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Accidents happen, even to the most careful parents.

If you drop your baby by accident, or they fall for some other reason, first take a deep breath and try to give yourself some grace. The Centers for Disease Control and Prevention (CDC) notes that falls are the leading cause of accidents among children.

But although it’s common, it’s still scary. Here’s what you should do if your baby takes a spill, what warning signs warrant calling 911, and what you can expect if you end up in the emergency room.

If your baby has significant external injuries, is unconscious, or seems confused or disoriented, call 911 or your local emergency services.

The worry here is that your baby may have a skull fracture or internal injury, like bleeding on the brain (intracranial hemorrhage). Without immediate treatment, bleeding can worsen and put pressure on the brain, causing a traumatic brain injury (TBI).

Other warning signs include things like:

  • vomiting
  • irritability
  • imbalance
  • headache (you may only notice inconsolable crying)
  • firm or bulging soft spot
  • any other changes that just seems off from your baby’s normal personality

In general, it’s a good idea to head to the emergency room if your baby has more than just a small bump or if your child fell from a height over 3 feet. Otherwise, you should see a doctor within a day or two if you notice any new or ongoing symptoms.

Related: Signs of concussion in children: When to call the doctor

Take a look at your baby. You’ll probably notice that their head is large in proportion to their body. Not only that, but you may also notice their head isn’t totally smooth and has hard and softer spots.

The skull isn’t a single bone. Instead, it’s made up of various bones and sutures (acting as expansion joints) that allow it to grow and expand as your baby’s brain and body grows.

Your baby also has two soft areas on the skull called fontanelles. These areas are protected by a soft membrane that goes over the tissue of the brain underneath.

The anterior fontanelle is also called your baby’s soft spot. It remains soft until your baby reaches between 18 months and 2 years old.

The posterior fontanelle is located near the occipital bone — which is located at the base of the skull above the back of the neck — and generally closes sometime in the first few months of your baby’s life.

You may drop your baby from your arms while carrying them up or down the stairs. Or they could fall off another surface, like a bed or changing table.

Even if you’re very careful, sometimes these things happen. And however it happens, the most common scenario is that your child will hit their head.

It goes back to your baby’s center of gravity and how the head is large in comparison to the body. Add to that your baby’s lack of head control, and it’s easy to see why goose eggs happen more often than not.

If the fall wasn’t terribly far or high, your child may recover quickly with a kiss and hug. If the fall was from a height over 3 feet, your child may still be OK — but it’s worth getting checked out by your pediatrician.

Possible serious injuries

There are a few possible injuries your child may sustain that are more than skin deep:

  • Concussion. This is an internal injury where the brain doesn’t work as it usually would for a period of time. Your child may not seem themselves for a few minutes or hours. Concussions range from mild to severe. It’s a good idea to have your child seen by a doctor if you suspect a concussion. Signs include things like loss of awareness, headache, balance issues, vomiting, and irritability.
  • Contusion. You may be familiar with contusions, like bumps and bruises, that form on the outside of your child’s skull. Another possibility is an internal contusion, which causes bleeding and swelling in and around the brain. Contusions may form right where your child fell onto their head (coup injury) or on the opposite side, caused by the brain striking the opposite side of the skull on impact (contrecoup injury).
  • Skull fracture. This is a break in the bones of the skull. Imaging can determine if your child has a fracture and what type it is. There are four types:
    • linear fracture (break in bone that doesn’t move the bone)
    • depressed fracture (skull is sunken where it’s broken)
    • diastatic fracture (break along suture lines)
    • basilar fracture (break at the base of the skull)

Before getting caught up in the blame game, try your best to stay calm. What’s most important at this point is that you assess and monitor your child’s condition and get the help you need as it makes sense.

Baby is easily consoled? Look at the site of impact — the bump. Even big bumps aren’t necessarily as serious as they seem.

Your baby’s bump is the result of blood collecting under the skin. It may continue swelling over the first day after the accident. And the bruise may change color from black and blue to more of a yellow green as it heals.

If your baby loses consciousness or shows other warning signs — imbalance, vomiting, confusion — don’t hesitate to get immediate medical attention. It’s also worth noting that you should be careful about moving your baby if you suspect they may also have injured their neck.

When you get to the hospital, your doctor will likely ask you about your baby’s accident. This isn’t to put somebody at fault — it’s to gather important information to determine the extent of the injuries.

Questions might include:

  • From what height did your baby fall?
  • What did your baby do right after falling?
  • Did your baby lose consciousness?
  • What symptoms has your baby had in the time since the accident?
  • What medications — if any — is your baby currently taking?

There are also a variety of tests your doctor may order to find out more:

  • X-rays may help initially identify any fractures to the skull or other bones of the body that were injured.
  • MRI is short for magnetic resonance imaging. This test is performed using — you guessed it — large magnets. With MRI, you can capture more specialized images of your baby’s organs and tissues.
  • CT scan uses both X-ray and computer technology to provide extremely detailed images of bones, muscles, fat, and organs.

You may feel pretty bad about the accident or responsible in some way, but keep in mind that this type of accident is common and can happen to anyone. Doctors see these injuries a lot, and they’re doing their job to help your baby, not to judge you.

The good news is that in most cases, the answer to this question is no.

Serious injury from falling/dropping — even falls onto the head — is rare. Still, the possibility is there, and you should certainly pay attention to symptoms as they immediately happen and progress over time.

Concussions (mild TBIs) in babies tend to heal within a couple of weeks. During this time, you should be lying low with your little one and letting them get plenty of rest.

It’s hard for babies to tell their caregivers when they feel back to normal, so be sure to pay close attention to fussiness or any other signs that your child isn’t feeling well. Over time, you should see them return to normal activity without triggering concussion symptoms.

In some cases, however, you may notice signs or symptoms that last weeks or months after the initial accident.

Symptoms that last this long are considered part of what’s called post-concussion syndrome. Speak with your child’s pediatrician for guidance. Post-concussion syndrome is more likely if your baby has experienced more than one concussion in their lifetime.

With more serious TBIs, your doctor is your best source for information regarding long-term prognosis. Each brain injury is different, and there’s really no one-size-fits all approach or timeline for healing.

Again, the CDC found in its 2008 Childhood Injury Report that falling is the leading cause of nonfatal injury among children. Approximately 2.8 million kids visit emergency rooms across the United States each year due to falls/drops. And falling is the primary cause of more than 50 percent of injuries in babies younger than a year old.

One older 2001 study examined accidental injuries in pre-mobile (before crawling/walking) babies. Of the 2,554 children included in the surveys, there were 3,357 falls reported by caregivers.

First off, this should assure you that falls are common — and that some babies may experience more than one major fall in their first year.

The most common situation — 53 percent of accidents — involved falling from a bed or couch. Another 12 percent involved falling from a caregiver’s arms. The rest were unspecified.

In 97 percent of these falls/drops, babies experienced injuries to the head. Around 14 percent resulted in visible injuries (so, ones you can see), and 56 percent of the injuries were bruises. Fewer than 1 percent of the falls resulted in a concussion or fracture to the baby’s skull.

Babyproofing can only get you so far when it comes to protecting your little one from the various dangers of childhood. As a parent, the best you can do is familiarize yourself with the warning signs of serious head injury in case you need to get immediate care.

When in doubt, call your pediatrician. Your child’s doctor can help you determine if emergency treatment is needed or an office follow-up in a few days is a better course of action.