Immediate Management of Infant Fall from Bed with Vomiting
The baby should be closely observed for at least 24 hours for signs of serious head injury, though most falls from bed result in only minor injuries and the immediate vomiting followed by normal behavior is reassuring. 1, 2
Immediate Assessment
Evaluate for red flag symptoms that require emergency medical attention:
- Altered mental status - persistent lethargy, difficulty arousing, or excessive sleepiness beyond normal sleep patterns 3, 4
- Repeated or persistent vomiting - especially if it becomes projectile or bilious (green/yellow) 5, 3
- Seizure activity or abnormal movements 3
- Unequal pupil size or abnormal eye movements 3
- Clear or bloody fluid from nose or ears 3
- Severe or worsening headache (manifested as inconsolable crying in infants) 3, 4
- Loss of consciousness at any point 3
- Bulging fontanelle (soft spot on head) 3
Understanding the Injury Pattern
Falls from bed typically cause minor injuries in infants:
- Most bed falls occur from heights of 1-3 feet and result in scalp hematomas, bruising, or minor lacerations 2
- Skull fractures occur in approximately 4% of infant bed falls, with traumatic brain injury in about 2% 1
- Severe injuries are extremely rare from typical bed falls 2
- The single episode of vomiting immediately after the fall, followed by crying and normal behavior, is consistent with minor head trauma 1
Observation Protocol
Monitor the infant closely for the next 24 hours for:
- Behavioral changes - increased irritability, inconsolable crying, or unusual lethargy 3, 4
- Feeding difficulties - refusal to eat or drink, or vomiting with feeds 4
- Sleep pattern changes - difficulty arousing from sleep (though normal sleep is expected) 3
- Neurological signs - weakness, abnormal movements, or balance problems when age-appropriate 3
When to Seek Emergency Care
Go to the emergency department immediately if:
- Vomiting recurs, especially if it becomes projectile or bilious 5, 3
- The baby becomes lethargic or difficult to arouse 3, 4
- Any seizure activity occurs 3
- Behavioral changes develop - excessive irritability or altered consciousness 3, 4
- Visible deformity, significant swelling, or large hematoma develops on the head 1
- Any of the red flag symptoms listed above appear 3, 4
Important Clinical Caveat
Severe injuries from simple bed falls are extremely rare - if significant injury is present with a reported "fall from bed," child abuse should be considered and evaluated 2. However, in the scenario described with immediate crying and return to normal behavior, this is consistent with typical minor trauma from an accidental fall 1, 2.
Safe Sleep Environment Going Forward
Prevent future falls by:
- Placing the infant's crib or bassinet on a firm, flat surface away from hazards 6
- Never leaving an infant unattended on adult beds, couches, or elevated surfaces 6
- Using appropriate sleep surfaces with safety standards - cribs with proper mattress fit and no gaps 6
- Avoiding soft surfaces like couches and armchairs for infant sleep, as these pose extremely high risk 6