Source: Lallier M, Bouchard S, St-Vil D, et al. Falls from heights among children: a retrospective review. J Pediatr Surg. 1999:34;1060–1063.Lallier et al report on 64 patients from 1 to 18 years of age (mean age 7.4 years) who fell 10 feet or more as identified by retrospective chart review of 1,410 patients admitted after falls to Sainte-Justine Hospital in Montreal, Canada, from 1994–1997. Fifty (78%) fell from a height of 20 feet or less and 14 from a height of greater than 20 feet. Seventy percent (45) of the patients were male. Thirty-six percent of the patients were less than 4 years of age and 70% were less than 10 years old. Falls were from balconies (23%), windows (20%), and trees (14%). Two patients had minimal or no injuries, 55 (86%) sustained only a single major injury, and 7 had multiple system injuries. Head injuries were most frequent, occurring in 25 patients (39%), followed by extremity fractures (34%), abdominal injuries (12%), maxillofacial (8%), and spine injuries (6%). Twenty-two (88%) of the patients with head injuries were less than 10 years old and 48% were less than 5 years old. Among those with head trauma, 10 patients sustained skull fractures, 8 had concussion, and 7 had intra-cranial injuries. In contrast, abdominal injuries were more common in older children with 75% of these injuries occurring in children over 5 years of age. Abdominal injuries included splenic trauma in 5, kidney injury in 3, pancreatic trauma in 2, diaphragmatic injury in 2, and retro-peritoneal hematoma in 1.Of the 25 children sustaining head trauma, epidural hematoma occurred in 1 (4%) and subarachnoid hemorrhage occurred in 3 (12%). Concussion was seen in 8 (32%) and brain contusion seen in 3 (12%). There were no subdural hematomas. The only death in this series occurred after a 5-story, 50-foot fall. The authors’ conclusion was that significant injuries were infrequent in falls from less than 20 feet and most fall injuries in young children involved the head or musculoskeletal systems.More data are presented in this report to support the conclusion that children rarely sustain intra-cranial bleeding from falls under 20 feet.1,2 The only death in the series occurred after a plunge from 5 stories. Subdural hematoma was not recorded in any of the fall victims, and subarachnoid hemorrhage in only 2. Significant injuries (as opposed to linear skull fractures or minor soft tissue injuries) are not likely to be produced by short falls, and serious life-threatening injuries (with the exception of epidural hematomas) are virtually never caused by short falls. Abuse should be suspected in infants and young children who have significant head injuries—those involving subdural or subarachnoid hemorrhages—because these rarely occur in short falls.This is another in a series of papers on falls in children.3,4 The message from all of them is remarkably similar: serious injuries, especially serious head injuries, occurring in children are unlikely to be due to short (less than 20-foot) falls. Child abuse is a much more likely possibility.