Mayerson Center for Safe and Healthy Children

Helfer RE, et al. Injuries resulting when small children fall out of bed . Pediatrics. 1977;60:533-535.

Methods:

• 246 children <5 years old divided into two groups: survey group: parents filled out survey in doctor’s office whether child had fallen off bed or sofa (n=161)
• hospital group: fall in hospital from bed, crib or exam table (n=85)

Results:

• Survey group: (all falls <90cm)

  • three clavicular fractures (ages: 6 months-5 years)
  • two skull fractures (ages: <6 months)
  • one humerus fracture (age: <6 months)
• Hospital group: (fall = 90cm) one skull fracture (“no serious  sequela”)

Conclusions:

• Severe head injuries did not occur when these children fell out of bed.
• Fractures can occur when children fall out of bed.

Lyons TJ, Oates RK. Falling out of bed: A relatively benign occurrence . Pediatrics 1993;92:125-127.

Methods:

• 207 children <6 years of age who fell from a hospital crib (n=124) (32 inches with sides down; 54 inches with sides up) or bed (n=83) (25 inches; 41inches with bed rails)
• 15 percent who fell from cribs and 18 percent who fell from beds fell over the side rails

Results:

• 31 injuries: 29 trivial injuries (skin contusions and small lacerations), one linear skull fracture (10-month-old  fell out of crib), one clavicle fracture (21-month-old  fell out of crib with rails up)
• 26 (84 percent) injuries were to the head
• Not all patients received a radiograph

Conclusions:

• Clinically significant head injuries are uncommon with falls from these heights.

Nimityongskul P, Anderson LD. The likelihood of injuries when children fall out of bed . J Ped Ortho 1987;7:184-186.

Methods:

• 76 children <16 years of age (23 were less than 1 year of age) who fell out of bed / crib / chair / wagon while in hospital (1-3 foot fall)

Results:

• Most of the patients sustained minor injuries (bruises, minor lacerations)
• 1 patient  (1 year of age) had an occipital skull fracture
• 1 patient  (with osteogenesis imperfecta) had a non-displaced tibial fracture
• Total of nine radiographs performed (seven skull films) in all patients

Conclusions:

• Severe head injuries were not seen in these children who fell out of a hospital bed, crib or chair.

Wheeler DS, Shope TR. Depressed skull fracture in a 7-month-old who fell from bed . Pediatrics 1997;100:1033-1034.

Methods:

• Case report of 7-month-old fall from bed who sustained a 2x4x0.5 cm depressed right parietal skull fracture

Results:

• No underlying brain injury, no retinal hemorrhages, no other fractures
• Scene investigation revealed a car toy-roof fit the dimensions of skull depression

Conclusion:

• Depressed skull fractures may occur when children fall short distances onto an object.

Mayr JM, Seebacher U, et al.  Bunk beds – a still underestimated risk for accidents in childhood?  Eur J Pediatrics  2000; 159:440-3

Methods: 

• This study retrospectively looked at 218 children aged 1 to 15 involved in non-fatal falls from bunk beds in Australia between the years 1990 and 1999
• Patients with skull fractures were followed for an additional two to five months to rule out neurological deficits 

Results: 

• Mean age was 4.5 years 
• 41.7 percent had major injuries and 58.3 percent had minor injuries
• 3.2 percent had cranial vault fracture  
• Follow-up revealed no children with head injuries displayed neurologic or behavioral changes

• A small percentage of children suffered skull fractures from bunk bed falls.

Ruddick C, Platt MW, Lazaro C.  Head trauma outcomes of verifiable falls in newborn babies .  ADC Online First, published as 10.1136/adc.2008.143131.

Methods: 

• Babies who fell accidentally to the floor in the maternity ward between 1999 and 2003 were identified, and included in the study if falls were witnessed or circumstances verifiable. 

Results: 

• The floor of the hospital was identified as vinyl tile on concrete subfloor
• Falls were from one meter or less, except one case which was from 1.2 meters
• 11 cases were included.  Immediate assessment was available for each case
• eight cases presented without clinical findings.
• three included a presentation of bruising over the temporal area, one with swelling over the parietal area, and one case of traumatic encephalopathy. 
• Radiographically:
• five linear parietal skull fractures were identified. 
• three of these fractures did not have associated scalp swelling.