Concerns After Toddler Falls: X-Ray Insights and Safety Tips

A child fell from a height onto a tiled floor?

Hello, doctor.
My son, who is one year and ten months old, fell from his high chair onto the tile floor tonight.
He stood up after falling from a height of about 120 cm and cried loudly.
We immediately took him to a nearby surgical clinic for an X-ray.
The doctor said that the X-ray of his head and neck appeared normal and advised us to observe him for three days for any unusual symptoms such as vomiting, excessive sleepiness, or rapid breathing.
If none of these symptoms occur, there is no need to worry.
However, I would like to ask:
1.
The X-ray was taken only about 10 minutes after the fall.
I understand that X-rays cannot detect bleeding, but can the X-ray results within such a short time frame ensure that there are no injuries to the skull or cervical spine?
2.
If my child shows no abnormalities after three days of observation, can we be certain that there will be no long-term effects? Or is it necessary to perform a CT scan after three days for final confirmation?
3.
Besides the head and neck, is there a possibility of internal organ injury? Since my baby is too young to express himself, how can we determine if there are any abnormalities? I am really worried, and I appreciate your response! Thank you!

Cherry, 30~39 year old female. Ask Date: 2023/02/15

Dr. Hong Yuanbin reply Internal Medicine

Hello,
1.
X-ray results can reveal significant injuries to the skull and cervical vertebrae, but they cannot detect bleeding.

2.
Due to radiation concerns associated with computed tomography (CT) scans, clinicians will first assess symptoms to determine the necessity of the scan.
If there are no symptoms at all, the likelihood of a normal CT scan is very high, and it may not be necessary to perform one.

3.
It is recommended to evaluate for any visible abnormalities, persistent crying, signs of bleeding, and changes in consciousness as indicators for assessment.
Thank you for your inquiry.

Reply Date: 2023/02/15

More Info

When a toddler falls from a height, such as from a chair, it can understandably cause significant concern for parents. In your case, your child fell approximately 120 cm onto a tiled floor, which is a considerable height for a young child. You mentioned that an X-ray was performed shortly after the fall, and the initial results showed no abnormalities in the head and neck area. Here are some insights and recommendations based on your questions:
1. X-ray Timing and Limitations: While it's true that X-rays can provide valuable information about bone fractures or dislocations, they have limitations, especially when it comes to detecting soft tissue injuries or internal bleeding. The fact that the X-ray was taken within 10 minutes of the fall is beneficial, as it allows for a timely assessment. However, X-rays cannot definitively rule out all potential injuries, particularly those that may develop or become apparent over time. For instance, some fractures may not be visible immediately and could manifest later. Therefore, while the initial X-ray results are reassuring, they do not guarantee that there are no injuries.

2. Observation Period: The recommendation to observe your child for three days is standard practice following a fall. During this time, you should monitor for any signs of abnormal behavior, such as vomiting, excessive sleepiness, or difficulty breathing. If your child exhibits any of these symptoms, it is crucial to seek medical attention immediately. If your child remains symptom-free after three days, it is generally a good sign, but it does not completely rule out the possibility of delayed injuries. A follow-up with a healthcare provider, including a discussion about whether a CT scan is necessary, may be warranted based on your child's condition and any ongoing concerns.

3. Internal Injuries: In addition to head and neck injuries, there is a possibility of internal injuries, especially in young children who may not be able to articulate their discomfort. Signs of internal injury can include abdominal pain, swelling, changes in appetite, or unusual behavior. If your child seems unusually fussy, refuses to eat, or shows signs of pain when moving, these could be indicators of a more serious issue. If you notice any of these symptoms, it is essential to consult a healthcare professional promptly.

4. Monitoring for Signs of Distress: Since toddlers may not be able to communicate their feelings effectively, it's essential to be vigilant. Look for changes in behavior, such as increased irritability, lethargy, or changes in sleeping patterns. Additionally, check for any physical signs, such as bruising or swelling, especially around the head, neck, or abdomen. If you have any doubts about your child's condition, do not hesitate to seek medical advice.

In summary, while the initial X-ray results are reassuring, continued observation is crucial. If your child shows any concerning symptoms, or if you have lingering worries, it is always best to consult with a healthcare provider for further evaluation. Your child's safety and well-being are of utmost importance, and seeking professional guidance can provide peace of mind.

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