It’s a heart-stopping moment if your baby falls off the bed, change table or couch. Whether you’re seeing it happen in what may seem like slow motion as you rush to catch them or you turn your back and suddenly hear a thump, it’s a pretty terrible feeling. What should you do? “My general advice is to see how the baby is acting,” says Roxanne MacKnight, a family physician in Miramichi, NB. If they are crying but settle down and are their normal selves after a cuddle, they’re probably just fine (but still keep an eye on them for a day or so). In this scenario, it’s OK to give an age-appropriate dose of infant ibuprofen or acetaminophen and gently apply a cold pack wrapped in a cloth.
“If they’re acting abnormally—irritable, vomiting or seem off balance or dizzy when they’re crawling or walking—this could be a sign of a head injury,” says MacKnight. “Also, watch to see if they’re not moving part of their body, like a leg or a wrist, or if a toddler doesn’t want to walk because that raises the possibility of a broken bone.” Tim Lynch, a paediatric emergency medicine physician in London, Ont., agrees. “If you notice any change in behaviour that persists or concerns you, that’s my open invitation to get your child assessed,” he says.
If anything seems off, call your doctor or a public health hotline or head to the emergency room. (And, of course, if something is drastically amiss, like they lose consciousness or have a seizure or if a bone is through the skin, call an ambulance.) It can be harder for parents to assess very young babies, aged four months or younger (OK, they’re sleepy or fussy, but why?). Babies at this age are more vulnerable to head injuries because their skulls are less developed than those of older children, so err on the side of caution and call your doctor.
If your doctor refers you to the emergency room or you go directly to the hospital, the nursing staff will do the initial assessment. If that first assessment finds that your baby is stable and appears well, then you will probably wait your turn, according to the seriousness of other cases in the ER. If the assessment reveals an immediate concern, you’ll be seen quickly by a physician. “I ask the parents to walk me through exactly what the baby did throughout the impact and after,” says Lynch. “Did anyone see the fall? How far did the baby fall, and onto what surface? Is the child more irritable than usual? Is the child sleepier than usual? Has the child had anything to eat or drink since the injury? Has there been vomiting?” If the doctor needs more information, they could order an X-ray or a CT scan or call in a specialist like a neurosurgeon for a consult.
“The most common area for injury is the front part of the skull because most babies tend to fall forward when they land,” says Lynch. “The second most common is the back of the head, if they’ve fallen backwards off something. It gets a little more concerning if they hit the side of their head because the bone is a little thinner there and more susceptible to injury, and some of the underlying vascular structures can be damaged.” The doctor will evaluate the patient’s signs and symptoms to determine whether the child has a minor head injury (like a bump or bruise), a concussion, a skull fracture or a more significant injury (like bleeding in the brain).
A “goose egg,” or a bump on the forehead, tends to be less serious, but pay attention to your baby’s behaviour and get it checked out if you have any doubts. Swelling in any other area of the head (the back, sides or temple) could be more serious and deserves a trip to the ER. Softer areas of swelling (called boggy haematomas) that appear a few days after a fall are often associated with underlying skull fractures, says Lynch.
“If your child comes down on more of an angle and lands on their shoulders, they will often fracture their clavicle, or collarbone,” says Lynch. Broken bones may not be immediately obvious, but they usually mean a cranky kid who doesn’t want to move part of their body. Injuries to internal organs are pretty rare with a household fall, unless it involved significant trauma, like falling down many stairs, he says.
In most cases, if the child looks well at discharge, they’ll continue to be fine at home, says Lynch. “We usually have a good discussion prior to discharge about watching for signs like vomiting, irritability and a severe headache,” he says. The ER doctor should discuss next steps with you (in the case of a suspected concussion, your child should rest, and your doctor probably won’t recommend waking your child up at regular intervals because that practice is no longer routine). If the doctor has asked that you wake your child every two to three hours in the first 24 hours, your child should wake up easily and not show any of the abnormal behaviours mentioned above.
Babies can move in an instant, so it’s important to keep one hand on them at all times, whether they’re on the bed, change table or doctor’s exam table. If you want to play it extra-safe, change them on the floor. Never put baby chairs or floor seats on counters or leave babies unattended on a couch or bed, and always use safety straps in chairs and strollers. Be sure to install a baby gate on the stairs once your child is four months old because that’s what they frequently start rolling over and develop the skills to move around and crawl. “I remember my oldest daughter fell off our bed when she was five months old,” says Lynch. “I didn’t realize she could actually roll over until that day. I tell parents that it happens to many of us and, moving forward, let’s think of ways to prevent it from happening again.”