Discharge Instructions for 6-Month-Old Female with Unwitnessed Fall
Parents should monitor the child closely for 24-48 hours for any concerning symptoms and return immediately to the emergency department if the child shows any signs of altered mental status, vomiting, unusual irritability, lethargy, or seizure activity. 1
Key Monitoring Instructions
After an unwitnessed fall in an infant, even with normal observation in the hospital for 3 hours, parents need clear instructions on what to watch for at home:
Mental Status Changes:
- Difficulty waking the child
- Unusual drowsiness or lethargy
- Excessive irritability or inconsolable crying
- Decreased responsiveness to parents
Physical Symptoms:
- Vomiting (especially repeated vomiting)
- Seizure activity (rhythmic jerking movements, stiffening)
- Unequal pupil size
- Weakness or poor coordination
- Difficulty feeding or nursing
- Unusual breathing patterns
Return to Emergency Department Criteria
Instruct parents to return to the emergency department immediately if:
- Any of the above symptoms develop
- The child seems "not right" to the parents
- Parents have any concerns about the child's condition
Home Care Instructions
- Feeding and Hydration: Continue normal feeding schedule but observe for any difficulty swallowing or decreased interest in feeding
- Activity: Allow normal activity but observe closely for any changes in movement patterns or balance
- Medication: Acetaminophen (Tylenol) may be given for pain or discomfort at age-appropriate dosing
- Sleep: Wake the child once during the night for the first night to check responsiveness
Follow-up Care
- Schedule follow-up with the child's primary care provider within 2-3 days
- Bring discharge paperwork to the follow-up appointment to ensure continuity of care 2
Communication Strategies
Research shows that approximately 20% of parents may not fully comprehend discharge instructions 3. To improve understanding:
- Use simple, non-medical terminology when explaining instructions
- Provide written diagnosis-specific information sheets that complement verbal instructions 4
- Ask parents to repeat back the warning signs and when to return to the emergency department
- Ensure parents feel "completely prepared" to explain the hospital course to their primary care provider 2
Important Considerations
- Parental anxiety may be high after an unwitnessed fall, so reassurance along with clear instructions is important
- Health literacy and cognitive factors may impact parents' ability to execute discharge instructions 5, so tailor communication accordingly
- Diagnosis-specific written instructions have been shown to improve understanding of treatment plans 4
Remember that the first 24-48 hours after discharge are the most critical observation period for this infant, and parents should err on the side of caution if they notice any concerning changes in the child's condition.