What is your approach to return to play of a contact sport after mild concussion in children?

My approach to return to play (RTP) after a mild concussion in pediatric patients follows the Concussion in Sport Group (CISG) consensus guidelines (Patricios et al., PMID 37316210), adapted for the developing brain.

Following a concussion, I recommend a minimum 24-48 hours of relative rest before initiating any graduated RTP protocol, emphasizing "relative" rest; complete rest beyond 48 hours has not been shown to hasten recovery and may worsen outcomes. This rest period should be extended if symptoms have not resolved by this time.

The stepwise RTP protocol consists of six stages, each requiring a minimum of 24 hours symptom-free progression before advancement. In children under 13, I apply a more conservative timeline, typically doubling i...