When a 1-year-old child falls down stairs, the moment can be terrifying for a parent. Falls are common in this age group as they learn to walk and climb. However, because a 1-year-old’s skull is softer and their developing brain is more susceptible to injury, specific symptoms following a fall must be taken seriously. This guide outlines immediate actions and subsequent monitoring, but it is not a substitute for professional medical consultation. If you have any doubt about your child’s condition, always seek emergency medical attention immediately.
Immediate Post-Fall Assessment
Remain calm, as your reaction can soothe your child and help you focus on assessment. If the child is crying, this is usually a positive sign, indicating they were not unconscious and their airway is clear. A normal, robust cry is reassuring, but a weak, high-pitched, or inconsolable scream may signal distress or a neurological problem.
Before moving your child, quickly check for visible injuries, severe bleeding, or obvious deformities in the limbs. If the fall was significant or the child is not moving their neck normally, assume a neck or spinal injury and avoid moving them until emergency medical services arrive. Otherwise, carefully pick up and comfort your child, applying firm, direct pressure with a clean cloth to any bleeding cuts for five to ten minutes.
Check the child’s responsiveness by noting if they are alert and can focus their eyes on you. Feel the scalp for any large lumps, known as a “goose egg,” or a dent in the skull, which could indicate a fracture. While a large bump or bruising on the head is common, new swelling or bruising around the eyes or behind the ears could signal a more serious injury.
Recognizing Critical Head Trauma Symptoms
The primary concern after a fall is a traumatic brain injury, and several red flag symptoms require an immediate trip to the emergency room. These include a loss of consciousness, even if brief, a seizure, or abnormal, repetitive movements. If your child was unconscious for more than a minute, call emergency services immediately.
Persistent vomiting—more than one or two episodes—can indicate increased pressure within the skull. While a single vomit may be a response to pain, frequent or projectile vomiting is a major warning sign. Similarly, if the child is suddenly hard to wake up, unusually drowsy, or showing signs of extreme lethargy, emergency care is warranted.
Pay close attention to any changes in the child’s eyes, as unequal pupil sizes signal potential brain compression. The draining of clear fluid or blood from the ears or nose is a sign of a possible basilar skull fracture and requires immediate emergency attention.
For a child who cannot verbalize a headache, an inconsolable, high-pitched scream or excessive irritability that cannot be calmed often signals severe pain. Any sudden change in their ability to sit up, walk steadily, or use their arms and legs normally after the fall also suggests a neurological injury. For babies, a bulging soft spot (fontanelle) when the child is not crying is a serious sign of pressure on the brain.
Monitoring for Non-Head Injuries
While head trauma is the primary concern, a fall can cause other injuries. Musculoskeletal injuries are common; a one-year-old may signal a broken bone or severe sprain by refusing to bear weight on a limb. If the child is walking, refusing to use one arm could indicate a fracture, such as a collarbone injury.
Gently check the limbs and torso for swelling, tenderness, or an obvious deformity. Palpation involves softly pressing along the bones and joints; if this causes the child to cry out or pull away, it suggests localized pain. Pay particular attention to the mid-section, as falls can cause internal injuries to the abdomen.
Signs of potential internal injury include tenderness upon gentle pressure to the belly or significant bruising on the torso. Unusual paleness that lasts for more than an hour may signal internal blood loss. Additionally, look inside the mouth for dental injuries, such as chipped teeth, bleeding gums, or a change in the positioning of the teeth.
The Crucial 48-Hour Observation Period
Even if your child appears fine immediately after the fall, a 36- to 48-hour observation period is necessary because symptoms of a brain injury can be delayed. Maintain a low threshold for seeking medical attention if any new concerns arise during this time. The focus shifts to monitoring for behavioral shifts that indicate the brain is recovering.
Watch for changes in their normal temperament, such as becoming unusually clingy, excessively fussy, or irritable. A change in feeding or sleeping patterns is a key indicator of a possible concussion in this age group. If your child is sleeping significantly more than usual or is difficult to wake up, they require medical assessment.
If the child wants to sleep, you do not need to keep them awake, but you must monitor them frequently to ensure they can be roused. It is advisable to have the child sleep in the same room as you for the first night. Any new or worsening symptom is a sign to contact your pediatrician or return to the emergency department.