When a child takes a hard fall or hit, it’s natural to worry about a possible concussion. Parents may also be unsure what comes next, including whether their child needs emergency care, can safely go to sleep or should stay home from school.

However, concussion guidelines have changed over the years. Doctors once commonly recommended prolonged rest with little light and with little noise or activity until all their symptoms have subsided. Today, recovery generally involves a brief period of rest and reduced activity (think lounging around at home) followed by a gradual return to school and other everyday activities.

Here’s what parents should know about the first few hours after a possible concussion and the path back to the classroom.

What should you know during the first few hours after a possible concussion?

If your child shows signs of a concussion after a hit or fall, remove them from sports and other activities where another injury could occur. Symptoms may also develop or become more noticeable over the next several hours, so pay attention to any changes in how your child feels or acts.

“The most important thing to do is monitor your child for at least three hours. If symptoms remain stable or improve during that time, it is OK to let your child to continue to rest or even go to sleep without interruptions.”

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Dr. Kenneth Podell, neuropsychologist and the director of the Concussion Center at Houston Methodist

Dr. Podell also recommends keeping your child hydrated and offering a light meal or snack if they feel up to eating. For headache or other pain, use only acetaminophen during the first 48 hours. After that, ibuprofen or naproxen may also use ibuprofen or naproxen. Ice or heat may help with related neck pain or strain, he adds.

Some symptoms require emergency care, but all suspected concussions should be evaluated by a health care professional to ensure your child receives an individualized recovery plan to recover as quickly as possible. The CDC recommends that any child with a possible concussion be evaluated by a health care provider. Be prepared to explain how the injury occurred, which symptoms you’ve noticed, whether your child lost consciousness, and whether they’ve had a previous concussion. The evaluation can help determine the appropriate next steps.

(Related: How to Know If You Have a Concussion)

When does a head injury require emergency care?

“In most cases, there’s no need to rush to the emergency room,” Dr. Podell says. “As long as symptoms aren’t worsening significantly and there are no red flags, it’s safe to let your child rest.”

Worsening symptoms or significant behavioral or neurological changes may point to a more serious injury involving the brain or neck and require emergency care.

Warning signs that require emergency care include:

• Any loss of consciousness, especially if prolonged

• Vomiting two or more times

• A worsening or severe headache

• Increasing confusion or disorientation

• Slurred speech or difficulty speaking

• Seizures

• Unequal pupil size

• Weakness, numbness or loss of coordination

• Significant drowsiness or difficulty waking up or arousing

• Severe neck pain or an inability to turn the neck, particularly after a high-impact injury

• Fluid draining from the ears or nose (that is not blood)

If your child goes to the emergency room, Dr. Podell recommends letting the physician decide whether a brain or neck CT scan is needed. Most children with a concussion won’t need a CT or MRI scan, according to the CDC.

“CT imaging can be overused in the evaluation of concussion, so it is important to avoid unnecessary scans and minimize radiation exposure, particularly in children,” Dr. Podell says.

Doctors use the child’s symptoms, physical examination and other risk factors to assess whether brain imaging is appropriate.

After addressing any urgent injury, recovery begins with finding the right balance between rest and activity.

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What does relative rest after a concussion look like?

For the first 48 to 72 hours after a concussion, Dr. Podell recommends pairing rest with light physical and mental activity. Known as relative rest, this approach helps children stay connected to everyday life while adjusting activities based on their symptoms.

“‘Cocoon therapy,’ the old approach of isolating a child in a dark, low-stimulation room, is no longer recommended and may actually slow recovery,” Dr. Podell says.

During the first day or two, the CDC recommends limiting screen time and activities that are physically or mentally demanding or worsen your symptoms. Children can begin light activity, such as taking short walks, if their symptoms remain mild. A temporary reduction in activity may be needed if symptoms become noticeably worse.

Children can also spend time with family and friends and take part in manageable pieces of their usual routine. Sports, bike riding and other activities that could lead to another head injury should remain off-limits until a healthcare provider determines they’re safe.

According to Dr. Podell, combining relative rest with light, symptom-limited physical activity and mental engagement can lead to faster recovery than strict inactivity and minimal stimulation. A healthcare provider can tailor that balance based on how the concussion affects the child’s physical activity, concentration, vision, balance and other functions.

(Related: How Long Does a Concussion Last?)

When can your child return to school after a concussion?

As symptoms begin to settle, school is often the first major step back into a child’s routine. Dr. Podell generally recommends beginning that transition within a few days rather than waiting for every symptom to disappear.

“Unlike return to sports, returning to the classroom is often more challenging,” Dr. Podell says. “Schoolwork doesn’t stop while a child is recovering. In fact, it piles up the longer your child is out.”

A gradual return gives students time to rebuild their academic workload as their symptoms improve. According to the CDC, temporary accommodations may include:

• Shortened school days

• Breaks in a quiet area

• Reduced homework or class assignments

• Extra time to complete assignments

• Extra time or fewer tests

• More time to move between classes

• Reduced exposure to bright lights or noisy environments

The right accommodations depends on how the concussion affects the individual student. Headaches or sensitivity to light may make brightly lit classrooms and projectors difficult, while problems with concentration, memory or mental fatigue can make reading and completing assignments take longer. An evaluation with a healthcare provider experienced in concussion will develop a treatment plan with specific school-based support and an exercise treatment plan to help your child be successful academically while recovering from their concussion.

The CDC recommends sharing the child’s recovery plan with teachers, the school nurse and other staff involved in their care. Once the student is back in the classroom, school staff may notice difficulties that weren’t apparent at home and share those observations with the family and healthcare provider. The school can gradually scale back temporary support as the child improves.

“That’s why a thorough concussion evaluation by an experienced healthcare provider matters,” Dr. Podell says. “It can lead to earlier, targeted treatment that helps your child get back to academics both sooner and more successfully.”

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