When a child under a year is seen in the E.R. for an accidental injury, more than half the time it's because of a fall. Learn how to protect your little one.
Jessica Slocum was in a rush to get to work one morning. Holding her 5-month-old daughter, Olivia, and a few diapers in one arm, she headed down the stairs in heels. A few steps in, she tripped. "The next thing I knew, we were at the bottom of the stairs and I was on top of Olivia," says the mom from Mount Royal, New Jersey. "Olivia's head had hit the baseboard at the foot of the staircase, and it looked to me like she had twisted her neck." Slocum screamed for her husband, who fortunately hadn't left yet, and they rushed the crying infant to the emergency room. Tests revealed a hairline fracture to her skull, but she didn't appear to have a concussion.
Olivia's head seemed sore for a few days, and the fracture took six weeks to heal completely. But five months later, Slocum and her husband, Chris, still hadn't recovered. "I would lie in bed and replay the scene over and over in my head," she notes. "For a long time, whenever I called Chris, he would immediately ask, 'Everything okay?' "
Falls are responsible for more than 50 percent of trips to the E.R. for an unintentional injury in a baby under age 1. "Whenever I'm on call, I get questions about falls," says Kyran Quinlan, M.D., a Chicago pediatrician and chair of the American Academy of Pediatrics' Injury Prevention Committee.
To prevent falls, "you need to get ahead of the safety challenges that come with a rapidly developing infant," says Joseph Wright, M.D., a pediatric emergency physician and chairman of pediatrics at the Howard University College of Medicine, in Washington, D.C. "Usually the root cause of kids under a year falling is the parent saying, 'I didn't know she could do that.' " Read up on the biggest risks, and learn how to stop your child from taking a scary tumble.
Risky Move: Leaving your infant on a bed or a couch
When Jessica Hendricks needed to put a load of wash into the dryer one evening, she laid her 4-month-old daughter, Stella, on a playmat on the sofa. She thought it was safer to put Stella on a surface their dog couldn't reach -- plus, she wasn't rolling yet. "Suddenly, I heard a thud, followed by a shrieking cry," says the mom from St. Louis. "Stella must have dug her heels into the couch and scooted right off onto the floor." Luckily, the baby fell onto a rug they had purchased the week before. Hendricks and her husband rushed little Stella to the hospital. "I could hardly give them my name and phone number in the E.R. because I was sobbing so hard," Hendricks recalls. "The doctors and nurses told me, 'Honey, there's nothing to worry about. She's fine.' "
Falling off the bed or a sofa is a common scenario, says Dr. Quinlan. "Babies often roll over earlier than you might think. I've seen newborns move in the nursery on the first or second day of life; some babies have the innate ability to arch their back, twist their pelvis, and get really close to rolling," he notes.
Falls from a bed or sofa generally don't lead to serious injuries because the distance is only a few feet and there's often a carpet that can help cushion the fall. Plus, "infants don't usually land with all the force on their head," says Dr. Quinlan. "The force is distributed across their body -- their lower extremities, back, and arms break the fall."
Protect your baby Never put your child on an elevated surface unless you're right there with her. "Practice 'touch supervision,' " says Dr. Wright. "You need to be close enough to touch your child at all times." If you have to put your baby down for a minute, a playmat on the floor is a better choice than a bed or sofa.
Risky Move: Not being careful on staircases
Losing your footing while heading up or down stairs with a baby is terrifying, and the resulting injuries tend to be more serious to infants because of the force of the tumbling adult. In 87 percent of these cases, the baby hurts his head and/or neck, according to a study in Pediatrics. "When we examined stories of parents who fell with children, there was usually another factor at play," says coauthor Gary A. Smith, M.D., director of the Center for Injury Research and Policy at Nationwide Children's Hospital, in Columbus, Ohio. For example, the caregiver had a laundry basket in the other arm.
Protect your baby Try to minimize the times you must carry Baby on the stairs. "If you're only going to be a minute, it's best to leave your child in a safe location -- such as a play yard -- on the other end while you handle chores," recommends Dr. Smith. If you need her to come along, wearing her in a front carrier is a good idea, suggests Dr. Wright, so you have at least one hand free to hold onto the railing.
Try not to multitask, either When you're carrying your baby, you shouldn't be on your phone, for instance. "Infants don't have good neck control, so you need to place your hand behind their head for support," says Dr. Wright. And even a younger baby can surprise you: "Babies develop truncal control before they develop head control, so the child can twist in your arms."
Finally, think about footwear High heels, flip-flops, and slippery socks are not as safe as shoes with good traction or being barefoot.
Risky Move: Placing Baby's seat on a table or other elevated surface
Despite product warnings, parents often put Baby in a bouncy seat on a kitchen table, restaurant seat, counter, bed, or sofa to keep their child at eye level. This is fraught with danger, because you never know when a baby will wiggle enough to throw the seat off the edge, or you, someone else, or a pet could bump into the furniture and send the seat flying.
The same goes for car seats that double as infant carriers. Approximately 8,700 babies are treated annually in the E.R. for injuries due to caregivers using car seats outside of cars, according to a study published in Pediatrics. Nearly 65 percent of those injuries occur when an infant falls out of the car seat -- often because the seat was placed on an elevated surface and the baby wasn't properly strapped in. And almost 15 percent occur when the child and the seat fall together from a high surface.
Protect your baby Always place any type of infant seat on a floor that's smooth and level, and make sure to fasten the safety straps. Even tiny infants who are unsecured can fall out if they wiggle enough or get upset and stiffen their bodies. "Babies can be little gymnasts and Houdinis," reminds Dr. Quinlan.
Risky Move: Stepping away from your baby on the changing table
Lindsey Smith Mahan's husband, Brian, was changing their 10-month-old daughter, Naomi, and turned around for a few seconds to grab pajamas. That's all the time it took for Naomi to roll off the table and onto the hardwood floor. "She wouldn't stop crying, and I was concerned that she'd hit her head," says the mom from Liverpool, New York. "Then when she tried to crawl, I realized she wasn't using her left arm." A visit to an urgent care center revealed that Naomi had broken her clavicle, and she went home wearing a sling.
Protect your baby Stepping away from the changing table is always dangerous, says Dr. Quinlan. Make sure you have everything you need before you start a diaper change, buckle your baby securely on the table, and keep one hand on her at all times. If you've forgotten something, scoop up your child and bring her along to get it. Even if your changing table has a ridge at the edge, that's not enough to prevent an infant from going overboard. Once your baby becomes really active or starts to struggle during changes, you may prefer to put a pad on the floor and change her down there.
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Originally published in the June 2015 issue of American Baby magazine.