Concerns After Toddler Falls from High Chair: What Parents Should Know

The child stood up from the high chair and fell to the ground?

Hello, doctor.
My son is one year and ten months old.
On February 14, he stood up from his high chair and fell onto the tile floor from a height of approximately 120 cm.
After the fall, he cried but did not lose consciousness.
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, lethargy, or rapid breathing.
If none occur, there is no need for concern.
However, I would like to ask:
1.
The X-ray was taken no more than 10 minutes after the fall.
I understand that X-rays cannot detect bleeding, but can the results taken so soon ensure that there are no injuries to the skull or cervical spine?
2.
If my son shows no abnormalities after three days of observation, can we be certain that there will be no future 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 in the brain based on symptoms? How long should we observe before feeling assured?
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?
6.
We are planning to travel abroad in three months.
Will the takeoff and landing of the airplane affect intracranial pressure? Or if there are no significant abnormalities within three months, will it be safe? I am really worried, and I appreciate your response! Thank you!

Cherry, 30~39 year old female. Ask Date: 2023/02/16

Dr. Jiang Junyi reply Neurology

Hello Cherry,
You mentioned "confirming whether there is delayed bleeding in the brain." If the child is active and responsive within a week, a small amount of bleeding can be absorbed.
Generally, radiation exposure should be minimized as much as possible.
The anterior fontanelle in infants typically closes between 16 to 18 months after birth.
Usually, a pediatric neurologist can assist in diagnosing brain hemorrhage through cranial ultrasound.
If your child's symptoms persist or worsen, it is advisable to seek medical attention.
It is recommended to consult a pediatric neurologist.
Thank you for your inquiry.
If you have any related questions, feel free to discuss further!
Wishing you good health and peace,
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2023/02/16

More Info

Dear Parent,
I understand your concerns regarding your toddler's fall from the high chair, especially given the height and the potential risks involved. It's completely normal to feel anxious after such an incident, and I appreciate your proactive approach in seeking information. Let's address your questions one by one.

1. X-ray Timing and Reliability: While it's true that an X-ray taken shortly after a fall can help identify fractures in the skull or cervical spine, it is not definitive for detecting internal bleeding or soft tissue injuries. X-rays are primarily used to visualize bone structures, and they may not reveal subtle injuries or complications that could develop later. The fact that the X-ray showed no immediate abnormalities is reassuring, but it does not entirely rule out the possibility of delayed injuries.

2. Observation Period: The three-day observation period is a standard recommendation following a head injury. If your child shows no signs of distress, such as persistent vomiting, unusual drowsiness, or difficulty waking up, it is a good sign. However, it is essential to remain vigilant for any symptoms that may arise after this period. If you have any lingering concerns, a follow-up with a pediatrician or a pediatric neurologist for further evaluation, including a CT scan, may be warranted.

3. Internal Injuries: While the focus is often on head injuries, it's important to consider the possibility of internal injuries, especially after a significant fall. Since toddlers cannot always articulate their discomfort, look for signs such as changes in appetite, unusual fussiness, or changes in bowel movements. If your child exhibits any of these symptoms or if you notice abdominal swelling or tenderness, seek medical attention promptly.

4. Delayed Bleeding: Delayed bleeding in the brain, known as a subdural hematoma, can occur after head trauma. Symptoms may include severe headache, vomiting, lethargy, or seizures. If you notice any of these symptoms, especially if they develop days after the fall, it is crucial to seek immediate medical evaluation. Generally, if your child remains symptom-free for a week, the likelihood of significant complications decreases, but continued monitoring is essential.

5. Timing for Ultrasound: If you are considering an ultrasound to check for internal bleeding, it is typically most effective within the first few days post-injury. However, the timing can vary based on the specific circumstances of the injury. If you suspect any internal injuries, consult your pediatrician about the best timing for imaging studies.

6. Air Travel Concerns: Regarding your upcoming travel, if your child has shown no significant symptoms or complications within three months of the fall, it is generally safe to fly. The changes in air pressure during takeoff and landing can affect ear pressure, but they should not pose a risk to a previously healthy child who has recovered from a minor head injury. However, if there are any concerns or if your child develops new symptoms before the trip, consult with your healthcare provider for personalized advice.

In summary, while your child's initial assessment appears reassuring, it is crucial to remain observant for any changes in behavior or health. If you have any doubts or if new symptoms arise, do not hesitate to seek medical advice. Your child's safety and well-being are of utmost importance, and being vigilant is a key part of caring for a young child after an injury.

Wishing you and your family all the best, and I hope your little one continues to thrive!
Sincerely,
Doctor Q&A Teams

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