Emergency Evaluation for Infant Fall from Bed
A baby who fell from a bed should visit the emergency department immediately if they exhibit any concerning signs, particularly vomiting, altered consciousness, focal neurologic deficits, or if the fall was from a height greater than 3 feet. 1, 2
Immediate Red Flags Requiring Emergency Evaluation
The following symptoms mandate immediate ED assessment:
- Repeated or persistent vomiting, especially if projectile or bilious 1
- Any loss of consciousness at the time of fall or afterward 2
- Focal neurologic deficits (weakness, numbness, abnormal movements) 2
- Seizures or convulsions 2
- Altered mental status (excessive drowsiness, difficulty waking, confusion, irritability beyond normal) 2
- Unequal pupil size 2
- Clear or bloody fluid draining from nose or ears (suggesting basilar skull fracture) 2
- Visible deformity or swelling suggesting fracture 3
- Severe or worsening headache (manifested as inconsolable crying in infants) 2
Risk Stratification Based on Fall Characteristics
High-risk falls requiring ED evaluation:
- Falls from greater than 3 feet (approximately 1 meter) 2
- Falls where the infant was dropped by a caregiver (6.4 times higher risk of significant injury compared to rolling off furniture) 4
- Falls onto hard surfaces (tile, concrete) versus carpeted surfaces 3
Lower-risk falls (but still warrant close observation):
- Falls from standard bed height (25-32 inches) onto carpeted or padded surfaces 5
- Rolling off furniture without witnessed head impact 4
Expected Injury Patterns from Bed Falls
Research shows that among infants presenting to ED after bed falls 3:
- 56.4% have minor injuries only (abrasions, bruising, contusions, lacerations) 3
- 9.4% sustain significant injuries, most commonly:
- 6% require hospitalization, all due to head injuries 3
Critical caveat: Intracranial hemorrhage from simple short falls (<4 feet) is extremely rare in the absence of abuse. When severe injuries occur from reported short falls, child abuse must be investigated 4, 5
Home Observation Protocol (If No Red Flags Present)
If the infant has none of the red flag symptoms and the fall was from standard bed height:
- Check on the infant every 2-3 hours for the first 24 hours, including waking from sleep 2
- Monitor specifically for:
Return to ED immediately if any warning signs develop during observation period 2
Age-Specific Considerations
Infants under 4 months are at highest risk for serious injury from falls due to:
- Immature motor skills preventing protective responses 6
- Larger head-to-body ratio increasing momentum of head impact 6
- Thinner skull bones 3
Peak age for bed falls is 7 months (when infants gain rolling mobility but lack safety awareness) 3
Prevention Counseling
To prevent future falls 1:
- Never leave infants unattended on adult beds, couches, or elevated surfaces 1
- Use cribs with proper safety standards (firm mattress, no gaps between mattress and crib walls) 1
- Avoid placing infants on couches or armchairs, which pose extremely high risk of injury or death 1
- Place cribs away from windows, cords, and other hazards 1
When ED Visit is NOT Immediately Necessary
An infant can be safely observed at home without immediate ED visit if ALL of the following are present 2, 4, 5:
- No loss of consciousness
- No vomiting
- Normal behavior and alertness
- Fall from standard bed height (≤3 feet)
- No visible deformity or significant swelling
- Reliable caregiver available for close observation
However, maintain a low threshold for seeking evaluation given the vulnerability of infants and difficulty assessing their symptoms 3