What to do for a 1-year-old with a tongue laceration after a fall?

Management of Tongue Laceration in a 1-Year-Old After Fall

Most tongue lacerations in young children from falls heal spontaneously without intervention and should be managed conservatively with observation alone. 1, 2

Immediate Assessment

Assess for signs requiring urgent intervention:

• Active bleeding that cannot be controlled with direct pressure - if present, immediate medical evaluation is needed 2
• Airway compromise - rare but requires emergency intervention 3
• Size and depth of laceration - most childhood tongue lacerations are superficial and do not require suturing 1, 2
• Ability to eat and drink - if significantly impaired, closer monitoring is needed 4

When to Observe vs. Refer

Conservative management with observation is appropriate for:

• Small to moderate lacerations without active bleeding 1, 2
• Lacerations that stop bleeding with direct pressure 2
• Child able to tolerate oral intake 4

Immediate referral to emergency department or dentist is indicated for:

• Lacerations >1-2 cm or involving significant depth 1
• Persistent bleeding despite pressure 2
• Through-and-through lacerations 1
• Signs of infection (fever, increased swelling, purulent drainage) 4
• Inability to eat or drink 4

Home Care Instructions

For lacerations managed conservatively:

• Apply direct pressure with clean gauze if bleeding recurs 2
• Offer cold liquids or ice chips to reduce swelling and provide comfort 2
• Maintain soft diet for several days 4
• Avoid hot, spicy, or acidic foods that may irritate the wound 4
• Monitor for signs of infection (increasing pain, swelling, fever) 4

Pain Management

Consider age-appropriate analgesia:

• Acetaminophen or ibuprofen for pain control 3
• Cold liquids provide local comfort 2

Critical Red Flag: Child Abuse Screening

In any child younger than 5 years with oral trauma, consider child abuse as a possible etiology. 3 Tongue lacerations from biting have been documented in abuse cases 5. Assess for:

• Inconsistent history with injury pattern 3, 5
• Multiple injuries at different stages of healing 3
• Delay in seeking care 3
• Repeated injuries 4, 5

Follow-Up

Routine follow-up is typically not necessary for minor tongue lacerations that are healing well. 1, 2 Instruct parents to return if:

• Bleeding recurs and cannot be controlled 2
• Signs of infection develop 4
• Child refuses to eat or drink 4
• Wound appears to be worsening rather than healing 1

Common Pitfalls to Avoid

• Do not routinely suture tongue lacerations in young children - most heal spontaneously and suturing requires sedation or general anesthesia, which carries unnecessary risks 1, 2
• Do not miss signs of abuse - tongue injuries in children under 5 warrant careful evaluation of the mechanism and social situation 3, 5
• Do not overlook self-biting as a cause of recurrent injury - if the laceration recurs, consider protective measures for the teeth 4