A two-year-old child’s increasing mobility, coupled with still-developing coordination, makes accidental falls down stairs a common but deeply frightening event for parents. While the vast majority of these tumbles result only in minor bumps, bruises, and temporary distress, the potential for a more serious injury requires immediate, calm, and informed assessment. This guidance will help you monitor your child effectively in the hours and days following the fall.
Initial Checks Immediately Following the Fall
The first moments after the fall are for immediate assessment and basic first aid. Your initial priority is to quickly check for consciousness and responsiveness. A loud, immediate cry is typically a reassuring sign, indicating the child was conscious and their airway is clear.
Once the initial shock subsides, evaluate the child’s movement. Observe whether they can move all their arms and legs normally and if they resist being gently moved or picked up. Look for any visible signs of injury, such as cuts, abrasions, or swelling, and apply a clean cloth with firm pressure to any bleeding wounds. A cold compress or ice pack wrapped in a towel can be applied to any rapidly forming bumps or bruises for about 15 to 20 minutes to help reduce swelling.
Recognizing Signs of Serious Head Injury
Because the head is disproportionately large in toddlers, head trauma is the most frequent injury following a fall down stairs. While a simple “goose egg” bump on the forehead is usually minor, especially if the child returns to their normal self quickly, some symptoms can signal a concussion or more severe internal injury. These signs often appear over the subsequent hours, making continued monitoring necessary.
One of the most concerning signs is persistent vomiting, particularly more than two or three times, as this can indicate increased pressure within the skull. Another serious indicator is any change in the child’s level of awareness or difficulty rousing them from sleep. While it is not necessary to keep a child awake after a fall, you should be able to wake them fully at any time. Be alert for neurological changes like unequal pupil sizes, which can be a sign of a serious brain injury.
Watch for signs of confusion, extreme irritability, or behavior that is not normal for your child, as these can indicate a change in brain function. This includes slurred speech, a constant headache, or unsteadiness when walking that was not present before the fall. A severe head injury can sometimes involve a “lucid interval,” where a child appears normal for a period before symptoms rapidly worsen due to delayed internal bleeding.
Monitoring for Non-Head Injuries
While head injuries are common, you must also monitor for injuries to the rest of the body. Look for signs of a possible fracture in the limbs, which can manifest as a refusal to use an arm, or an inability or refusal to bear weight on a leg. Any noticeable deformity of a limb, where the bone or joint looks clearly out of alignment, requires immediate medical evaluation.
Although rare, severe falls can cause internal injuries to the torso. Be observant for signs of severe abdominal pain, which a two-year-old may show through inconsolable crying or guarding their stomach. Bruising on the abdomen or back, persistent severe pain along the spine, or a new loss of bowel or bladder control are serious signs that warrant professional attention.
When Emergency Care is Necessary
Certain symptoms are non-negotiable red flags that require an immediate trip to the emergency room or calling for emergency services.
- Loss of consciousness, even if it was brief, or being unable to wake the child completely.
- Seizure activity or any abnormal, jerky movements.
- Vomiting that is persistent, forceful, or occurs more than two or three times.
- Any bleeding or clear fluid draining from the nose or ears.
- A major change in behavior, such as increasing confusion, extreme listlessness, or an inability to stop crying.
- Obvious deformity of a limb or a complaint of severe pain in the neck or back.