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The first parent freakout: Baby falls

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The night was going well. My husband and I — along with our newborn son — were visiting our good friends at their house for dinner. We talked and laughed over a meal of enchiladas, and then all paused to put our kids down to sleep before continuing with our conversations and games.

With our 3-month-old baby happily full, freshly changed and pajama-clad, I picked him up and headed toward the basement to put him down.

In one second, disaster struck. My wool sock slipped on the thick carpet, and I fell, banana-peel style, onto my back. As my elbows hit the ground, my son launched out of my arms and fell on the ground 4 or 5 feet below.

I have no idea how I landed or how far I slid down the stairs. I only remember the horror as I watched him leave my hands in what felt like slow motion.

I instantly popped up to pick him up off the floor. While the thick carpet was likely responsible for my fall, it also provided a cushion for him to land on.

He instantly started crying. I instantly started crying. Our friend, who had been at the top of the stairs and had seen the fall, was asking how he could help. Through my shock and sobs, I managed a frantic “I’m OK! Is he OK?”

A few hours later, we had the definitive answer to that question, courtesy of James (Jim) Homme, M.D., our friendly emergency room doctor at Mayo Clinic in Rochester, Minnesota. Dr. Homme is also an assistant professor of emergency medicine and pediatrics at the Mayo Clinic Alix School of Medicine. Our son was totally OK. But the whole experience of taking him to the emergency room had me and my husband pretty freaked out.

Unfortunately, falls seem to be a sort of rite of passage for new parents. Mention your own experience, and fellow parents are sure to chime in with their own horror stories. (When my mom was a child, she dropped her baby sister down the stairs. When my sister was a baby, she fell down the stairs in a walker. They are both alive and well!)

While falls tend to happen once your baby can crawl, walk, roll, or tip an infant seat or walker, falls can also happen to babies like mine, who couldn’t yet do any of those things.

“I think one of the most common falls that we’ll see is an infant that’s left unattended on a bed or a couch for a moment, or (a caregiver) turns from the changing table,” Dr. Homme says. “As they (babies) continue to grow and develop, sometimes they end up becoming more mobile than we expect.”

Here’s the good news: Babies are resilient. Because baby bones are softer and more flexible than adult bones, they may not fracture. But if they do, they heal very well.

A head injury can cause pressure and bleeding in or around your infant’s brain. But unlike adults, babies still have open spaces in the skull (fontanels). These allow the skull to be molded into a shape that makes birth easier. Fontanels also provide some relief if pressure is building up due to bleeding inside the skull — which can be indicated by a raised fontanel. A raised fontanel is a very serious sign, and your infant should be seen immediately.

The dangers of a fall include head trauma and broken limbs. Below are some quick things to look for after your baby falls. However, don’t hesitate to call a health care provider to talk over symptoms or ask questions.

 

What to check for:

  • Did the baby instantly start crying or interact with you after he fell? This is good, because it indicates that the baby wasn’t knocked out, unconscious or stunned.
  • Was the baby able to be calmed? This is an encouraging sign because if a baby keeps crying, he or she is probably in pain.
  • Is the baby acting differently? If the baby seems lethargic, irritable or just “off,” this is cause for concern.
  • Is the baby moving differently? If the baby is wiggling his or her arms and legs normally (or crawling if able to crawl), this is a good sign that there’s not a major fracture. If the baby is refusing to use a limb or bear weight in some way, this is concerning.
  • Are there physical signs the baby is injured? Are there bruises or swelling? Vomiting after a head injury is very common. If it happens soon after the fall, it is not as concerning in infants and small children. If vomiting occurs later or repeatedly, this is cause for concern.
  • Has your baby gotten progressively worse after the injury? Has the baby gotten progressively more fussy, irritable or sleepy? Is the baby having problems eating? These could be signs of an ongoing issue, such as bleeding in the brain or the abdomen.

 

Our little boy responded positively to all those tests — he was eating, calm and acting like himself in a few minutes. But we were still concerned because he fell from what seemed like such a scary height.

Generally speaking, Dr. Homme says falls are more concerning when they are from a height that is twice the length of the baby. However, height alone doesn’t predict the severity of injury. The type of surface a baby falls onto plays a role as well.

“I think as a parent trying to decide, ‘Should I bring my child in?’ If you have really reassuring answers to all those other things, then what they fell off of or what they fell onto becomes less important,” Dr. Homme says.

But the younger your kid, Dr. Homme says, the harder it can be to tell if an injury is concerning. As first-time parents, we decided to take our son to the emergency room (ER).

“Parents should never feel bad for bringing their child in to have us check them out,” Dr. Homme says. “Sometimes it’s just a good head-to-toe exam, history and maybe a short period of observation, and that’s all it takes. And it wasn’t a waste. If you sleep better at night, it’s worth it.”

