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We have hardwood floors in the house, and have made a little "play area" out of foam interlocking "tiles" for our 9 MO to play on. Of course, he's not content to restrict his explorations to the designated area (on the contrary - he loves dropping his blocks on the hardwood floor so that they make a more interesting sound!)

Naturally, as he learns to crawl, cruise and get about, there are bound to be spills, falls and other bumps - he seems to be particularly talented at bumping his head when he's sitting and turns around too quickly.

How much of a concern are these bumps to the head (I'm not talking about falling from a height - just falling from a crawl or sitting position)?

Should we be hovering and not letting him fall at all? Is falling a natural and reasonably safe thing that teaches children about cause and effect and hopefully to be less clumsy? Can they seriously injure themselves as the result of a bump to the head on a mat or the floor?

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7 Answers

up vote 26 down vote accepted

Toddlers happen to be "designed" with the right height and mass that they very rarely injure themselves when falling from their own height. Mostly what you need to worry about is them falling from higher than their own height, like from furniture or stairs, falling onto something sharp, or something heavy falling on them. Most of the falls you are worrying about now, you will notice shortly that your child looks to see if you're watching before deciding whether it's worth it to cry or not. My 18 month-old actually head butts things for fun now.

My 7 year-old has cerebral palsy from her skull getting a little squished during her premature birth, so we are well acquainted with the signs of brain trauma. Mostly what you need to look out for is a sudden change in typical behavior, like:

  • Sluggishness
  • Eyes looking glazed over
  • Seizing
  • Vomiting
  • Dizziness
  • Slurred speech
  • Non responsiveness
  • Being inconsolable after several minutes

If those things happen after a nasty fall, consult a doctor right away, or even get an ambulance depending on severity. Bumps and bruises are not fun, but are normal and nothing to worry about. They happen even to children of the most conscientious parents.

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+1 for a very well-written answer! –  Torben Gundtofte-Bruun May 9 '11 at 6:41
    
+1 I concur. Thanks Karl for the informative answer. I appreciate the insight! –  Tom Auger May 10 '11 at 3:15
    
-1 for implying that children are designed and for not backing up the argument that children rarely injure themselves when falling from their own height. –  Javid Jamae May 10 '11 at 4:10
    
I didn't realize "designed" was such a bad word. I don't think there was any religious or controversial implication there. –  Tom Auger May 10 '11 at 16:08
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indeed, i read "designed" as "evolved". –  DanBeale Aug 10 '11 at 17:24
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If the child falls and cries unusually then make sure to check. Otherwise we've generally taught our toddler to just get up again and get on with the show. As long as he doesn't learn that every small bump results in a panic reaction from the parents, he just gets up again. If he feels that he really hurts we always notice.

Falling is okay and usually safe as long as he lands on a reasonably flat surface, especially if it's not rock-hard (tiles etc.). The skin on the forehead is actually the thickest on the whole body - I don't think that's a coincidence.

Obviously avoid sharp edges, and put soft guards on corners. But hitting the head on the floor is not a big concern - remember that kids have learned to walk this way for thousands of years.

You can find all kinds of protection online, right down to baby knee pads. IMHO that's overkill and doesn't help teach the child (or the parents) anything useful, but you might feel differently.

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Thanks Torben for the response. I agree that there must be a line between taking sane precautions (we use a mat and have kept a keen eye for any sharp edges) and going overboard (knee pads, really?). –  Tom Auger May 10 '11 at 3:25
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One thing in addition to what torbeng says is to watch your reactions, sometimes our kids will hit themselves and not be sure of what happened, if we look worried they will cry. So we don't give them cues unless it looks like a really hard bump, don't worry after awhile you'll know, then we go up and hold them and check. Otherwise if its a light one we will laugh at it and the kids will go on. They are pretty resilient, mine have taken some spills I was sure would have resulted in serious injuries only to see them get up and run around more.

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Thanks Michael. I also try not to react too much, though I wonder whether that doesn't make me seem a little "cold" at times. It's a tough balance between being "there" for your child and not encouraging them to "embellish" the situation just to get more of (the wrong kind of) attention. –  Tom Auger May 10 '11 at 3:19
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A friend told me it's when they are silent that there is a problem.

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"A friend told me..." with no reasoning or context isn't very helpful, because there isn't enough information to evaluate the reliability of the answer. –  HedgeMage May 8 '11 at 22:13
    
I actually heard that too, Ashley - and that was from a pediatrician. Thanks for the warning. –  Tom Auger May 10 '11 at 3:26
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+1 While I agree that "a friend told me" is not a reliable source, and the absence of any supporting evidence or context is less than ideal, the idea that a child who is unusually quiet after a fall is something to pay particular attention to is helpful enough that it does not deserve such a low score. –  Beofett May 10 '11 at 13:19
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One day, your child is going to learn how to climb stairs safely, how to go down them safely (on his bottom at first, sitting down on the step and descending, sitting down, one step at a time), how to climb onto the couch and get back off, etc. He's going to fall quite a few times between now and when he will have mastered staying upright on two feet - and that's OK.

From a sitting position, when a toddler falls over, it's only a few inches to the floor and most of the impact is amortized by the fact that the toddler doesn't usually fall, but rather rolls over (tumbles). Even if they do fall, the impact is pretty small (small distance, little weight, no starting velocity) and the head being more or less round, it's practically designed to handle that kind of impact.

