School concussion policies missing in one-quarter of public schools

A national look at school concussion policies found that one in four U.S. public schools did not have a policy in place during the 2023-2024 school year, according to a study published in the Journal of School Nursing. The findings matter because students recovering from a concussion may need classroom changes while symptoms affect learning, sleep and behavior.

Researchers analyzed responses from the 2024 School Pulse Panel, a survey of nearly 1,700 U.S. public school principals. Part of that survey asked school leaders whether their schools had concussion policies and what those policies covered.

The study found that 75% of schools reported having a concussion policy. Among schools with a policy, 58% said it included information on how to support students in class during recovery, and 29% required staff training on concussions, according to the researchers.

What did the school concussion survey find?

The survey points to gaps beyond whether a written policy exists. Kelly Sarmiento, lead researcher and director of outreach programs for the Brain Injury Association of America, said school nurses often have to cover missing pieces by educating staff, coordinating care and helping students get needed accommodations.

Sarmiento also said school nurses play a central role in concussion management at schools and often carry much of that work. The study’s results suggest that role may be heavier in schools where policies are absent, incomplete or not supported by staff training.

A concussion can cause headaches and can affect concentration, balance, memory, mood and sleep, according to the researchers. Because those symptoms can interfere with classroom work, a student’s return to school after a concussion may require limits, monitoring and short-term changes rather than an immediate return to a normal workload.

Why do some schools lack concussion policies?

The study was not designed to determine why schools lack policies or training, according to senior researcher Dana Waltzman, an associate research professor of physical medicine and rehabilitation at Indiana University. Waltzman said prior research points to possible factors such as limited staffing and resources, lack of access to full-time school nurses or athletic trainers, competing priorities and uneven policy implementation.

Waltzman also said the researchers found lower reporting of concussion policies among schools in higher-poverty communities, schools with larger shares of nonwhite students and smaller schools. She said those patterns may reflect differences in resources and capacity.

What should schools do after a student has a concussion?

The U.S. Centers for Disease Control and Prevention recommends that schools assign people to monitor a student’s symptoms during the school day. The agency also recommends identifying what kinds of activities, and how much activity, the student can handle based on their condition.

The CDC also advises schools to make temporary changes to workload and schedules to help students return to their regular routine. Those changes can give students time to recover while keeping them connected to school.

The study, titled “Concussion and Traumatic Brain Injury Policies in K-12 Public Schools: National Data from the 2024 School Pulse Panel Survey,” was authored by Sarmiento and colleagues and published in 2026 in the Journal of School Nursing.

This story draws on original reporting from Medical Xpress.