Falls

Table of Contents

Common Childhood Injuries.

Children, being naturally active and curious, are more susceptible to different injuries. It is vital for parents and caregivers to be equipped with the knowledge of how to handle these common injuries promptly and efficiently.

When dealing with injured children, certain aspects demand special consideration. The composition of infants and children significantly varies from that of adults, affecting the way injuries present themselves and affecting the child’s physical and emotional response to injury.

Most childhood injuries and blunt trauma stem from falls and vehicle accidents. Falls, a common form of paediatric trauma, seldom lead to fatality, unlike traffic accidents which are a major contributor to both death and long-term disability. While penetrating trauma is less common in younger children, it tends to result in more severe injuries.

In managing children, the principles and priorities are akin to those for adults. Due to children’s distinct anatomical and physiological traits, multiple system injuries are more common than not in vehicle accidents. Hence, it is essential to treat all systems as injured unless proven otherwise. While penetrating injuries are uncommon, they become more frequent in older children and adolescents.

Released on the 18th of April by the Australian Institute of Health and Welfare (AIHW), Injuries in children and adolescents discusses around 604,000 ED presentations and 89,000 injury hospitalisations occurring during 2021–22. The report covers the main types, causes, and severity of injuries experienced by Australians aged 0–18 years. 

Falls caused the highest number of injury hospitalisations across all age groups except 16 to 18 years old.

Falls

Falls are the leading cause of injuries treated across all age groups in hospitals. Each year in Australia, 68,000 children are hospitalised because of unintentional injuries. Even from birth, babies are susceptible to falling, as children’s natural curiosity leads them to climb on and explore everything they encounter.

It is typical for children to experience slips and falls during their development, such as when they are learning to walk and stumble in the process as they develop balance skills. To prevent injuries, it is crucial to create a safe environment for them to practice their newfound skills.

While many falls result in minor bumps or bruises, some can lead to fractures, cuts, or head injuries. Taking preventive measures can help avoid more severe injuries.

 

Causes of Fall Injuries

Falls cause the highest number and rate of injury hospitalisations

Dr Heather Swanston from AIHW stated ‘1 in 3 hospitalisations for children and adolescents in 2021–22 were caused by a fall,’. 

Children under five are also prone to falling from change tables, chairs or highchairs nearly 1 in 4 falls involved a bed. More than 1 in 5 occurred while being carried or supported by another person.

‘Playground equipment was the most common cause of falls amongst children, with hospitalisation rates being highest among children aged 5–9 years.’

The most common type of fall for 13–18-year-olds was due to colliding with, or being pushed by another person.

While falls caused the highest number of injury hospitalisations for children and adolescents, adults are over twice as likely to be hospitalised for a fall.

 

Three key factors determine the severity of a fall:

  • The height from which the child falls: Lower heights pose less risk. Children under five should not be exposed to heights exceeding 1.5 meters, while older children should avoid heights over two meters.
  • The surface the child lands on: Hard surfaces like concrete, ceramic tiles, and compacted sand are more dangerous than softer surfaces such as grass and garden beds.
  • Potential obstructions the child may encounter during the fall: Landing on sharp-edged furniture or glass can lead to severe injuries.

What to do When a Child Falls.

As a parent and hearing the blood curdling scream, our first instinct is to run to our child, scoop them up in our arms and take away the pain by comforting them.

Our first instincts could be doing them more harm then good. 

When you hear that horrible scream and you see your child is injured.

First thing you will need to do is stop, take a breath, think and stay calm. A parent that is hysterical is useless to an injured baby or child. Taking a couple of seconds to help yourself to stay calm, could prevent you exacerbating your child’s injury.

First Remember DRSABCD and never move a baby or child until you have fully assessed them. 

 

Call 000 for emergency help or get someone else to call when:

  • the child may have seriously injured their head, neck, back, hipbones, or thighs
  • the child is unconscious or lost consciousness
  • the child has trouble breathing or isn’t breathing
  • have a seizure
  • the child starts vomiting which could be a sign of shock
 

Other signs that you will need immediate medical attention:

  • becomes very sleepy or is hard to wake up.
  • is very fussy or upset and can’t be comforted.
  • vomits more than once
  • complains of head, neck, or back pain
  • complains of increasing pain anywhere
  • is not walking normally
  • does not seem to be focusing their eyes normally
  • has any behaviour or symptoms that worry you
 

If your child isn’t vomiting and doesn’t have any of the symptoms above:

  • Comfort your child and look for any injuries.
  • Place a cold compress or ice pack on any bumps or bruises.
  • Give acetaminophen or ibuprofen for pain if your child is alert.
  • Let your child rest, as needed, for the next few hours.
  • For the next 24 hours, watch your child closely for any unusual symptoms or behaviour.
 

How to Deal with Baby Falling off the Bed

Most Common Type of Injury from a Fall

In Australia, males and females who seek medical attention for falls experience different types of injuries.

  • Females more often suffer from fractures and superficial injuries compared to males.
  • Males tend to have a higher incidence of soft tissue, open wound, intracranial, and internal organ injuries.

Additionally, there are variations in the body parts affected. 

  • Females commonly experience hip and lower limb injuries, as well as shoulder and upper limb injuries. 
  • Males are more prone to wrist and hand injuries.

Additionally the age range also played a part in the type of injury sustained.

