Coping/child Care

January 01, 1991|By T. Berry Brazelton, M.D. | T. Berry Brazelton, M.D.,SPECIAL FEATURES/SYNDICATION SALES

Infants and toddlers are always falling. They can roll off changing tables or beds. Toddlers learning to walk lose their balance and fall backward, hitting their heads.

They are constantly exploring new situations and they get themselves in trouble.

No parent can expect to get through the early years without experiencing a few accidents. But there are measures parents can take to prevent these falls from causing serious injury.

Parents should make sure there is a rug under the changing table and under each large piece of furniture from which the baby could fall. A cement or slippery hardwood floor adds to the danger of a child hurting himself.

There should also be a carpet on the stairs and a gate at either end. Cushioning under a child's crib is necessary. He'll always climb out when you least expect it.

A baby turns over on a table with a sudden reflex. If no one is there he may fall off.

Parents should get in the habit of keeping a hand on the baby whenever they turn to do something. Not only is it safer, but it is comforting to both adult and baby.

I have known a 4-week-old infant to flip off a flat table to the floor, fracturing her skull, while her mother's back was turned. Had her mother kept a hand on her this need not have happened.

Fortunately, most falls do not result in serious injury to the child. The skull of a baby or a year-old toddler who is learning to navigate and balance is cushioned for falls. Nature must have expected these accidents.

The anterior fontanel (or soft spot) does not close until l8 months of age in most children. This soft spot allows the skull to "give" with each whack, acting as a cushion for the brain inside. That is why each fall a small child sustains does not result in a concussion as it might with an adult.

This is not to say that a child is fully protected from injury. Children can -- and do -- suffer concussions and other injuries. A fall that results in unconsciousness or a dazed, inconsolable child must be taken seriously. Medical advice should be sought as soon as possible.

There are symptoms parents should watch for to rule out a concussion. Periods of unresponsiveness, pupils that do not shrink down in response to a light, and/or repeated vomiting are signs of a potential concussion.

If a baby is unconscious or develops any of these symptoms after a fall, report this to the doctor right away. He or she will want to examine the child.

Most bangs on the head occur so often and are such a part of these early years that they can usually be taken with a grain of salt.

It is difficult for parents to do this. In fact, parents always feel guilty when a child falls. They feel they should have been more careful, should have somehow been able to prevent the fall.

No one can prevent a toddler from toddling, but you can make the environment safe for toddling and falling. Be prepared by "childproofing" your home and reading a sound guide to accident prevention such as that found in The New Child Health Encyclopedia by Boston Children's Hospital.

For instance, one can firmly restrain a baby when she is too active on a changing table. Toddlers can be taught how to climb and to descend stairs. When a young child gets the feeling of how to lower a leg to feel the step below her, she will take descent on as a project. She will easily learn how to ascend the stairs, but she can fall down just as easily. Be there to watch her as she learns.

When a new baby experiences a sudden change in position that causes him to drop his head backward, he becomes startled, throws out his arms and legs, extends his neck, cries briefly, then rapidly brings his arms together and flexes his body as if to clasp the branch of a tree or his mother as he falls.

This reflex may reinforce a baby's inclination to fall straight back with his head and body extended.

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