Thud! baby’s big fall

‘OH my God! Is that my baby?’ shouts mummy as she abandons utensils in the kitchen and dashes to the sitting room. There was such a thud in the sitting room that her heart skipped a beat and she braces for the worst. There is a ‘bit of silence, then a loud squeal from the baby; ‘Waaaaiiii!’ Silence.

Mum gets to the sitting room and the baby is sprawled on the floor. The elder five-year old sister with whom the baby was playing while mum made a meal is not in the room. She is gone in to the bedroom to collect a sweater leaving the baby alone in the sitting room. No one else is in the house and mum does not know what happened. From where did the baby fall and where is he hurt? At only nine months the baby cannot talk to explain what went wrong. Mum is annoyed with her elder daughter for leaving the baby ‘alone.’ For a moment mum forgets that the poor girl is also a kid and shouts, ‘Why did you leave the baby alone?! You are so careless!’ The young girl bursts into tears and now mum has to soothe two babies!

• What do you do when your baby falls?
• Who do you blame?
• Do you rush the baby to hospital?
• What first aid do you administer?
• When is a fall fatal?

By the time a child is ten years, he will have fallen so many times and sometimes with such severity that a parent will have braced for the worst. Sometimes you think the baby is: .. dead!

From where do babies fall most? Babies fall mostly from furniture, windows, baby walkers, playgrounds and swings.

• Furniture – Babies who are left unsupervised on top of beds, sofa sets and even couches are more likely to fall unexpectedly even if they have never rolled over before. It is not advisable to leave a baby alone on open furniture.
• Stairs – Toddlers do not realise the danger of falling down the stairs. Even older children who run up and down the stairs can trip and injure themselves. Clutter on stairs increases the risk of falling. Nothing should be left lying on the stairs. A good staircase should have strong handrails and no gaps through which children can fall.
• Windows – You live in a flat. You are leaving the house and are about to go out of the gate when you hear a shout from your toddler, ‘Bye Daddy!’ You look up and hanging precariously out of the window is your child. ‘Get back!’ you shout to the child who is apparently amused by the urgency in your voice. ‘I said get away from the window!’ you shout as you run back and up the stairs. Once you are in the house, the house help sees fire in your eyes. If she is lucky she will keep her job. Young children are naturally curious. Any opened window poses a danger to children below ten years. Falls from windows may be more severe depending on the height from the ground. If you must open windows for ventilation, make sure your child stays away from it. Also avoid placing chairs,tables and other furniture near the window. These act as ladders to aid young ones to climb on. As a parent talk to your child about the dangers of playing near the windows. Burglar proofs go a long way in preventing falls from windows and balconies, but may also trap your baby and cause injury.
• Baby walkers – When babies are on their walkers they can move close to hot substances on tables or stoves. The walkers can also fall downstairs or tip over even if the kids are with adults.
• Playgrounds – Although playgrounds provide children with exercises and outdoor enjoyment, they also pose safety hazards. Adults should always supervise children during trips to the playground. Kids do not know unsafe situations and proper supervision can help prevent accidents.When your baby is playing with equipment on the playgrounds ensure that the equipment is appropriate for your child’s age~'” Choose a play area that is separate from older children as this helps reduce the risk of injury. Swings and see-saws should be located in areas separate from the
  rest of the playground to prevent children from crossing directly in front or behind swings when they are moving. Also ensure that the kids are safely buckled when seated On the swings.
• Tripping – Discard the plastic wrappings from toys immediately before they become deadly and trip your child over or even cause suffocation. Teach older children to keep toys designed for them away from younger children. For instance, a skateboard can be a very dangerous toy if a toddler decides to experiment on what he sees the elder sibling doing.

Reacting to a baby’s fall
‘Get out of my house you good for nothing … l’ might be the first thing you shout to your househelp when your baby falls while under her care. Or you might .give a hard slap to your older child when the baby falls in his presence. You might say things to your sister that you will live to regret. ‘You let my baby fall because you do not have one of your own!’ Or even to your own mother, ‘I know it is because she is not named after you, mum!’ You might lose the friendship of neighbours if your baby falls while playing with other kids. ‘You stupid little things!’ you might have uncontrollably uttered.

