When to get help

Call emergency services now — 999 in the UK, 112 or 999 in Ireland and across the EU, 911 in the US and Canada, 000 in Australia, 111 in New Zealand — if after the fall your baby has any of these:

Was knocked out, even briefly, or is difficult to wake and keep awake.
A fit or seizure.
Vomited more than once or twice. NICE guideline NG232 treats three or more discrete episodes of vomiting as one of the risk factors that can trigger an urgent CT head scan in a person under 16.
A bulging or tense soft spot. NG232 lists a tense fontanelle as a reason to scan within one hour.
Clear or watery fluid, or blood, coming from the nose or an ear; bruising behind an ear or around both eyes.
A bruise, swelling or cut on the head larger than 5cm. NG232 names this specifically for babies under one year as a reason to scan within the hour.
Weakness down one side, unequal pupils, a squint that was not there before, or a change in the way your baby moves an arm or leg.
Bleeding you cannot stop, or a wound that is gaping open.

Seek urgent same-day advice — NHS 111 in the UK, your GP or out-of-hours service in Ireland, your paediatrician in the US or Canada, healthdirect on 1800 022 222 in Australia, Healthline on 0800 611 116 in New Zealand — if your baby is under one and has any head injury you are unsure about, if the crying has not settled after an hour, if your baby seems drowsy or unusually irritable, if they are refusing feeds, or if you simply cannot get a clear look at what happened. Babies are harder to assess than older children because the usual questions about headache, dizziness and memory cannot be asked, and clinicians know that.

The first two minutes

Pick your baby up and hold them. A baby who cries immediately, quite loudly, and then settles in your arms within a few minutes is showing you a reassuring pattern. Silence, floppiness or a delay before any reaction is not.

Do not shake or jostle your baby to get a response. If there is any suggestion that your baby is unresponsive or not breathing normally, call emergency services and start infant resuscitation with the phone on speaker so the handler can talk you through it.

If there is a bleeding cut, press a clean cloth on it firmly. Head wounds bleed dramatically for their size because the scalp has a rich blood supply, so a small cut can produce a frightening amount of blood without meaning the injury is deep.

Swelling and bruises

A soft, squashy swelling that comes up quickly over one part of the skull — the classic egg — is common after a knock and usually reflects bleeding under the scalp rather than inside the head. A cold compress wrapped in a cloth, held on for a few minutes at a time, helps the swelling and the pain. Do not put ice directly on a baby's skin.

Size is what changes the plan. NICE draws the line for babies under one at a bruise, swelling or laceration of more than 5cm on the head, and a lump that big is a reason for assessment rather than observation at home, however cheerful your baby seems.

What to watch for over the next 48 hours

Most falls from a bed or sofa produce nothing worse than a bruise and a bad half-hour for everyone. The reason to keep watching is that the small number of significant injuries can declare themselves hours later.

Over the next two days, look for: increasing drowsiness or difficulty waking at a time your baby is normally alert; repeated vomiting; a high-pitched or inconsolable cry; refusing feeds; a bulging soft spot; unusual irritability or a change in behaviour that you cannot explain; a seizure; weakness or reluctance to use one arm or leg; or a squint or unequal pupils. Any of those and you go back, or ring 999 if it is one of the emergency signs above.

You do not need to keep your baby awake all night. Normal sleep is fine, and a baby who has had a fright often sleeps afterwards. Check on them as you would anyway, and satisfy yourself that they rouse normally when you would expect them to.

Height, surface and how they landed

Parents fixate on the height, and it does matter, but it is not the only variable. A short fall on to a hard floor can do more than a longer one on to thick carpet. Landing on the head is more concerning than landing on the bottom or the back. A fall down stairs, or a fall while being carried, is treated more seriously because more energy is involved.

NICE describes a dangerous mechanism in an under-16 as a high-speed road traffic collision, a fall from a height of more than 3 metres, or a high-speed injury from a projectile or other object. Most bed and sofa falls are nowhere near that. What matters far more in a baby is the child in front of you: how they responded, how they are feeding, and how they are behaving.

Telling the story, including the guilt

Say exactly what happened, including that you had put your baby down for a second, or that you were changing a nappy on the bed. Staff hear this every single day and are not judging you. NICE does ask clinicians to consider whether an injury fits the explanation given, which is a safeguard for babies, not an accusation aimed at you; a straightforward, consistent account is what makes that question easy.

Preventing the next one

Babies roll earlier than parents expect, and the first roll is often the one nobody sees. Change nappies on the floor rather than on a bed, sofa or changing table once your baby can wriggle. Keep a hand on your baby at all times on any raised surface, including for the two seconds it takes to reach a wipe. Use the harness in a bouncer, high chair or pram, and never put a bouncer or car seat on a table or worktop.

Baby Fell Off the Bed