Short vertical falls in infants

Abstract

Objective: To define injuries from short vertical falls (SVF) in infants, and to compare those with minor or no injuries to those with significant injury.

Design: Descriptive, retrospective chart review.

Setting: Pediatric emergency department (PED) of an urban teaching hospital.

Subjects: Infants < or = 10 months treated between January 1990 and December 1992 presenting with a SVF (< or = 4 feet).

Results: 167 patients met the definition. The mean age was 5.2 months; 56% were male. The mechanisms of injury included rolling off a bed (55%), being dropped from a caretaker's arms (20%), rolling off a couch (16%), and falling from other objects (10%). The majority of patients (85 %) had minor or no injury. Significant injuries were sustained by 15% (n = 25), including 16 with a closed head injury (12 with skull fractures), two with intracranial bleed, and seven with a long bone fracture. Subsequently, the two patients with intracranial hemorrhages were confirmed as being from child abuse. After excluding cases of suspected abuse, the only characteristic found to be independently associated with significant injury was being dropped by the caretaker (odds ratio: 6.4 vs rolling or falling from furniture, 95% CI: 2.0, 21.5).

Conclusion: The most common mechanism of a SVF was rolling off a bed. Most patients sustained minor or no injury. No child sustained an intracranial hemorrhage from a SVF. The child with intracranial injury and/or multiple injuries warrants an investigation. Being dropped appears to be a greater risk for significant injury than rolling off or falling from furniture.