Children and Fall – Why Do They Occur and How to Manage Them?

“Humpty Dumpty sat on a wall, Humpty Dumpty had a great fall” While Humpty took a risk and sat atop a wall to cause his fall, infants, and children don’t need such atrocious conditions to injure themselves. As newborns and neonates, they are unable to move around independently but as they grow older to infants and toddlers the chances of fall increase dramatically.

According to data from ALSPAC, to determine the injuries in the premobile infants, in a case of 11,466 cases, 76% reported one fall and only 5% had three or more falls.  In 2554 children, 3357 falls were reported; 53% fell from beds or settees and12% fell from arms or while being carried. The most common type of fall being the fall from beds. Only 14% reported visible injury, of which 56% were bruises; 97% of injuries specified involved the head. Only 21 falls (<1%) resulted in a concussion or fracture.

The study also showed that older siblings carrying an infant was a common cause of falls from arms. Falls from baby bouncers often occurred when the poppers came undone or the baby was dropped while being put into or taken out of the bouncer.

What happened to the kids after the fall then?

An injury was sustained in only 437 cases, and 244(56%) of these were bruises.  Serious injury, defined as concussion or fracture, occurred in only 21 cases, less than 1% of all falls. In 206 cases the actual site of injury was not specified. The commonest site of injury was the head in 375 cases (97%), with the remaining injuries being to the leg (five cases), arm (four cases).

A prior systematic review found that young age, male sex, and low socioeconomic status were consistent risk factors for fall injuries among children ages 0–6.

How and why do these falls occur?

Babies go through a lot of changes in a relatively small time and injuries can occur because as children grow, their mobility increases from generally being able to hold their head to rolling over at 4–5 months, sitting up at 6 months, pulling to a standing position at 9 months, and finally taking those precious steps at 12 months, and swiftly beginning to run/climb stairs at 18 months.

Reflexes help in the survival of the infants, while rooting and sucking reflex help infants consume food, Stepping reflex, Moro reflex or startle reflex, Tonic neck reflex all prepare the body for movements.

These falls occur in infants often more than compared to adults because:

  • Lack of control: Young children can’t control the movement of their heads as well as adults.
  • Babies have bigger heads. Babies’ heads are often proportionally larger than their bodies, making it easier for them to lose their balance.
  • Their neck muscles are not as well developed. Babies’ physical strength and abilities are constantly changing, which affects their stability and coordination.
  • Young children’s legs are somewhat shorter in proportion to the rest of their bodies. This makes a child’s center of gravity closer to the head than an adult’s center of gravity.
  • Young children are more likely to have an accident or fall as they learn new skills such as walking, running, and jumping.

What happens after Injury?

Rest assured a lot of crying and pacifying and guilt wraps up the fall. It is very important to stay calm and evaluate the situation. Anxiety and panicking can cloud or assessments and decisions to follow, so as much as it a fearful situation a parent or caretaker must not panic.

  • Children often bump their heads accidentally, resulting in minor bumps, bruises, or cuts in the scalp, but no damage to the brain inside.
  • In case of minor bump followed by minor swelling and devoid of other symptoms like unconsciousness rest the baby and apply something cold to the injury: for example, frozen vegetables wrapped in a tea towel.
  • Injuries to the head can cause a concussion, which is a mild traumatic brain injury- symptoms may include headache, confusion, problems with concentration and fatigue, and can be mild or severe. While it isn’t very serious repeated concussions can hamper the brain of the child.
  • A superficial cut on the head often bleeds heavily because the face and scalp have many blood vessels close to the surface of the skin. While it is alarming – it can be managed at home, if the cut is superficial with antiseptics and band-aid. If your instinct tells you there is more to the injury than meets the eye, take them to a doctor.

When to worry?

If your baby is showing any of these symptoms after experiencing an injury to their head, call emergency health services.

  • Uncontrolled bleeding from a cut
  • Dent or bulging soft spot on the skull
  • Excessive bruising and/or swelling
  • Vomiting more than once
  • Unusual sleepiness and/or difficulty staying alert
  • Loss of consciousness or not responding to voice/touch
  • Blood or fluid draining from the nose or ears
  • Seizure
  • Suspected neck/spinal cord injury
  • Trouble breathing

Check for changes/consistency in the size of your baby’s pupils. Monitor your baby while they’re sleeping during naps and at night.

Where can injuries take place?

Injuries can happen anywhere, most times they are freak accidents that cannot be predicted. Yet most of the time accidents happen due to momentary lapse of judgment, fatigues of new parents, and an active child, accidents do occur. There are a few places where accidents have been predicted. Like:

  1. slipping in the tub
  2. falling backward
  3. falling off a bed or changing table
  4. falling after climbing on the furniture or up on countertops
  5. falling in or out of the crib
  6. tripping over rugs or objects on the floor
  7. falling down steps or stairs
  8. falling while using an infant walker (one of the reasons why such walkers are considered unsafe)
  9. falling from playground swing sets

Precautionary Measures

Precaution is always better than cure. To be armed with knowledge and precautionary measures gives us peace of mind as well as structure in our lives. Only when we are secure we can give the child security which is important for a thriving life.

  1. Windows: Most children 5 years old and younger can fit through a 6-inch opening. To prevent falls from windows, install a stop that prevents windows from opening any further than 4 inches. Alternatively, install window guards that cover the lower part of the window. Move furniture away from windows and supervise.
  2. Stairs: Install safety gates at the top and bottom of staircases and don’t clutter stairs.
  3. Beds: Install safety rails on beds for toddlers. Use bed bumpers to prevent bumping against the railings. Check on the baby frequently to prevent SIDS. Make them sleep on their back.
  4. Baby bouncers and highchairs: Use preinstalled safety straps on a changing table or highchair. Select a high chair with a wide base that makes tipping less likely. Don’t leave a child unattended on a changing table or in a highchair.
  5. Place baby bassinets or portables car carriers on the floor, rather than on tables, counters, beds or other furniture. Place bumpers or guards on sharp corners of furniture to protect toddlers when they fall.
  6. Bathtubs: Use a bathmat in tubs to lower the risk of falls. Check the water levels not to drown the baby. Don’t leave your child unattended in a bath. Use a non-slip bathmat and clean up wet floors promptly.
  7. Use Nightlights and avoid baby Walkers.
  8. Strollers: When choosing a stroller, look for one with a wide base that is less likely to tip. Always use the safety harness when your baby or toddler is in the stroller. To avoid tipping the stroller, don’t hang bags from the handles. Check the weight limit of strollers that have a place for older children to stand in the back.
  9. Seek out playgrounds with shock-absorbing surfaces, such as wood chips, mulch, rubber, or sand. Falls on cement, packed dirt, and turf are more likely to result in injuries. Steer your child to age-appropriate activities to help prevent falls from equipment.

We can do these things to prevent injuries and in case of the injury remember not to panic, give a thorough check to the other body parts except head as well and monitor your child for any deviants from normalcy. Stay safe, stay happy.

Hi, I'm Dr. Swati, a dentist by profession, closeted writer by passion. Mother to a 4-year-old daughter, I believe a raising a child is an arduous yet rewarding task, and one must avail themselves all the aide you get.

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