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Childhood Falls With Occipital Impacts

Atkinson, Norrell, MD*†; van Rijn, Rick R., MD, PhD; Starling, Suzanne P., MD*

doi: 10.1097/PEC.0000000000001186
Original Articles

Objectives Falls are commonly reported in children who present with both accidental and inflicted brain injuries. Short falls rarely result in serious or life-threatening injuries. Our purpose is to describe a series of cases of short falls with occipital impact leading to subdural hemorrhage (SDH).

Methods We present a series of 8 witnessed accounts of young children diagnosed as having SDHs after striking the back of their heads during a short fall. Child-abuse physicians were surveyed to determine if they had evaluated a child younger than 24 months diagnosed as having SDH, with or without retinal hemorrhages, following a witnessed fall with occipital impact. Submitted cases were analyzed.

Results The median age of the children was 12.5 months. All fell backward from a standing or seated position onto a hard surface and immediately developed symptoms. There was an average of 4 witnesses per case. Physical examinations were normal; however, the majority of children had enlarged head circumferences. All were previously healthy. Six of 8 children had unilateral convexity SDH. All children had varying degrees of retinal hemorrhage but no retinoschisis. The majority of children had returned to their baseline within 24 hours of hospitalization.

Conclusions Although a larger study is needed to identify the full spectrum of injuries, we postulate that, if a history of a fall with an occipital impact is elicited during a trauma workup, accidental injury should be considered.

From the *Eastern Virginia Medical School/Children’s Hospital of The King’s Daughters, Norfolk, VA;

Children’s National Medical Center, Washington, DC; and

Emma Children’s Hospital-Academic Medical Center Amsterdam, the Netherlands.

Disclosure: The authors declare no conflict of interest.

Reprints: Norrell Atkinson, MD, Children’s National Medical Center, 111 Michigan Ave NW, Washington, DC 20010 (e-mail:

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