Managing “brain fog”

This leaflet gives an overview of how children and young people may experience “brain fog” or cognitive difficulties after a period of illness. It contains information about why you might be experiencing these difficulties and some tips and strategies to help manage them.

What is “brain fog”?

Brain fog refers to changes in our thinking skills, which can happen because of an illness, hormone changes, or receiving certain types of medical treatment.

These changes are usually temporary and generally get better over time.

Children and young people tell us that they notice things like struggling to pay attention, struggling to understand what you are told, not being as fast at understanding speech, or struggling to take in as much information as you used to.
 
The list below shows some of the common symptoms children and young people tell us they experience. There may be symptoms you have which are not on this list, that’s ok and very normal, everybody’s symptoms will be different.

Why are these changes happening?

People who have been poorly, or have had certain treatments such as chemotherapy, can sometimes notice a change in their thinking skills. This can bring with it changes in our ability to remember things, process information, pay attention to things, and perform difficult tasks that need us to hold information in mind.
 
These changes can have a huge impact on your life. You will need support and understanding from family, friends and school whilst you work on your recovery.
 
With time your thinking skills can improve. Trying some of the strategies in this leaflet can be a helpful place to start.

How does this make you feel?

All these changes can be very overwhelming. You may feel scared, confused, worried, sad or different somehow. You may wonder if it will ever go away or whether you will ever feel like ‘yourself’ again. These are all very human responses to a big change, and you are not alone.
 
Some people find they can’t manage school full time in the early days, or when they are at school, it all feels too much sometimes. Some people might have had to stop going to some of their favourite clubs and activities or feel less able to see their friends as often. Don’t worry, these things can get better over time.
 
Be reassured that there are lots of things you, and those around you, can do to help manage the changes you are experiencing.

What can I do to help myself?

• Improve your sleep
• Learn relaxation skills
• Create a daily routine
• Track your symptoms
• Learn ways to help you study/ manage school

Tips for improved sleep

It’s important to sleep well. We need good quality sleep to help our brain reset for the morning and process what has gone on in the day. Try these things:
 
Get as much daylight as you can. Daylight helps our bodies know when we need to be awake and when to feel sleepy. Getting as little as 20 minutes of daylight outside, even on a cloudy, rainy day can help. Try and open curtains when you can.

Keep your bed a “sleep only” zone. It can feel cosy to sit in bed and do other things like watch TV or eat and drink. However, this can trick our bodies into thinking bed is somewhere we are awake.

Try not to nap during the day. Napping can stop you feeling sleepy at bedtime. Consider rest periods instead, where you do little and allow your body and mind to rest.

Turn off all technology (including phones) at least 30 to 90 minutes before bedtime. Put your phone at the other side of your bedroom or in another room to avoid the temptation to look at it.

Try and keep a set bedtime and wake up time – even on weekends. This can help teach your body and mind to feel sleepy at the same time.

Ways to relax

We all have different ways to relax. It might be chatting to friends, playing a game, reading, or
watching your favourite TV programme.
 
It can also be useful to learn how to tap into our bodies “rest and digest” system using our breathing. This can be a great skill to master because with practice you can use this skill whenever you feel any difficult feelings, anywhere at all.

Square breathing

This picture can help show you how to square breathe, a helpful way to feel calm. You can do this anywhere, all you need is to find a square or rectangle near you, like a door or window, or you can imagine one in your mind.

To start:

1. Breathe in slowly through your nose whilst counting to four and feel the air filling up your lungs.
2. Hold your breath for four seconds.
3. Breathe out slowly through your mouth for four seconds.
4. Repeat this until your breathing is slower.

Keeping a set routine

Having a set routine can help you remember things you may otherwise forget and can help free up space in your brain. For example, put your school things away in the same place, then in the morning, you won’t forget things you need. You could make a plan for the day to help you keep on top of things you need to do. Have a look at the example below to get an idea of what this might look like.

Keeping track of symptoms

You may find your symptoms come and go or feel worse on some days and better on other days. Keeping track of your symptoms can be really helpful for spotting patterns and triggers.

It can also help your hospital team understand your needs better. Try and fill out a diary each day, like below.

Write down what symptom(s) you had, how long they lasted, how you were feeling, and where you were.

Tips for school

• Review your lesson notes as soon as you can after the lesson. Try and condense the notes into a few short bullet points of the main learning points. This may be helpful if you are learning content for GCSE or A level exams.
• Keep your folders and notes, as well as your school bag in the same place each day.
• Try to study when you are feeling at your best, and not feeling tired. This will make retaining the information much easier than trying to study when you are struggling and feeling fatigued. It’s important to try both electronic and non-electronic ways to help with learning and studying to see what works best for you as an individual. For example, studying for exams with mind maps on a whiteboard or using flashcards.
• Keep a paper copy of your timetable with you to help you remember your lessons.

The Pomodoro technique for studying

A method that has proven helpful for studying is the Pomodoro technique. This is a time management method for studying that can be helpful for people who get distracted easily and might experience mental fatigue quickly.

You may need to change the length of time spent studying, and the length of time resting, depending on what you can manage. Talk with your team at the hospital and they will be able to help advise you.

How can a parent or caregiver support their child?

As a parent of someone with brain fog there are several things that you can do to help including:

• Set realistic expectations so that you don’t ask too much of your child when they are struggling. This includes what they are able to manage when it comes to school work and social commitments such as sports clubs.
  
• When giving your child instructions or information, it’s important to give this information in manageable, bite-sized chunks so that they do not get overwhelmed with information. You can also do this by leaving notes for your child so they can remember what you have told them or asked them to do. Or you can send text or WhatsApp reminders.
  
• Talking to your child and understanding their symptoms, as well as keeping a list of important things that your child needs to remember is extremely important as it allows you to support your child in the best way possible.
  
• Ensuring that your child sets and maintains their boundaries when it comes to rest and sleep is important. This includes things such as helping them maintain a set bed time, ensuring that they include rest break within their day and helping to maintain good sleep habits.

Useful websites and books

• Cambridgeshire and Peterborough NHS – Post-covid brain fog
• The Fatigue Book: Chronic Fatigue Syndrome and Long COVID fatigue: practical tips for recovery. By Lydia Roller (2022).