Here are some tips on getting a hold of yourself

• Rule 1: Act before you talk. The last thing you should do when your baby falls is get angry. You need to first focus on saving your baby, not scolding those who were present when the baby fell.
• Rule 2: Do not be quick to apportion blame. Unless a person is malicious, it is unlikely that anyone would want to see a baby fall. In fact, most people find themselves just inches away from saving the baby from a fall when that final ‘thud!’ happens.
• Rule 3: Try to figure out where the baby is hurt rather than what those present were doing when the baby fell. It is more critical to determine whether the baby has sustained serious injuries than to learn whether the househelp was watching TV.
• Rule 4: Try to understand how the baby fell. This may lead to important deductions on where the baby might be hurt and how severe the fall might be. Did the baby fall 9ff a dining table or get tripped by a skipping rope?
• Rule 5: Administer first aid. It is crucial for all parents to understand the essentials of baby first aid and to keep within reach a first aid kit, also carrying such a kit when going out. The key components of such a kit include a disinfectant, a swab or cotton wool, bandage, pain killers like paracetamol and some ointment.
• Rule 6: Undertake a quick injury assessment. Look out for all possible bruises; not just those that you can see. Check for injuries under the baby’s clothes. Determine whether there may be any broken bones by gently pressing parts of the body, especially limbs and sections of the head.
• Rule 7: Take the baby for a check up by a doctor. Make no assumptions about baby falls. It is important that a doctor sees the baby to rule out fatal injuries. This is especially important if you know or suspect that the baby’s head hit the floor or wall. You need a doctor to rule out internal bleeding.
• Rule 8: Nurture the support of those present. Do not shout at anyone even when you think they are to blame. The harsher you are, the more likely that those who witnessed the baby fall will withdraw and sometimes mislead you or fail to reveal exactly what caused the fall. You may never really know where the baby was hit and how severely.
• Rule 9: Do not over-react. Babies fall everywhere every day. They cry loudly even when the injury is minor. They also cool down easily and even when hurt, heal quickly. This is because a baby’s body tissues are growing each day and depending on the age can replace torn tissue and equally fast repair broken bones. Moreover, the more soberly you handle the fall the better your judgement on your next steps will be.
• Rule 10: Follow your instinct to protect your baby. Act before a fall happens. If it does happen, learn a new lesson and do not let the same thing happen a second time. Many accidents involving babies could be avoided if the parents or minders are just a little more careful. In many cases a baby minder will have seen the baby get to the danger zone but momentarily ignored the risks the baby was facing. Many times a mum will have warned the baby, ‘Sweetie you are going to fall. .. ‘ Moments later, it happens!

What are the medical implications of a baby’s fall?
When a baby falls, the greatest danger is risk of incurring a major injury. He may knock the head and suffer a concussion (severe knock of the brain against the brain cage) which causes unconsciousness. There may also be brain haemorrhage or a fracture of the hands or legs known as green stick fractures. If very severe or if the fall is critical the child may suffer death or permanent damage and disability.

There may also be minor injuries like bruises and small cuts. Apart from causing pain with possible swelling it exposes the child to risk of bacterial infection and bleeding. These might end up being more serious than even the initial injury. For instance, the child may develop tetanus, a life-threatening bacterial infection.

Then there is the problem of medication and the availability of appropriate medical attention. This also goes with costs and availability of time. It adds extra expense to care which might not be easily affordable. There are also stresses, worries, uncertainty and fears of parents and the legal issues involved. Chances of the accident or another one occurring again add to the problem.

There are occasions when parents may even pose a bigger medical problem than even the child who has had the accident. Parents have been known to collapse or undergo severe depression.

How can a parent tell when to go to hospital after a fall?

Any child who falls, especially when they present with severe symptoms or change of normal behaviour, should be seen by a doctor. A child may appear normal and later deteriorate without warning. Keenly observe characteristics of your child which have changed from his normal state. Things to watch out for are skin lesions, bleeding, altered behavior, pain, loss of movement, loss of consciousness, fever developing after a fall and in general any deterioration of the child’s condition before the fall.

What first aid measures should a parent administer after a fall?

The most important thing is to ensure that there is no further injury and avoidable deterioration in the child’s condition. All dangerous objects should be removed or the child adequately protected from them. Take the child to an uncrowded area and observed for breathing and pulse. If there is a problem with the child’s breathing gently press on the child’s chest while attempting to resuscitate the child. If stable, continue to examine the child for more injuries. Stop bleeding by applying pressure bandage. Take care while handling fracture sites so as not to cause any movement at the fracture points. Injury to the neck should not be disturbed. If the child is in critical condition rush him to hospital immediately as you administer first aid on the way, where possible.

END: BL 03/53