A toddler falling down the stairs is frightening, but most falls result in only minor bumps and bruises. However, the potential for serious trauma, particularly to the head, requires immediate attention. This guide provides a clear framework for assessing your child after a fall, helping you distinguish between minor injuries and those that require immediate medical intervention.
Immediate Response and Initial Assessment
The moments following the fall require a calm and systematic approach. First, ensure the environment is safe by removing any hazards or debris from the area. Resist the urge to immediately pick up the child, especially if the fall was severe, as this can worsen a potential spinal injury.
If the toddler is unresponsive, having trouble breathing, or if you suspect a neck or back injury, stabilize their head and neck and call for emergency help immediately. For a conscious child, check for responsiveness, breathing, and any massive bleeding that requires direct pressure with a clean cloth. Providing comfort and reassurance is paramount, as intense crying can sometimes mask the initial symptoms of a concussion.
Critical Signs of Head Trauma and Concussion
Head injuries are the most common consequence of stair falls in children under four, demanding close scrutiny. The most definitive warning sign of a severe traumatic brain injury is any loss of consciousness, even if brief. If your child passed out, call emergency services immediately, even if they appear awake and alert now.
Repetitive or forceful vomiting (more than once or twice) is a significant red flag. This symptom can indicate increased pressure within the skull and requires an immediate trip to the emergency room. A change in the child’s level of awareness, such as becoming increasingly drowsy, lethargic, or having difficulty waking up from a nap, also signals a medical emergency.
Be vigilant for acute neurological signs. Carefully examine the child’s eyes for unequal pupil sizes. Seizures or convulsions, manifesting as uncontrolled shaking or stiffening, require immediate emergency intervention. Additionally, clear or bloody fluid draining from the nose or ears can indicate a skull fracture and leakage of cerebrospinal fluid.
Evaluating for Non-Head Injuries
While head trauma is the primary worry, a thorough assessment must include the rest of the body for non-head injuries. Focus on the child’s limbs and torso, looking for obvious swelling, bruising, or deformity, which could indicate a bone fracture. A classic sign of a possible fracture is a toddler’s refusal to bear weight on a leg or use an arm after the initial fussiness has subsided.
Pay particular attention to the collarbone and shoulders, as these areas often absorb impact and are common sites for injury. If the child complains of neck pain, exhibits stiffness, or holds their head in an unusual position, maintain the “do not move” rule and seek emergency care to rule out a spinal injury.
Monitor for signs of internal abdominal injuries, such as persistent pain or tenderness when the stomach is gently touched, or any blood noted in the urine or stool. Also, check the mouth and face for chipped teeth, cuts to the lips or tongue, or deep gashes. Facial injuries often bleed heavily but are frequently less severe than they appear.
The 24-Hour Observation Period and Follow-Up
If your child did not exhibit any severe, immediate warning signs, close observation at home is recommended for the next 24 hours. This monitoring period is designed to catch symptoms that may develop hours after the initial trauma, such as a slow bleed in the brain.
It is acceptable to allow the child to sleep, but check on them frequently. Gently rouse them every few hours to ensure they are easily awakened and can respond appropriately. Monitor for subtle behavioral or neurological changes, including increased irritability, being inconsolable, or a change in gait or coordination. If the child’s condition worsens, or if emergency symptoms appear, proceed immediately to the emergency room.