  • Children in the 0-1 year range are more likely to sustain a superficial injury.
  • Children in the age range 1-4 are more likely to sustain an open wound from a fall. 

Figure 5: Fall injury hospitalisations, by type of injury, by sex, 2021–22

Bar graph showing type of injury sustained by category and by sex. Fracture was the most common for both males and females, followed by open wound. The reader can select to display either the crude rate per 100,000 population or the number of cases. The default display shows data for males and females, and the reader can also select to display for persons.

Fractures among children

AIHW reports stat ‘More than half of injuries caused by falls resulted in fractures, with fractures accounting for more than a third of injury hospitalisations among children and adolescents,’ said Dr Swanston. 

‘Nearly half of fractures presenting to the ED involved the shoulder and upper limb. For children aged 5–9, this increases to over 3 in 5.’ 

For fractures overall, children aged 10–12 had the highest rate of emergency department presentations, while adolescents aged 13–15 had the highest rate of hospitalisations.

Children in the 0-4 year old range 

A Mums Story

A Victorian mum tells of her nightmare since her baby fell off the nappy change table. Michelle hopes that sharing her experience will be a warning to other parents to be more vigilant.

boy who fell of change table in hospital

Preventing Falls Across Different Age Groups:

Each new learning stage for your baby requires you to pay more attention to prevent an injury from a fall. It may surprise you how fast your baby can move from one stage to the next. Being aware of what your baby can do and what skills your baby is likely to learn next will help you prevent injuries.

Babies

 

  • Ensure your baby is never unattended on elevated surfaces. Ensure babies are placed in safe areas to prevent falls as they start to move and explore. 
  • Exercise caution around tables, changing tables, cribs with lowered sides, beds, and sofas. Substitute a change table for a mat on the floor.
  • Avoid leaving your baby alone in any infant seat or “sitting” toy, such as swings, bouncers, and jumpers. Always use the provided safety straps.
  • Install sliding gates at both ends of staircases instead of accordion-style gates to prevent potential accidents. Adhere to the manufacturer’s installation instructions.
  • Refrain from using baby walkers as they can be deemed unsafe.  Opt for a stationary activity centre under adult supervision instead.
  • Keep your baby away from raised porches, decks, and landings.
  • Never leave your baby unsupervised in or near a bathtub to prevent slip and fall accidents.
  • Eliminate any home hazards that could lead to falls.
  • Always secure a five-point safety harness and apply brakes on prams or pushers when not holding onto them.

 

Toddlers and Young Children

Toddlers and young children are naturally curious and active, engaging in activities like exploring, climbing, walking, running, and dancing. However, these activities can increase the risk of falls and injuries. To help prevent injuries, consider the following tips:

  • Once your baby starts crawling, secure doors to hazardous areas.
  • Ensure keys are out of your child’s reach.
  • Use caution when using equipment like high chairs and changing tables. Always use harnesses provided and never leave unsupervised.
  • Install sliding gates at both ends of stairways.
  • Maintain clean and safe stairways, ensuring carpeted stairs are in good condition and uncarpeted stairs are not slippery.
  • Secure throw rugs to the floor to prevent slipping. Use double-sided tape or rubber pads under throw rugs to keep them in place.
  • Create a safe environment by removing tripping hazards and padding sharp edges.

  • Supervise your toddler outdoors, especially on uneven or sloping surfaces.
  • Install window guards and keep furniture away from windows.
  • Avoid allowing children to climb on high furniture.
  • Use bed rail guards to prevent falls, ensuring openings are small to prevent entrapment.
  • Transition toddlers from cots to beds cautiously to prevent falls. Use a low children’s bed as the first bed.

  • Avoid bunk beds for children under nine years and ensure guardrails on the top bunk.

  • Ensure outdoor play areas are safe:
    • Choose playgrounds with soft surfaces under equipment.
    • Avoid open trampolines due to the high risk of injury.
    • Allow children to ride sturdy tricycles with helmets on flat surfaces.
  • Supervise children closely during play to prevent accidents.
  • Supervise tired or unwell children to reduce the risk of falls.

  • Avoid letting children stand or ride on the sides of shopping trolleys for their safety.

Preventing Falls in Your Home

Slippery Surfaces:

  • Surfaces can become dangerously slippery when wet, posing a risk to all age groups.
  • Promptly clean up spills to prevent accidents, especially in areas like the kitchen.
  • Encourage children to sit while eating and drinking to minimize spills.

Bathroom Safety:

  • Falls are common in bathrooms due to wet and slippery conditions.
  • Ensure slip-resistant surfaces in the bath/shower and on the floor.
  • Consider using rubber mats for added safety.

Anti-Slip Products:

  • Various anti-slip products are available for indoor and outdoor use.
  • Examples include safety walk tape, rubberized paint, slip-resistant concrete spray, and lock matting.

Glass Safety:

  • Prevent accidents involving glass doors and windows by making them visible to children.
  • Use safety glass or shatter-resistant film for added protection.
  • Place furniture away from windows to avoid collision risks.

Balcony Precautions:

  • Supervise children on balconies and keep entrances locked.
  • Ensure non-slip surfaces and remove tripping hazards.
  • Position furniture away from railings to prevent climbing.
  • Comply with building codes for balcony construction to ensure safety.

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