Once they get upright, they usually fall either forward, in which case they put their hands before their faces and the arms take most of the impact, or they fall backward, in which case they usually fall on their bottoms first (and the fall is cushioned by the diaper as well). Falling forward may cause a bit more crying because it's scary to see the floor coming at you all of a sudden! (And sometimes it hurts a bit).

If your 9 MO bangs his head turning around too quickly and it bothers him, he'll start turning around slower - becoming more careful. That's how we learn. If he starts to yank at power cords (fun until the TV falls to the ground) you might want to intervene before the TV falls to the ground.

Monitor your child's behavior without letting him know you're watching (e.g. drink a cup of coffee pretending to look the other way) and see if he takes any unnecessary risks. as long as he doesn't, let him explore. Keep a closer eye when he does take risks but try not to intervene unless there's a real hazard (like electricity, height, weight, etc.). Your child will use you as a secure base to explore the world. If he sees you as being confident in his capabilities, he'll become confident as well but will also become prudent not to break that trust.

Wikipedia has an excellent article on Attachment theory: http://en.wikipedia.org/wiki/Attachment_theory Under the headings "Behaviours" and "Tenets" there are quite a few references to studies that may interest you (and reassure you).

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Thanks Ronald. I am also inclined to think along the lines that a little "ouch" now and then will just make them less likely to repeat the same mistake twice. I appreciate your feedback, and the excellent link! –  Tom Auger May 10 '11 at 3:18
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For the most part, my wife and I have hovered over our kids until they we're old enough to stop with daring climbing and toddler clumsiness. As the kids get older, we maintain basic rules to minimize falls and head injuries in particular. For example:

  • No sitting on tables or countertops
  • No standing in chairs
  • You must sit on your bottom in your chair, not on your feet or knees
  • No toys can be left out in common walking areas (which could cause tripping)
  • No standing or tricks on tricycles
  • Always wear helmets when riding bikes
  • No running or playing on the stairs
  • Always hold handrails on the stairs
  • Etc.

We have known several children who have had head injuries that seemed minor initially, but which turned out to have major impact on the child and the parents. One 3yo child hit his head and began losing his vision and ultimately went blind. A coworker's 2.5yo child went into a coma after falling off of a chair (luckily she's fine now). Another child 5yo lost parts of his memory.

The effects of head injuries could be a lot more subtle. From this article in the Journal of Pediatric Psychology:

Many children with head injuries are left with residual impairments, including seizures, speech and gait problems, hearing or vision changes, and memory or attention problems (Anderson et al., 1997, 2001). Children who suffer head injuries in the preschool years are at substantially greater risk for subsequent behavior disorders that interfere with school performance (Michaud, Rivara, Jaffe, Fay, & Dailey, 1993). McKinlay, Dalrymple-Alford, Horwood, and Fergusson (2002) found that children whose mild head injury, severe enough to be hospitalized, occurred before they were 5 years old were more likely to display hyperactivity/inattentiveness and conduct disorder when they reached 10–13 years old. Even in preschoolers with mild head injury not severe enough for hospitalization, Wrightson, McGinn, and Gronwall (1995) found deficits in solving visual puzzles by 6 months after injury and lower reading ability by 6.5 years.

If your child hits his head, this article from HealthyChildren.org says to watch for the following signs after head trauma and take your child to the doctor or hospital immediately if you observe any of them:

  • A constant headache, particularly one that gets worse
  • Slurred speech or confusion
  • Dizziness that does not go away or happens repeatedly
  • Extreme irritability or other abnormal behavior
  • Vomiting more than 2 or 3 times
  • Stumbling or difficulty walking
  • Oozing blood or watery fluid from the nose or ears
  • Difficulty waking up or excessive sleepiness
  • Unequal size of the pupils (the dark center part of the eyes)
  • Double vision or blurry vision
  • Unusual paleness that lasts for more than an hour
  • Convulsions (seizures)
  • Difficulty recognizing familiar people
  • Weakness of arms or legs
  • Persistent ringing in the ears
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Thanks Javid, for this sobering opinion. I think we all need to be extra vigilant when these sorts of injuries occur. I think what I may be missing from your post is the connection between these types of relatively "serious" injuries and the likelihood of them occurring from an infant just learning to crawl and walk. I certainly agree that falling from chairs, stairs or anything at height is a very serious issue. But I think my post was more focused on falling from a crawling, sitting or standing position. I should re-check my OP and see if I need to re-word it. –  Tom Auger May 10 '11 at 3:23
    
@Tom - Sorry, I don't know of any study that compares head-trauma from different elevations (though there might be one out there). I would imagine that falling from a standing position and falling out of a chair could potentially cause similar damage depending on the location of the head hit, the flooring, etc. I don't think you'll get an answer that will make you feel comfortable (or uncomfortable) about the amount of hovering you have to do as they learn to walk. We just try to play it safe and watch over them more closely when they are in a position where they could hit their head harder. –  Javid Jamae May 10 '11 at 4:02
    
+1 for a comprehensive answer with very good lists. I agree that not all of it applies to infants'/toddlers' early steps, but the symptoms are good to know in any case. –  Torben Gundtofte-Bruun May 10 '11 at 6:30
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Infants & Toddlers learn by Experimentation, Trial & Error. This means that they will make a lot of failed experiments, and a lot of errors before they figure out what works.

As a parent your role is to make sure there are plenty of little bumps to learn from, but no bumps that are going to cause trauma/damage etc.

Also you should learn to recognise then your Infant/Toddler is crying for attention or reassurance, and when they are actually hurt.

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