Delayed Bleeding Risks After a Child's Fall

Delayed bleeding after a fall in children?

Hello, doctor.
My son, who is one year and ten months old, fell from his high chair onto the tile floor last night.
He fell from a height of about 120 centimeters and cried immediately after the fall.
We took him to a nearby surgical clinic for an X-ray, and the doctor said that the X-ray of his head and neck appeared normal.
We were advised to observe him for three days for any unusual symptoms such as vomiting, lethargy, or rapid breathing; if none occur, we need not 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 results be considered reliable in ensuring that there are no fractures in the skull or cervical spine after such a short time?
2.
If my son shows no abnormalities after three days of observation, can we be certain that there will be no long-term effects? Or should we consider a CT scan for final confirmation after three days?
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?
4.
Can we assess the possibility of delayed bleeding based on symptoms?
5.
If we want to perform a full-body ultrasound to check for bleeding, how long after the incident would be the most accurate time to do so?
I am really worried, and I appreciate your response! Thank you!

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

Dr. Pei Rensheng reply Pediatrics

Hello! In children with mild blunt head injury, there are several factors that can affect prognosis: 1.
The younger the child, the more severe the injury.
2.
The higher the fall, the more severe the injury; statistically, falls from heights greater than 90 cm should be monitored, and falls from over 150 cm are particularly dangerous.
3.
The presence of a large scalp hematoma or fractures indicates a higher risk.
4.
Injuries to the forehead are the least severe, while the occipital region poses moderate risk, and the temporal and parietal regions are the most dangerous.
Overall, only 1% of cases will present with clinically significant symptoms, such as seizures, loss of consciousness, limb weakness, or frequent vomiting.
If any of these symptoms occur, or if multiple factors from points 1-4 are present, further brain imaging studies are recommended! Wishing you health and safety! Sincerely, Ren Sheng.

Reply Date: 2023/02/15

More Info

When a child experiences a fall, especially from a significant height, it is natural for parents to be concerned about potential injuries, including internal bleeding. Here’s a comprehensive response to your questions based on medical knowledge and practices.

1. X-ray Limitations: X-rays are excellent for visualizing bone structures but are not effective for detecting soft tissue injuries or internal bleeding. If the X-ray taken shortly after the fall showed no fractures in the skull or cervical spine, it is a good sign, but it does not completely rule out the possibility of internal injuries. The timing of the X-ray (10 minutes post-fall) is generally sufficient for initial assessment, but it’s important to monitor for symptoms that may develop later.

2. Monitoring Symptoms: If your child shows no abnormal symptoms such as vomiting, excessive sleepiness, or difficulty breathing within the three-day observation period, it is a positive indicator. However, some injuries, particularly those involving the brain or internal organs, may not present symptoms immediately. A follow-up with a healthcare provider is advisable if any concerning symptoms arise. A CT scan may be warranted if there are persistent symptoms or if new symptoms develop after the initial observation period.

3. Internal Injuries: While the focus is often on head and neck injuries, internal organ damage is also a possibility, especially in a fall from a height. Signs of internal injury can include abdominal pain, swelling, bruising, or changes in behavior. Since young children may not articulate their discomfort, parents should be vigilant for any changes in eating habits, activity levels, or unusual crying.

4. Delayed Bleeding Symptoms: Delayed bleeding can manifest in various ways, including swelling, bruising, or changes in consciousness. If your child exhibits any signs of distress, such as irritability, lethargy, or changes in appetite, these could be indicators of internal bleeding or other complications. Regularly checking for any new symptoms during the observation period is crucial.

5. Timing for Ultrasound: If there is a concern about internal bleeding, an ultrasound can be a useful tool for assessing abdominal organs. Ideally, an ultrasound should be performed within a few days of the injury if there are symptoms suggesting internal bleeding. However, if your child remains asymptomatic, it may not be necessary. Always consult with a pediatrician or a specialist if you have concerns about your child's health following an injury.

In summary, while the initial X-ray results are reassuring, continuous monitoring of your child's condition is essential. If any new symptoms arise or if you have ongoing concerns, do not hesitate to seek further medical evaluation. It’s always better to err on the side of caution when it comes to the health and safety of your child.

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