From the Guidelines
Management for a pediatric patient after a fall from bed requires a systematic assessment and appropriate interventions based on the child's condition, prioritizing immediate evaluation and stabilization to minimize morbidity, mortality, and optimize quality of life. The assessment should begin with a thorough physical examination focusing on the head, neck, extremities, and abdomen to identify any injuries, as emphasized in the management of pediatric trauma 1. Checking vital signs including heart rate, respiratory rate, blood pressure, and oxygen saturation is crucial, along with assessing neurological status using age-appropriate methods, including level of consciousness, pupillary response, and motor function.
For minor injuries without concerning symptoms, observation at home may be appropriate with instructions to parents about warning signs, such as those for increased intracranial pressure (persistent vomiting, severe headache, altered mental status, seizures, or unequal pupils) in cases of head injuries. Mild pain can be managed with acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) for children over 6 months, as these are common practices in pediatric care. Imaging studies like CT scans should be considered for significant head trauma, loss of consciousness, persistent vomiting, or concerning neurological findings, given the importance of early detection and intervention in traumatic injuries 1.
Documentation should include the height of the fall, the surface the child landed on, the child's position after the fall, and any symptoms, which is essential for understanding the mechanism of injury and guiding further management. Prevention education for parents is also critical, including proper use of bed rails, lowering the mattress height when possible, and never leaving infants unattended on elevated surfaces, as preventive measures can significantly reduce the risk of falls and associated injuries 1.
Key considerations in the management of pediatric patients after a fall from bed include:
- Thorough initial assessment and ongoing monitoring for signs of serious injury
- Appropriate use of imaging and diagnostic tests based on clinical presentation
- Pain management and prevention of further injury
- Education of parents and caregivers on safety measures to prevent future falls
- Integration of care within a trauma system that recognizes the unique needs of pediatric patients, as highlighted in recommendations for pediatric trauma care 1.
From the Research
Management of Pediatric Patients After a Fall from Bed
The management of pediatric patients after a fall from bed involves several key components, including:
- Assessment of the patient's risk of falling and implementation of a fall prevention program based on patient-specific identified risks 2
- Use of a validated fall risk assessment tool, such as the Humpty Dumpty fall Scale, to assess the risk of fall in pediatric patients 2
- Implementation of evidence-based interventions, including fall bundle elements and fall prevention education to patients and families, to reduce the risk of falls 3
- Evaluation of the patient for potential injuries, such as head trauma, and provision of appropriate treatment and management 4
Treatment of Injuries
In the event of a fall from bed, pediatric patients may be at risk of sustaining injuries, such as head trauma. The treatment of these injuries may involve:
- Neuroimaging, such as CT or MRI, to evaluate for life-threatening intracranial hemorrhage and mass effect 4
- Administration of analgesia, such as ibuprofen or acetaminophen, to manage acute postconcussive headaches 5
- Provision of standard concussion management education and instruction on how to use a headache diary to monitor symptoms 5
Prevention of Future Falls
To prevent future falls, pediatric patients and their families can be educated on: