a research 

setting at this time. 

• Chronic headache following mTBI is likely to be 

multifactorial; therefore, healthcare providers should

refer children with chronic headache after mTBI for 

multidisciplinary evaluation and treatment, with 

consideration of analgesic overuse as a contributory factor. 

CDC PEDIATRIC mTBI GUIDELINE

Management and Treatment Recommendations

CDC PEDIATRIC mTBI GUIDELINE: Management and Treatment Recommendations

• Acutely worsening headache:

consider neuroimaging

• Chronic headache: nonopioid 

analgesia (monitor for overuse), 

multidisciplinary evaluation

• Vestibulo-ocular dysfunction:

vestibular rehabilitation

Healthcare providers should identify and tailor 

treatment plans/referrals to address:

• Worsening sleep problems: 

sleep hygiene, sleep specialist

• Cognitive impairment:

treatment directed at etiology, 

neuropsychological evaluation 

• Emotional dysfunction:

psychotherapeutic evaluation 

and treatment

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Problems with attention, memory and learning, response speed, and other cognitive impairment can occur 

following mTBI. These disturbances can result in significant problems with learning in school, or social interactions.

Cognitive Impairment Treatment and Management

• Healthcare providers should attempt to determine the etiology of cognitive dysfunction within the context 

of other mTBI symptoms.

• Healthcare providers should recommend treatment for cognitive dysfunction that reflects its presumed etiology. 

• Healthcare providers may refer children with persisting complaints related to cognitive function for a formal 

neuropsychological evaluation to help determine etiology, and to recommend targeted treatment. 

Sleep disturbances after mTBI are common and may exacerbate ongoing 

problems. Adequate sleep has been shown to improve overall health and 

should be an important part of treatment for children with mTBI.

Sleep Treatment and Management

• Healthcare providers should provide guidance on proper sleep 

hygiene methods to facilitate recovery from pediatric mTBI. 

• If sleep problems emerge or continue, despite appropriate sleep 

hygiene measures, healthcare providers may refer children with 

mTBI to a sleep disorder specialist for further assessment.

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To view all 19 sets of recommendations, 

including those that cover diagnosis and 

prognosis, and to learn more about the 

CDC Pediatric mTBI Guideline, visit 

www.cdc.gov/HEADSUP.

Take action to improve 

the health of your young 

patients with mTBI.

CDC PEDIATRIC mTBI GUIDELINE

Management and Treatment Recommendations

CDC PEDIATRIC mTBI GUIDELINE: Management and Treatment Recommendations
CDC PEDIATRIC mTBI GUIDELINE: Management and Treatment Recommendations www.cdc.gov/HEADSUP