When a bang on the head needs 999 or A&E
Any one of these, on its own, is enough:
- A fall from higher than a metre — roughly, taller than the child — or down more than five stairs
- A bruise, swelling or cut on the head bigger than about five centimetres
- Vomiting three times or more, with at least ten minutes between each
- Any loss of consciousness, however brief; drowsiness, or being difficult to wake
- A fit or convulsion
- Odd behaviour, confusion, or not seeming to know where they are
- Difficulty speaking or understanding speech
- Weakness in an arm or a leg, or loss of balance
- New problems with eyesight
- Clear fluid from the nose or an ear
- Bruising around the eyes or behind the ears
- No memory of what happened before or after
- A headache that will not go or is getting worse despite paracetamol, within forty-eight hours
- In a baby: not waking for feeds, or crying constantly and impossible to settle
Babies under a year are treated more cautiously throughout. A baby who starts vomiting, behaves oddly, or has fallen from any height taller than they are needs assessing — 111 at the minimum, and the red list above still applies on top of that.
Vomiting once or twice, a mild headache, poor concentration, poor appetite or disturbed sleep is the middle ground: a call to 111 or a GP the same day rather than A&E, with the red list kept in mind in case anything changes.
If it is none of those
A child who is alert, interacting normally and back to themselves soon after the crying stops can be looked after at home.
- A cold pack — or frozen peas in a tea towel — on the swelling for short spells over the first few days.
- Paracetamol or ibuprofen for pain.
- Clear fluids, small amounts of food.
- Quiet play, and no screens or loud noise for a couple of days.
- An adult in the house for at least the first twenty-four hours.
Mild headache, nausea, low appetite, poor concentration and tiredness for the first day or two are expected rather than alarming. Most children need a day or two of rest; rough play and contact sports wait three weeks, and sport proper waits until at least two weeks after the last symptom has gone.
And the piece of old advice to discard: a child is not kept awake. Sleep is allowed and normal, and the instruction to keep them conscious belongs to a previous era. What replaces it is checking on them a couple of times in the night — breathing normally, lying in a normal position, responding properly when gently roused — and waking them fully if there is any doubt.
Stairs
The stairs account for a large share of the serious falls, and most of them happen in the window between a baby becoming mobile and the gate being fitted.
- Gates at the top and the bottom, fitted before the baby can crawl rather than after the first incident. For a child under two the recommendation is wall-mounted gates rather than pressure-fitted ones, and to the current standard, EN 1930. Pressure gates can be dislodged and leave a bar to trip on.
- Fittings checked periodically, because they work loose.
- Stairs kept clear — the pile of things waiting to go up is the commonest adult fall in a house with children, usually while carrying one of them.
- One hand on the handrail when carrying a child, which means not carrying anything else.
- Carpet, handrail and banister in good repair, and banisters without horizontal footholds, because a climbable banister is a ladder.
- Decent lighting, and a landing light reachable from the bottom.
Windows
Falls from windows are rare and catastrophic, and they follow the same pattern almost every time: something climbable under the window, and an opening a child can get through.
- Nothing climbable under a window. A bed, a chest of drawers, a toy box, a sofa pushed to the wall. This is the single most effective thing on the list and costs nothing.
- Restrictors on upstairs windows. The measure used by building control is an opening too small for a 100mm sphere to pass through, which is a useful mental picture — a gap narrower than a tennis ball. Releasable restrictors are what people actually fit at home, and they work only if they are used, since the whole point of being releasable is that they can be overridden.
- Window keys kept somewhere an adult can find them in the dark, because a locked window is also a blocked escape route in a fire. Out of a child's reach, but not out of the house.
- Children discouraged from sitting on sills, and in rented housing a restrictor is a reasonable thing to ask a landlord for.
Blind cords
This is a different mechanism in the same place, and it kills more children than falls from the window do — around two a year in the UK.
A looped cord catches round the neck of a child who has climbed on furniture or a sill. A toddler's head is proportionally heavy, their muscle control is not developed enough to get themselves out of it, and their windpipe is narrow and soft. A child can lose consciousness in about fifteen seconds and die within two or three minutes. It happens silently, in bedrooms and sitting rooms, with adults in the house.
- The cord gets tied up every single time, on a cleat high on the wall — not looped over the bracket, which is where it slips off.
- Any blind without a safety device gets one fitted.
- Roman blinds need checking for a device at the back designed to break under load.
- Cots, beds, highchairs and playpens moved away from cords, and ideally other furniture too, since climbing is the first step in all of these.
- For a child's bedroom, blinds with no cord or chain at all remove the hazard rather than managing it.
Furniture and televisions
A chest of drawers with the drawers open is a set of steps attached to a top-heavy object, and a flat-screen television on a low unit is a heavy thing with a small base. Both go over.
- Anchor straps or brackets on anything tall or top-heavy — chests of drawers, bookcases, shelving units, wardrobes. Most flat-pack furniture is supplied with them and most people leave them in the bag.
- Televisions wall-mounted, or strapped to the unit they stand on. Low units at toddler height are the worst arrangement.
- Heavy items in the lowest drawers, and nothing tempting on top — a remote control or a toy on top of a chest of drawers is an invitation to climb.
- Drawer catches, which stop the staircase forming in the first place.
Babies on raised surfaces
The classic fall of the first year, and it happens at the moment a baby first rolls, which is always sooner than expected.
- Nappies changed on the floor wherever possible. A changing mat on the carpet removes the whole category.
- Where a raised surface is used, a hand stays on the baby and nothing is fetched from across the room.
- Car seats and bouncy chairs go on the floor, never on a worktop, a table or a bed. A baby's kick travels a bouncy chair surprisingly far, and a car seat on a kitchen worktop is a familiar and genuinely dangerous habit.
- Nothing is left on a sofa or a bed, even briefly, even asleep.
Highchairs, walkers and bouncers
- A highchair harness is used, ideally five-point, every time. Standing up in a highchair is a fall from adult height onto a hard floor. The chair goes where the child cannot push off against a table or a wall, which is how they tip.
- Baby walkers are not recommended by RoSPA or by most health professionals — they cause falls, particularly down stairs, and give a child reach and speed they have no control over, with no evidence of any benefit to walking. Where one is used anyway, it should meet the current standard, BS EN 1273, be used for short spells only, and never be treated as a way of leaving the room.
- Door bouncers carry the same reservations.
Beds, cots and outside
- Bunk beds are not for children under six, and the top bunk is the part of that advice that matters.
- Cot mattress base lowered as soon as a baby can pull to standing, and nothing left in the cot that can be used as a step.
- Bed guards on a first proper bed, and a clear floor beside it.
- Trailing cables, rugs with curled edges and spills dealt with promptly, which sounds trivial and accounts for a lot of minor injuries.
- Outdoors, the surface under equipment matters more than the equipment — that is covered under choosing outdoor play equipment, along with trampolines and climbing frames.
- Garden safety more broadly, including gates and steps, is under garden safety for children.
The pattern worth knowing
The hazard moves with the child, and it moves faster than the childproofing does. A baby falls from the thing they were put on. A crawler falls down the stairs. A toddler falls off the thing they climbed, and climbs higher than seems plausible. A four-year-old falls outdoors.
Which is why the single most useful habit is to re-walk the house at each new skill — rolling, crawling, pulling up, climbing — rather than once at the start. Most of the serious falls happen in the gap between a child acquiring an ability and anyone noticing they have it.
Room-by-room detail on the rest of it is under childproofing the home.