My 3-year-old fell about 4 feet off a pl
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My 3-year-old fell about 4 feet off a play structure onto her head approximately 1 hour ago. Since then:
- She has vomited twice (not just a little spit-up — full vomiting)
- She is unusually sleepy and harder to rouse than normal — she will open eyes when we call her name but goes right back to closing them
- No visible wound or bump on the back of her head yet, though her forehead has a small red mark
My partner is saying "kids bounce back, just let her sleep it off, it's normal to be tired after a fall." I am extremely worried and feel we need the E now.
Could you help me understand:
1. Which of her current symptoms (vomiting ×2, altered sleepiness, 4ft drop height) are recognized red flags requiring immediate emergency evaluation?
2. Why "sleep it off" is or is not safe advice in a head injury scenario with these specific signs?
3. What to monitor / document in the car on the way if we do go to E?
Answer
I have what I need from the cards. The picture is a clear C-level pediatric head injury (4-ft fall + repeated full vomiting + altered wakefulness in a 3-year-old) — the first sentence has to be the action. Let me write the draft, validate it, and ship it.
Lint returned PASS. Now I'll render a one-page hand-off sheet for triage in parallel, then ship the answer.
Go to the nearest pediatric emergency department now, or call your local emergency number for an ambulance — do this before reading further. If driving is faster than waiting for an ambulance, leave now with another adult in the back seat watching her, and tell me which country or city you are in so I can name the right door.
Three of her signs are the pediatric head-injury warning features the emergency card calls out, and each one is reason to go on its own — they do not need to add up:
- Vomiting twice after a head injury. epeated vomiting after a fall is a warning feature on its own, especially full vomiting rather than spit-up.
- She is harder to rouse than her normal — opens eyes to her name, then goes straight back to closing them. That is altered mental status, a warning feature on its own.
- A 4-foot fall onto the head on a play structure is a significant mechanism for a 3-year-old — roughly twice her own height, the threshold pediatric trauma guidance uses for higher-risk falls.
"Sleep it off" is not safe advice in this picture. The pediatric head-injury card explicitly says do not put a child to bed to "sleep it off" and do not treat "she didn't black out" as reassurance, because the brain swelling or bleeding that needs treatment can develop over the first hours after a knock that looked mild at first. The two red flags she is showing now are exactly the kind that can worsen before they improve, and being sleepier than her baseline while asleep is the one change you would otherwise miss. Your instinct is the right one — go.
What to write down on the way (the team will ask):
- Time of the fall, what she landed on (surface, head first or other), how far.
- Every vomit, with its time.
- Whether she lost consciousness at any point, and if so, for how long.
- Her normal awake / sleepy pattern so you can describe what is different now.
- Any medicine she takes, allergies, and any recent illness.
- Last food or drink and the time — important if she may need sedation or an operation.
In the car:
- Keep her neck still. A 4-foot fall onto the head can also injure the cervical spine, and twisting the neck freely to "check it is fine" can make that worse.
- If she vomits again, turn her gently onto her side as a unit — head and spine together — so she does not breathe it in.
- Keep her warm. Do not give food or drink.
- Watch her wakefulness every few minutes. Note any new drowsiness she cannot be roused from, a fit, weakness on one side, slurred speech, or a new severe headache — say it on arrival.
Turn around or call for changes on the way: a fit, vomiting that will not stop, she becomes very sleepy and is hard to wake, breathing changes, or one-sided weakness.
I made a one-page hand-off sheet with the time-of-fall, vomit log, allergies and last-food lines you can fill in on the way and hand to triage — open it, print it on the way if you can, and pass it over at registration. pediatric-head-injury-visit-sheet-2026-09-21-79d9b2f7.pdf
A clinician needs to examine her and decide on observation or imaging — that is the next step, not something I can replace from here. Tell me the country or city and I will name the right pediatric emergency door.