What are the immediate steps to take if a 9-month-old infant falls off a counter top?

Immediate Management of 9-Month-Old Infant Fall from Countertop

Immediately assess the infant's responsiveness, airway, breathing, and circulation while ensuring scene safety, then activate emergency medical services (call 911) if the infant is unresponsive, not breathing normally, or shows signs of serious injury. 1

Initial Assessment Protocol

First 10 seconds - Simultaneous evaluation:

• Verify scene safety - ensure no ongoing danger to you or the infant 1
• Check responsiveness - tap the infant and call their name 1
• Assess breathing and pulse simultaneously - look for normal breathing (not just gasping) while feeling for the brachial pulse in the upper arm for up to 10 seconds 1, 2

Decision Tree Based on Initial Assessment

If infant is responsive, breathing normally, and has normal pulse:

• Monitor continuously until emergency responders arrive if you have already called 911 1
• Examine for visible injuries - particularly focus on the head, neck, and extremities 1
• Recognize that head injuries are most common - 74% of shopping cart-related injuries (similar height falls) involve the head and neck, with 92% in infants under 1 year 1
• Seek immediate medical evaluation even if the infant appears well, as serious injuries can occur from countertop-height falls 3, 4

If infant is not breathing normally but has a pulse:

• Provide rescue breathing immediately - 1 breath every 2-3 seconds (approximately 20-30 breaths per minute) 1
• Recheck pulse every 2 minutes - if pulse is lost, immediately begin CPR 1
• If heart rate is less than 60 beats per minute with signs of poor perfusion, start CPR 1

If infant is not breathing or only gasping and has no pulse:

• Start CPR immediately - for single rescuer, perform 30 compressions followed by 2 breaths 1
• Compression technique for infants - use two fingers on the lower third of the sternum, one finger's breadth below the nipple line, compress approximately 3 cm deep at 100-120 compressions per minute 1
• When second rescuer arrives, switch to 15 compressions and 2 breaths 1
• Continue CPR until advanced life support arrives or infant starts moving 1

Critical Red Flags Requiring Immediate Emergency Activation

Call 911 immediately if any of the following are present:

• Loss of consciousness or altered mental status 3, 4
• Abnormal breathing or apnea 1
• Seizure activity 5
• Visible deformity of skull or extremities 3, 6
• Bleeding from ears, nose, or mouth 3
• Vomiting 4
• Extreme irritability or inconsolability 4

Understanding Injury Patterns from Countertop Falls

Countertop falls (typically 3 feet) carry significant risk:

• Skull fractures occur in 4.1% of bed falls (similar height to countertops) in infants 6
• Traumatic brain injury occurs in 2.1% of bed falls, including intracranial hemorrhage 6
• Infants under 3 months are at highest risk - mean age of death from falls is 2.3 years, but younger infants have disproportionately higher mortality 3
• 86% of deaths from falls less than 5 stories are due to head injury, with 61% requiring neurosurgical intervention 3

Common Pitfalls to Avoid

Do not delay seeking medical attention:

• 38% of parents with infants who died from "minor" falls delayed seeking care, and all deteriorated during the delay 3
• Even if the infant seems fine initially, serious injuries can be present - skull fractures and intracranial bleeding may not be immediately apparent 4, 6

Do not assume the fall was "too minor" to cause serious injury:

• 41% of childhood fall deaths occur from "minor" falls such as falls from furniture 3
• Infants meeting low-risk criteria still had 5.1% rate of traumatic brain injury on CT and 4.6% rate of skull fractures 4

Transport Considerations

If transporting to emergency department yourself (only if infant is stable):

• Keep infant still and supported, particularly the head and neck 3
• Monitor continuously for any change in responsiveness, breathing, or behavior 1
• Do not wait if any concerning signs develop - call 911 immediately 3

Professional evaluation is mandatory - all infants who fall from countertop height require medical assessment, as 6% of similar falls result in hospitalization, all due to head injuries 6