If your baby initially seems OK, keep watching your baby over the next 24 to 48 hours for any unusual or progressively worsening behavior. For example, if the baby usually naps for two hours, sleeping for four or six hours is unusual. It can be a medical emergency if your baby is not responsive to you, is breathing irregularly, seems lethargic or excessively sleepy, or experiences a seizure.

 

Why not image?

When we got to the ER, they checked our son’s vital signs, asked us what happened, and examined his body and behavior for evidence of broken bones, a skull fracture or head trauma.

I assumed they would perform some kind of imaging scans on our son as a matter of course. So I was pleasantly surprised when Dr. Homme told us our son didn’t need any scans.

CT scans are fast and good at finding brain trauma, but they also expose your baby to a small amount of radiation. This increases the risk of future cancer, though it’s not clear by how much.

“The risk of radiation from medical imaging is hotly debated. No one will say that the risk is zero, but no one can clearly quantify the risk over a lifetime. And so there’s a principle that we use, which is called ALARA: As low as reasonably achievable,” Dr. Homme says. “If you can reasonably avoid using radiation to make a diagnosis in a young child, you should. But if you have a high concern, we as clinicians should not hesitate to use the best diagnostic modality available to us to get the information that we need to care for your child.”

And the vast majority of the time, a baby who has suffered minor blunt head trauma will not have a brain injury that needs neurosurgical treatment. This means a health care provider will generally only recommend a CT scan if your child is at a higher risk of serious brain injury, which the provider determines based on your baby’s signs and symptoms and the nature of the fall.

“A parent might come to us and say, ‘I just need the reassurance of the CT scan.’ And it would seem like it’s an easy thing to do, why not just do it?” Dr. Homme said. “If we can, by other means, essentially rule out — with as much certainty as one can have in life — that we’re not going to find something that is clinically important, then there is no value added to that CT scan. It only adds a tiny but incremental risk to the child.”

 

Why are they asking these questions?

Health care providers will sometimes perform a scan if they are unsure whether an injury could be from child abuse, medically known as nonaccidental trauma. This doesn’t mean you should be afraid to bring your child to the doctor for fear of being accused of abuse.

“I want to assure parents that as providers, our goal is not to accuse anybody of anything, but to try to provide optimal care to their child,” Dr. Homme says. “There’s a very rigorous process in place to make sure that we are not falsely accusing individuals.”

Part of that process is asking you about what happened, sometimes by different individuals. This is typically standard procedure and shouldn’t alarm you.

“We’re very cautious about making sure not to miss that very high-risk situation of nonaccidental trauma. And it’s not that we don’t trust people. But there are some key things that we want to just basically ask a few questions about. Sometimes someone else has injured the infant and parents were unaware,” says Dr. Homme.

 

Preventing falls

We came home from the hospital relieved that our son was OK. But we swore to do everything we could so that we would never have to repeat the trip to the ER.

General practices to prevent falls include:

  • Don’t use infant walkers, which can result in injuries in many ways, but especially by falling down the stairs. The American Academy of Pediatrics strongly advises against using these, because even if you’re watching your kid, you often can’t act fast enough to stop your child from getting hurt.
  • Always strap infants into bouncy seats, car seats and carriers. If it has a strap, use it!
  • Keep bouncy seats and car seats on the floor — not on countertops or tables.
  • Keep one hand on babies when they are on the changing table.
  • Place baby gates at the top and bottom of stairs. Safety gates at the top of stairs should attach to the wall.
  • Use night lights to prevent tripping while carrying the baby at night.
  • If you live in a cold climate, be on the lookout for icy sidewalks and driveways.
  • If you’re carrying the baby, try not to simultaneously carry other large items such as groceries.

“I kind of sum it up as: The only really safe place for a baby is on the floor if you’re not holding them,” Dr. Homme said. “They can’t fall from the floor. Anytime they’re any distance above the floor, they need to be strapped, held or secured.”

However, no matter how careful you are, you can’t always prevent a fall, especially if you trip or slip. If this happens, try not to blame yourself.

“These things happen and often it’s the parent who suffers more than the child. The emotional distress, the guilt, ‘Oh I should have held on to them.’ All that stuff doesn’t help; it only harms you,” Dr. Homme says. “And we’re happy to check out your baby and make sure that they’re okay.”

James (Jim) Homme, M.D., FACEP

Dr. Homme is an Assistant Professor of Pediatrics and Emergency Medicine at the Mayo Clinic Alix School of Medicine. He is trained in both pediatrics and emergency medicine and serves as the Program Director of the Emergency Medicine Residency at the Mayo Clinic in Rochester, MN. He loves caring for the very young and the very old. His primary clinical and academic interests include the care of children in the Emergency Department, alleviating parental and caregiver anxiety, and pediatric minor head injury.

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