A baby’s fall, whether from a bed, changing table, or down a step, is a frightening experience. Falls are common as children gain new mobility skills, but the anxiety they cause is understandable. The immediate concern is to move beyond the fear and focus on a clear, systematic assessment of the child’s condition and behavior. Understanding the specific symptoms to monitor—and the critical moments when an accident becomes a medical emergency—empowers you to provide the best care.
The Immediate Post-Fall Assessment
The first step after a fall is to compose yourself; a calm caregiver performs a more effective assessment. Your immediate focus must be on the baby’s responsiveness and the safety of the environment. If the baby is crying loudly immediately after impact, this is a reassuring sign, indicating a clear airway and a strong level of consciousness.
Assess the scene before moving the baby, especially if the fall was from a significant height (over three feet or five stairs) or involved a direct impact to the head or back. If the baby is silent, unconscious, or shows signs of severe bleeding or an obvious deformity, do not move them; call for emergency medical help immediately. The only exception is if the baby is at risk of further injury, or if they are vomiting or having a seizure. In these cases, gently roll them onto their side while keeping the head and neck aligned.
Once it is safe to pick them up, hold your baby and provide comfort, as fear and pain often cause initial cries. While comforting them, gently check the entire body for visible signs of trauma, such as cuts, bruises, or swelling. Pay particular attention to the head, noting the location and size of any bumps. The scalp is highly vascular, and even minor cuts can bleed profusely.
Monitoring for Signs of Head Injury
While initial assessment is important, signs of a serious head injury, such as a concussion or intracranial bleeding, can be delayed, sometimes appearing hours or even a full day later. Close monitoring over the first 24 to 48 hours is necessary, even if the baby appears normal right after the fall. A primary indicator of a neurological issue is a significant change in the baby’s typical behavior or temperament.
Prolonged or increasing irritability, especially if the baby cannot be consoled by routine comforting, can signal underlying distress or a persistent headache. Watch for unusual crying when moving the baby’s head, which may suggest pain or sensitivity. Notable changes in sleep pattern also warrant attention, including sleeping significantly more than usual or being difficult to wake up from sleep.
Vomiting is a common reaction to a blow to the head, but persistent or forceful vomiting (more than two or three episodes) is a serious warning sign. This symptom can indicate rising pressure inside the skull and requires immediate medical evaluation. Also, check the baby’s pupils to ensure they are equal in size and react similarly to light. One pupil being noticeably larger than the other is a sign of a severe neurological injury.
Be vigilant for any discharge from the ears or nose that appears clear, pink-tinged, or bloody. Clear fluid could be cerebrospinal fluid, a sign of a skull fracture, and requires urgent medical attention. Monitor the soft spot on the baby’s head, the fontanelle, for any unusual bulging or firmness.
Checking for Injuries to the Body and Limbs
Beyond the head, a fall can cause trauma to the neck, spine, torso, and extremities, which must be assessed independently. A common injury for infants and toddlers is a bone fracture, particularly in the arms, as they often instinctively reach out to break the fall. Signs of a potential fracture or sprain include a refusal or reluctance to use a specific limb, such as not moving an arm or not attempting to bear weight on a leg.
Observe the baby’s posture and movement for any stiffness or unusual positioning, especially in the neck or back, as this could suggest a spinal injury. Do not manipulate the neck or spine; any sign of discomfort or limited range of motion in these areas requires professional medical attention. A detailed examination of the baby’s torso is also necessary to look for signs of internal organ injury.
Check the abdomen gently for any unusual distension, firmness, or tenderness that causes the baby to cry when touched. Internal injuries, such as a splenic laceration or liver contusion, may not show outward signs immediately. They can present with increasing pain or swelling in the abdominal area. Any large, deep bruising or persistent tenderness over the ribs, back, or abdomen should be promptly evaluated by a physician.
Critical Symptoms Requiring Emergency Medical Care
Certain symptoms after a baby falls are considered “red flags” and necessitate an immediate call to emergency services or an urgent trip to the emergency department. Loss of consciousness, even if brief, is a serious sign of a traumatic brain injury and must be evaluated without delay. Any episode of seizure activity, characterized by rhythmic jerking or uncontrolled body movements, signals a potential neurological emergency.
If your baby is excessively drowsy, difficult to wake up, or cannot be roused from sleep, this indicates a depressed level of consciousness and requires urgent intervention. Other immediate emergency signs include:
- Profuse, uncontrolled bleeding from a wound.
- The presence of a clear or bloody fluid draining from the nose or ears.
- An obvious deformity, such as a limb bent at an unnatural angle.
- A visible dent in the skull.