December 13, 2024

12-month old and his mother have fallen down the stairs

By Med-Challenger · 2 minute read

A 12-month-old boy presents to you after his mother reported that both her and her child had fallen down the stair well. You note swelling and bruising around the left arm. The child does not appear to be using the left arm. The child is in notable pain when you try to move his left arm. You note no other areas of wounds. X-ray of the extremity shows a humeral fracture. No other signs of new or old fractures are appreciated.

What would you recommend for preventing such an injury?

The caregiver should carry the child while keeping one hand always on a railing.
The caretaker should let the child go down the stairs on her own.
Nothing; there was no intervention that could have prevented this from occurring.
Engage child protection services with concern for child abuse.

The correct answer is:

The caregiver should carry the child while keeping one hand always on a railing.

Educational Objective:

Identify the injuries associated with stairway falls and stairway injury prevention.

Explanation:

Caretakers should minimize stair use while carrying children by placing the child in a safe place instead of bringing the child with them if possible. Child caretakers can also reduce injuries by keeping the stairs well-maintained and free of objects that could result in tripping. Other items should not be carried in addition to the child, because this may make caretakers more likely to lose their balance; the spare hand should be on the handrail in case they do slip or trip. Caretakers should also avoid stair use when transporting a child using a stroller or other similar device. Caretakers should not attempt to wheel the child on the stairs and should instead use an elevator, if available, or carry the child while keeping their other hand on the railing.

More consideration should also be given to making stairs safer and more user-friendly, such as increasing the length of stair "goings," which are the horizontal depths of stair treads between vertical lines drawn from stair "nosings" (lead edges), in building codes. Missteps due to overstepping are a common cause of stair-related fall injuries. Lack of uniformity in short stair tread dimensions are important contributing factors to these events, especially in homes. Stair nosings should all line up as one sights down a flight of stairs. Misalignment of the top-flight nosing is a common and dangerous defect found in many homes and elsewhere. In addition, handrails should allow a power grip, rather than a pinch grip, for enhanced stability.

References:

Zielinski AE, Rochette LM, Smith GA. Stair-related injuries to young children treated in US emergency departments, 1999-2008. Pediatrics. 2012;129(4):721-727.

This question appears in Med-Challenger Pediatric Nurse Practitioner Exam Review with CNE/CE

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