When to Take a Child to A&E After a Fall

Children fall constantly. Most of the time it's a bump, a cry, a hug, and back to play. The job for a parent is to know the relatively short list of signs that say this isn't normal — and to act on those rather than vaguely worry about the rest.

Below is the practical version. Red flags first, then what's worth a same-day call, then what's safe to watch at home. The thresholds for a baby under one are deliberately tighter — small skulls, smaller arteries, less margin.

Healthbooq provides guidance on when falls warrant professional medical evaluation.

Call 999 / 911 — straight to A&E now

Any one of these means you stop reading and go:

• Lost consciousness, even for a few seconds. Includes "blanked out" or "went floppy" at the moment of impact.
• A seizure or any abnormal jerking after the fall.
• More than one vomit in the first few hours after a head injury. A single vomit at the moment of pain is common; repeated vomiting is not.
• Clear or pinkish fluid leaking from the ear or nose. That's cerebrospinal fluid until proven otherwise.
• Bruising behind the ears (Battle's sign) or around both eyes (raccoon eyes). Marker of a base-of-skull fracture.
• A visible dent in the skull, or a soft boggy swelling on the scalp in a baby under 1.
• Won't wake up, or wakes only briefly and is hard to rouse afterwards.
• A limb at an obviously wrong angle, or sticking out at a new joint.
• A baby under 1 year fallen from anywhere over their own standing height — sofa, changing table, parent's arms, downstairs flight. The thresholds are lower for infants because the skull, neck, and abdominal solid organs all bear injury more easily.
• Bleeding from a cut you can't stop with 10 minutes of firm pressure.
• Pale, sweaty, drowsy, weak — with a tense or rigid abdomen. Concern for internal bleeding.
• A swallowed tooth, or anything inhaled that the child is now coughing/wheezing on.
• Any fall onto the head from a window, ladder, balcony, tree, climbing frame, or down a full flight of stairs — even if the child seems fine afterwards. Get them looked at.

If anything on this list is happening, don't wait, don't drive yourself if it's serious, don't give food or drink (in case of operating room).

Same-day call to GP / NHS 111 / urgent treatment centre

Less acute but worth a professional eye within the day:

• A baby under 1 fell from anything, even if they seem completely fine — at minimum a phone call to NHS 111 or your GP. Many will see them; some will give specific symptom-watch instructions.
• One vomit shortly after a head bump in an otherwise alert child. (Two or more = A&E now, see above.)
• A child who's gone unusually drowsy but is rousable and behaving normally once roused.
• Persistent pain after an hour, won't bear weight on a leg, won't reach with an arm. Toddler fractures are easy to miss — particularly the spiral tibia fracture from a twist-and-fall.
• A cut that gapes open, is over a joint or near the eye, is more than ~5 mm deep, won't stop bleeding, or has dirt embedded in it. May need glue, stitches, or a thorough wash.
• A tooth that's loose, knocked out, or driven up into the gum. For permanent (adult) teeth knocked out: rinse gently in saline or milk, replant if possible, otherwise transport in milk and seek dental care within an hour. Don't replant baby teeth.
• A black eye after a direct hit, or any change in vision.
• A fingernail bed turning blue/black with throbbing pain (subungual haematoma; sometimes drained).
• A bump that's growing rather than settling over the first few hours.
• Mechanism that doesn't match the injury — the child fell onto carpet from sitting and now has a major bruise; or the bruise is in a place children don't usually bruise (back of ears, soft cheeks, neck, buttocks). Worth a clinician's eye both for medical safety and because we owe children that diligence.

Safe to watch at home

For a child over 1 year, behaving normally, with one of these:

• A bump on the head from sofa height with normal alertness afterwards
• A grazed knee or elbow
• A bruise that's stopped growing
• A small cut that closes without bleeding once you've cleaned it
• A bumped lip that bled briefly and stopped

Watch them for 24–48 hours. The standard checklist:

• Are they alert and behaving like themselves? Playing, eating, recognising you.
• Are they drinking and weeing as usual?
• Are they easily roused from naps?
• Any new vomiting, severe headache, drowsiness, unsteady walking, double vision, slurred speech, weakness, or odd behaviour?

Sleep is fine after a head bump — that's an old myth. Children get sleepy after stress and adrenaline; the modern advice is to let them sleep, but check them every couple of hours for the first night and ensure they rouse easily and look normal when they do. If they don't rouse, or look wrong when they do, that's an A&E trip.

For pain: paracetamol or ibuprofen at the right dose for their weight is fine. Skip ibuprofen if they've already vomited or have a likely abdominal injury.

Specific situations worth knowing

Falls from a changing table or bed. The most common A&E injury in babies under 1. The fall doesn't happen during the change; it happens during the reach for a wipe. Even if they seem fine, an under-1 from changing-table height is a low-threshold "phone NHS 111 or GP" fall.

Falls down stairs. Down a full flight is an automatic A&E visit, regardless of how the child seems afterwards. Down two or three steps onto carpet, with normal behaviour after, is usually watch-at-home.

Falls in a baby walker. Baby walkers down stairs cause the most serious injuries in this category — they reach speeds that prevent the parent intervening. RoSPA and the AAP both advise against baby walkers entirely. If a fall in a walker happens, A&E.

Falls onto teeth. Permanent teeth knocked out: see above (replant if possible, milk if not, urgent dental care). Baby teeth knocked out: don't replant — risk to the developing permanent tooth — but get a dental check.

A toddler who fell and now won't walk. Even in the absence of obvious deformity, persistent refusal to weight-bear is suspicious for a fracture. The "toddler's fracture" — a hairline spiral fracture of the tibia — is easy to miss without X-ray.

Anyone on anticoagulants (blood thinners), or with a bleeding disorder, or after recent neurosurgery. Lower threshold for A&E after head injury.

Useful information to bring with you

If you do head to A&E or the GP, the things that help:

• Time of the fall.
• Mechanism: what they fell from, how far, what they hit, how they landed.
• Did they cry immediately, or was there a delay? A delay is more concerning.
• Any loss of consciousness?
• Anything since: vomiting (how many times, when), drowsiness, unusual behaviour, headache.
• What pain relief they've had and when.
• Their immunisation status if there's a wound.

A photo of the area on your phone is useful, especially if you're worried about a wound or bruise that might change between now and being seen.

When to phone NHS 111 or your GP rather than go straight in

Phone advice is genuinely helpful when:

• You're not sure if a wound needs glue or stitches
• You're watching them and a single mild symptom is bothering you
• It's an under-1 with a low-energy fall (e.g. rolled off the bed) and they look fine
• You want to know whether to use ice or paracetamol or do something specific

Use 999 / 911 / direct A&E for anything on the red-flag list. NHS 111 is good for "I'm not sure, can you help me decide" — they will direct you to the right place.

Most childhood falls don't need a doctor. Call 999 / go straight to A&E for: any loss of consciousness, more than one vomit after a head injury, fluid leaking from ear or nose, suspected fracture (won't use the limb, obvious deformity), seizure, or under-1 fall from over their own height. Same-day evaluation: a fall under 1 year from anywhere, single vomit, persistent drowsiness, cuts that gape or are over a joint. Otherwise: ice, paracetamol, watch for 24–48 hours.