Introduction Concussion is a common injury in youth. Studies report that active rehabilitation interventions reduce symptoms in these youth. There is no literature that addresses its impact on occupational performance. The purpose of this study was to identify: (a) occupational performance issues experienced by these youth; (b) changes in occupational performance and satisfaction following participation in a 6-week active rehabilitation intervention; and (c) the relationship between changes in occupational performance and symptoms. Method As part of a larger prospective repeated measures study, measures of occupational performance (Canadian Occupational Performance Measure) and self-reported symptoms (Post-Concussion Symptom Inventory) were collected pre and post intervention. Paired t-test, Spearman correlation, and descriptive analyses were conducted. Results Youth (9–18 years; n = 52) reported a range of occupational performance issues in self-care, productivity, and leisure domains. The most frequently reported occupational performance issues were sport (32.70%) and school (31.75%) activities. Positive changes were found in both performance and satisfaction of occupational performance issues post intervention ( p<.001). Correlation analysis revealed that as symptoms decreased, occupational performance improved ( rs = –.359, p = .020). Conclusion Using a measure of occupational performance may provide meaningful insight into the functional recovery of concussion, and can help identify targeted functional approaches to paediatric concussion management.