The Scenario: Your buddy just became a dad, and you and the gang are meeting his little bundle of joy for the first time. You never were a sucker for babies, so you're underwhelmed heading into the meet-and-greet. But you may have developed a baby bias—after all, you're practically an uncle now!—because the second you lay your eyes on that big-headed newborn you can't wait to get your hands on him. "Don't drop him!" your idiot friend jokes the second you have the baby in your arms. You freeze. Your worst nightmare flashes before your eyes. He laughs it off, but you hang on for dear life. Are you right to be terrified of dropping this baby?
The Facts: In case you haven't noticed, babies have huge heads. Their big noggin is both the most important and the most vulnerable part of their body. "The brain is developing very quickly in the first year of life, it's incredibly metabolically active, and it's also relatively unprotected," says Christopher Moir, a pediatric trauma surgeon at the Mayo Clinic. An adult's skull is one solid structure, but at birth it's made of 22 separate bones that fuse together over the first two years of life. That flexible skull lets the baby squeeze through the birth canal—that's why some newborns' heads look misshapen right after birth—and gives the brain room to grow.
"Falls are the absolute number one cause of serious injury in children under age 1, and the head is by far the most common system injured," Moir says. When babies injure their heads from a fall, they most often fracture their skull or damage their soft tissue, according to a study from the University of Pennsylvania. Head injuries decrease with age, partially because the skull strengthens and because the baby's head becomes proportionately smaller compared to the rest of its body. From a physics perspective, that means the baby is less prone to plunge heavy-head-first.
Your hip—assuming that's where you're holding the baby—isn't a super dangerous distance from the ground. "There are very few serious injuries from that height," says Robert Sege, a general and child abuse pediatrician and a spokesperson for the American Academy of Pediatrics. English researchers looked at fall types, age, and injuries, and found that for infants, falling from a caregiver's arms had the highest rate of skull fractures—9 percent. Still, 84 percent of the babies had normal CT scans following the fractures, which normally heal on their own, Sege says.
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It's also important to remember that your body isn't the only thing that lifts a baby off the ground: A study published this year in Pediatrics found that nursery products—like changing tables, high chairs, and cribs—cause more than 66,000 injuries to children under the age of 3 every year in the United States.
The Worst That Can Happen: The baby could develop a brain bleed, but that could only really happen if the baby dropped head-first directly from your arms onto a hard floor with absolutely no break in the fall. That sort of unprotected drop is quite rare, Moir says, because most adults try to grasp for the baby or slow down the fall with their arm or leg before it reaches the ground.
If you're scared of sending the baby tumbling, stay away from stairs: The momentum and multiple impacts mean there's a greater chance of skull fracture and intracranial injury compared to being dropped on the floor, the English researchers found. In general, head injuries leading to permanent disability or death are so uncommon from short, accidental falls that when a baby comes into the emergency room with serious injuries to the brain, "we worry about non-accidental trauma: child abuse," Moir says.
What'll Probably Happen: The baby will probably bruise on whatever body part hit the ground, especially if it was a hard surface like tile or hardwood. If the baby got a blow to the head, it could get a skull fracture—but linear fractures, the most common, heal on their own and have no long-term effects. "You have to have a lot of force to not just injure the skin and get a bruise, but to break the skull, and then even more force to do anything inside the skull," Sege says. "A normal skull will protect a baby almost always from falling from a short height." The baby may break a bone, which would be apparent if it starts crawling differently or stops using one of its limbs.
What You Should Do: At the very least, call the pediatrician right away. The moments after the impact can be very telling: Does the baby cry? Are you able to comfort it? Does it continue to interact, eat, and move as usual? Then chances are the baby is fine, but your pediatrician will ask you specific questions and give you advice about what your next steps should be, Sege says.
If the baby loses consciousness, starts vomiting, refuses to eat, or doesn't cry or open its eyes after the fall, bring the baby directly to the emergency room, Sege says—those responses could signal a more serious injury, like a brain bleed.
In the end, you might suffer more than the baby does. "The overall outcome is generally that the parents are damaged for life from worry, and the babies are fine," Sege says. But this is a living human we're talking about, so if you're in doubt at all about the baby's well-being, it's always better to go to the emergency room than to hope everything is okay.
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