When To Take Your Child To The ER After A Fall

You might be familiar with the phrase “sickening thud,” but you don’t really understand what it means until you’ve heard your child’s body hit the ground.

As parents, it’s our job to keep our kids safe from preventable accidents. It’s also our job to help them explore the world and discover some of its many wonders. Sometimes it can feel like these two goals are at odds with each other.

Bumps, cuts and scrapes are normal consequences of outdoor play, which we know is vitally important to our kids’ physical and emotional health. Falling is inevitable when a child is learning how to walk and is also likely when they’re learning new skills like bike riding or ice skating. Some safeguards are obvious and non-negotiable, like wearing a helmet when riding a bike. Others aren’t always so clear. How high do we let them go in that tree before demanding that they come down?

If your child has the kind of fall that stops your heart for a couple of beats, try to remain calm as you figure out your next move.

Here, two pediatricians explain how to decide whether to take your child to the emergency room or urgent care. If you call your doctor’s office or their after-hours answering service, it’s likely that these are the kinds of questions you will be asked.

Assess your child for any severe symptoms.

Dr. Jen Trachtenberg, a pediatrician and parent in New York City, told HuffPost that you can remember these with the letters ABC: “airway, breathing and circulation (pulse).” If your child’s airway is clear, they are breathing and their heart is beating, then you can move on to assess for other injuries. If not, call 911.

Other symptoms that warrant calling an ambulance would be “persistent seizure, severe head injury, [they are] unconscious, lots of bleeding that won’t stop, severe difficulty breathing,” said Trachtenberg.

If they don’t seem to be in immediate danger, “your primary concern is to decide if you need to go to the emergency room and to keep them from having another injury if the first injury has them off balance,” Dr. Kelly Fradin, a pediatrician, parent and the author of “Advanced Parenting: Advice For Helping Kids Through Diagnoses, Differences, And Mental Health Challenges,” told HuffPost.

Note the approximate height they fell from, as well as what type of surface they hit.

“As a physician,” Fradin said, “I like to know an estimate of from what height the child has fallen because over 3 to 5 feet increases risk.”

You’ll also want to note the type of surface your child landed on. “Head injury from high distances or onto hard concrete floors can be severe,” Trachtenberg said. Soft grass or playground rubber/foam are less likely to cause injury.

Also try to figure out what part of their body took the impact. It’s natural to worry first about head injuries, but the treatment of dental injuries can also be time-sensitive.

“Note which part of the body hit the ground, specifically considering if the mouth and teeth are involved as sometimes teeth can become impacted,” Fradin said.

Check for other signs of injury that warrant prompt attention.

Most falls aren’t life-threatening, but there are other signs that you need to get your child evaluated right away. These include:

• loss of consciousness (even if they’re awake now)
• seizures
• vomiting
• severe headache
• being confused or disoriented
• slurred speech or saying things that don’t make sense

Fradin explained the differences between potential head injuries: “When a child has a fall, we worry about whether the skull may be fractured or the child may have intracranial bleeding, which are medical emergencies that may require imaging to fully assess. Concussion does require evaluation, too, but often it’s not quite as urgent if we are confident that imaging isn’t necessary, so as a pediatrician I’m happy to speak with my patients over the phone to help them decide.”

While alarming to look at, a bruised bump or “goose egg” does not necessarily indicate a serious head injury.

Other reasons to head to the ER or urgent care would include signs of broken bones and “bleeding that wont stop with applied pressure that may need sutures,” Trachtenberg said.

Fradin noted that it can be particularly tricky to ascertain the severity of an ankle injury: “When a child rolls their ankle or has a fall of the lower extremity, I typically recommend if the pain is such that you can’t walk on it to consider emergency evaluation to rule out a fracture. Also, if there is point tenderness at any of the bony prominences around the ankle, that may warrant evaluation.”

Go easy on yourself.

It’s tempting to dive into a shame spiral when your child gets hurt under your care, but remember that this is an experience that most parents share.

“My own son fell down a flight of stairs when he was a toddler and we were on vacation, so I’m very familiar with the guilt. I try to encourage parents to speak to themselves as they would a friend,” Fradin said.

If you were speaking with a friend, you would be quick to assure them that they are a good parent and accidents can happen to anyone. You should show yourself that same grace.

“Some accidents sustained during sport or adventurous play are the cost we pay for having our children have active lifestyles that support their well-being in other ways,” she added.

Trachtenberg agreed: “As a parent, you do your best to limit accidents by supervision or other preventive measures, but it’s just not always possible to prevent injury.”