After a Fall: What to Check in the First 24 Hours

Falls are the leading cause of injury in early childhood, and the vast majority leave nothing behind but a bruise and a startled adult. What matters is knowing which falls need assessment and what to watch during the following day.

Assess the fall itself

Height matters. A fall from a bed or sofa is usually low energy; a fall down stairs, off a changing table or out of a window is not. Surface matters: concrete and tiles are worse than carpet or grass. Age matters: a baby under six months has a heavier head and less protective reflex. Loss of consciousness, even briefly, vomiting more than twice, a seizure, unequal pupils, clear fluid or blood from the ear or nose, or an inability to move a limb all mean immediate assessment.

• Any loss of consciousness, seizure or repeated vomiting: go now.
• A baby under 12 months who falls from height should be assessed.
• A swelling in a young baby that grows quickly needs urgent review.
• Bruises in a baby who is not yet crawling are always worth a conversation.

The first day at home

For a minor bump, apply a cold pack wrapped in a cloth for ten minutes, keep the child with you, and check them hourly through the first evening. Watch for unusual sleepiness, confusion, repeated vomiting, a headache that gets worse, complaining of neck pain, or any change in how they move, speak or see. It is reasonable to wake a child once during the night after a head injury, and to look for a normal response. Paracetamol is fine for pain; avoid ibuprofen in the first 24 hours if there is any concern about bleeding.

Prevention pays better than assessment. Stair gates fitted properly, furniture strapped to the wall, changing mats never left unattended, no walkers with wheels, and windows with restrictors. Most serious injuries in the first two years happen within seconds of an adult turning their back, which is why removing the hazard is more reliable than increasing attention.