Monitoring a concussion means watching for specific physical, cognitive, emotional, and sleep-related changes in the hours and days after a head injury. The first 48 hours are the most critical window, but monitoring should continue until symptoms fully resolve. Here’s what to watch for, how often to check, and what signals an emergency.
What to Watch for in the First 30 Minutes
Immediately after a bump or blow to the head, start checking for observable signs at regular intervals. The CDC’s concussion checklist for schools recommends monitoring at the time of injury, again at 15 minutes, and again at 30 minutes. You’re looking for these signs:
- Appearing dazed or stunned
- Confusion about what happened
- Repeating the same questions
- Answering questions slowly
- Inability to recall events before or after the hit
- Any loss of consciousness, even briefly
- Personality or behavior changes
If any of these signs appear or worsen across those check-ins, the person needs evaluation by a healthcare provider experienced in concussion assessment. Write down what you observe and when. This record is useful for the clinician who evaluates them later.
The Four Categories of Symptoms
Concussion symptoms don’t always show up right away. Some take hours or even a day to emerge. They fall into four groups, and tracking all four gives you the clearest picture of what’s happening.
Physical symptoms include headache or pressure in the head, nausea or vomiting (especially early on), dizziness, balance problems, blurred or double vision, sensitivity to light or noise, fatigue, and numbness or tingling. A general feeling of something being “not right” counts too.
Cognitive symptoms show up as difficulty thinking clearly, trouble concentrating, problems with short or long-term memory, feeling slowed down, or a foggy and groggy mental state.
Emotional symptoms include unusual irritability, sadness, nervousness, or being more emotional than normal. These are easy to dismiss as a reaction to the situation, but they’re genuine concussion indicators.
Sleep changes round out the picture: sleeping more or less than usual, or having trouble falling asleep. If someone who normally sleeps well suddenly can’t, or someone who’s usually alert is unusually drowsy, note it.
Pay attention to whether symptoms get worse with physical or mental effort. If a headache intensifies during reading or light activity, that’s meaningful information to share with a provider.
How to Monitor During the First 48 Hours
The first 24 to 48 hours require the closest observation. Check on the person regularly, looking for any new symptoms or worsening of existing ones. There’s no single mandated schedule for home monitoring, but checking every few hours during waking hours is a reasonable approach. During sleep, some providers recommend waking the person once or twice overnight after a more significant injury to confirm they’re responsive and coherent.
During this window, the person should limit screen time and avoid activities that are physically or mentally demanding. This doesn’t mean lying in a dark room doing nothing. Current guidelines support light physical activity like short walks, even if mild symptoms are present. If symptoms get worse during an activity, scale it back. The evidence supports one to two days of relative cognitive rest followed by a gradual return to normal activity, rather than prolonged total rest until every symptom disappears.
Keep a log of what you observe. Note the time, which symptoms are present, and rate their severity on a simple 0 to 10 scale. This creates a symptom trajectory that helps a clinician understand whether recovery is on track or stalling.
Danger Signs That Require Emergency Care
Most concussions resolve on their own, but certain symptoms suggest something more serious, like bleeding in or around the brain. Go to the emergency department immediately if you notice any of these:
- One pupil larger than the other
- Drowsiness so severe the person can’t be awakened
- A headache that keeps getting worse and won’t go away
- Repeated vomiting
- Seizures or convulsions
- Slurred speech
- Weakness, numbness, or loss of coordination
- Difficulty recognizing familiar people or places
- Increasing confusion, restlessness, or agitation
- Any loss of consciousness
The key word across most of these is “worsening.” A mild headache after a head injury is expected. A headache that steadily intensifies over hours is not.
Monitoring Vision and Balance
Two of the most sensitive indicators of concussion involve the eyes and balance, and you can check both at home in simple ways.
For eye tracking, hold a finger about three feet from the person’s face and slowly move it side to side, then up and down. Watch whether their eyes follow smoothly or if they report increased headache, dizziness, nausea, or fogginess during the exercise. You can also test near-point convergence: have the person slowly bring a small target (like a pen tip) from arm’s length toward the tip of their nose. They should stop when they see two images instead of one. If that happens at 5 centimeters or more from the nose, it’s considered abnormal and suggests the visual system is affected.
For balance, watch the person stand with feet together, then in a heel-to-toe stance, then on one leg. Increased swaying, stepping out of position, or needing to grab something for support are signs worth noting. Timed heel-to-toe walking in a straight line is another useful check. Repeat these tests every day or two, and you’ll get a clear sense of whether balance is improving.
Monitoring Young Children
Babies and toddlers can’t describe their symptoms, so monitoring relies entirely on behavioral observation. Watch for excessive crying or fussiness that’s unusual for the child, changes in eating or nursing habits, altered sleep patterns, loss of interest in favorite toys or activities, and difficulty being consoled. A toddler who suddenly loses balance more than usual or seems unsteady could be experiencing dizziness they can’t articulate.
When you begin slowly reintroducing normal play and learning activities after a few days of rest, watch the child’s reaction closely. If they become fussy, upset, or show any sign of pain or discomfort during activity, that’s the equivalent of an older person reporting worsened symptoms. Pull back and try again later. Seizures, difficulty waking from sleep, passing out, or markedly altered behavior in a young child are emergency signs that warrant an immediate trip to the ER.
Tracking Recovery With the Return-to-Activity Progression
Once the initial rest period is over and symptoms are improving, the standard approach is a six-step progression back to full activity. Each step takes a minimum of 24 hours, and the person should only advance to the next step if no new symptoms appear.
- Return to regular daily activities like school or work, with clearance from a provider to begin the progression.
- Light aerobic activity only: 5 to 10 minutes of walking, light jogging, or a stationary bike. No weightlifting.
- Moderate activity that increases heart rate with body or head movement: moderate jogging, moderate-intensity biking, lighter-than-usual weightlifting.
- Heavy non-contact activity: sprinting, high-intensity biking, full weightlifting routine, sport-specific drills without contact.
- Full practice including contact, in a controlled setting.
- Return to competition.
If symptoms return or new ones appear at any step, stop the activity and drop back to the previous step. After the symptoms clear again, resume from that earlier step. This progression works as a monitoring tool in itself: each step tests whether the brain is ready for more demand. A setback at step 3 or 4 tells you recovery isn’t complete, even if the person felt fine at rest.
This same framework applies to cognitive demands, not just physical ones. Returning to school or mentally intensive work should follow a similar gradual approach, starting with shorter periods and building up as tolerated.