Falls from elevated surfaces like beds, couches, or changing tables are common, especially as babies become more mobile. While most falls result in minor bumps and bruises, the potential for a head injury means caution is necessary. If you are concerned about your baby’s behavior or if they exhibit any worrying symptoms, contact your pediatrician or emergency services immediately.
Initial Assessment Immediately Following the Fall
Your first reaction should be to pause and quickly assess the situation before picking up your baby. If the baby is unconscious, bleeding heavily, or appears to have a serious head injury, do not move them. Call emergency services immediately, as moving them could worsen a potential neck or spine injury. If immediate danger is not present, gently pick up your baby to offer comfort and begin a detailed physical check.
Once you are holding your baby, look for any visible injuries, paying close attention to the head. Because the scalp has a large blood supply, even minor bumps can result in a significant bruise or “goose egg.” Assess the baby’s fontanelle, or soft spot, to see if it is bulging or sunken, which can indicate internal pressure or dehydration.
A baby who cries immediately and intensely is generally a reassuring sign, demonstrating responsiveness and a strong nervous system reaction. Conversely, a weak cry, a delayed cry, or inconsolable, high-pitched screaming warrants medical attention. Gently check the movement of all four limbs and observe their overall responsiveness to ensure they are moving and reacting normally.
Critical Symptoms Requiring Emergency Medical Attention
Parents must understand the specific symptoms that indicate a potentially serious head injury, such as a concussion or internal bleeding, requiring an immediate trip to the emergency room. Urgent signs include a loss of consciousness, even if brief, or significant difficulty waking the baby. Extreme or persistent lethargy, where the baby appears unusually sleepy or cannot be roused, must be treated as an emergency.
Watch closely for repeated or projectile vomiting, which is more concerning than a single instance of spitting up. Another severe indicator is a seizure, which may appear as tremors, twitching, or staring episodes. Bleeding or the leakage of any clear or pinkish fluid from the nose or ears is a sign of a possible skull fracture or internal injury and requires immediate emergency care.
Other serious symptoms include pupils of unequal size, which can signify pressure on the brain. Any obvious dent or depression in the skull, or an excessively bulging soft spot, should be checked by a medical professional immediately. Seek emergency care if the baby seems confused, does not recognize familiar people, or exhibits unusual behavior that is a significant departure from their normal self.
Monitoring Sleep After a Head Injury
The central question for many parents is whether it is safe to allow their baby to sleep after a fall. It is generally acceptable for a baby to sleep following a minor head bump, especially if they passed the initial assessment and are not exhibiting critical symptoms. The concern is that sleep might mask developing neurological symptoms, such as increasing drowsiness or loss of consciousness.
For the first 24 hours after the injury, often referred to as “concussion watch,” close monitoring is necessary. The recommended protocol involves letting the baby rest, but waking them every two to four hours, especially if the fall occurred right before bedtime. When waking the baby, check for specific signs of normal function.
A successfully roused baby should be easily awakened, recognize you, and respond appropriately, even if they are grumpy about being disturbed. If the baby is excessively difficult to wake, remains drowsy after being woken, or cannot be fully roused, this is a sign of a worsening condition requiring immediate medical attention. If a baby is already showing signs of significant head trauma, such as repeated vomiting or extreme lethargy, they should be taken to the emergency room immediately.
Safety Measures to Prevent Future Falls
The most effective way to manage the anxiety of a fall is to prevent it, which requires constant vigilance and environmental adjustments. The single most important rule is never to leave a baby unattended on an elevated surface, including adult beds, couches, or changing tables, even for a moment. Babies can roll reflexively and unexpectedly, often before parents think they are capable.
When using a changing table, always keep one hand firmly on the baby, and ensure all necessary items are within arm’s reach to prevent turning away. For cribs, the mattress should be lowered to the lowest possible setting as soon as the baby can sit up or pull themselves to a standing position. Never use objects like pillows or toys inside the crib that could be used as a step for climbing out.
When a baby is on an adult bed, using safety rails or placing the mattress directly on the floor can mitigate the risk of falling from a height. Avoid placing a car seat or bouncer on high surfaces like tables or counters, as sudden movement or a slight bump can cause it to fall. These simple adjustments to the home environment are the best defense against recurrence.