Injuries from falling out of bed in infants under 1 year of age: a systematic review

Clinical Snapshot

Key Findings

• Effect Size: Serious injuries in approximately 5% of cases

• Primary Outcome: Frequency and severity of injuries from bed falls in infants under 1 year

• Nnt Or Sensitivity: Range of serious injury rates: <1% to 10.2% across studies

• Confidence Interval: Not reported

Clinical Application

Limited by small evidence base and heterogeneous findings across studies Relevant to Australian paediatric emergency departments and general practice, aligns with RACGP child safety guidelines, though local injury patterns may differ from international studies Infants under 1 year presenting after bed falls in emergency departments and paediatric clinics

Abstract

CONTEXT: Falls from beds are a leading cause of unintentional injuries in infants under 1 year of age. While most cases result in mild outcomes, the potential for severe injuries, such as skull fractures or intracranial haemorrhages, exists. Despite the prevalence of these incidents, no systematic review has focused specifically on injuries from bed falls in this specific age. OBJECTIVE: To evaluate the risk and severity of injuries caused by falls from beds in infants under 1 year of age through a systematic review. DATA SOURCES: We searched in PubMed, Embase, Cochrane Library and Lilacs Scielo for studies published between 1984 and December 2024. STUDY SELECTION: We included observational studies that reported injuries from falls from beds in infants under 1 year. DATA EXTRACTION: We extracted the relevant data from the included study details, recruitment setting, study design, sample size and outcome measures. We conducted a quality assessment using the Newcastle-Ottawa Scale. RESULTS: Out of 297 initially identified studies, three met inclusion criteria, comprising a total of 2034 infants under 1 year of age. Most falls resulted in minor or no injuries. Warrington et al reported <1% of cases leading to concussion or fractures. Samuel et al identified two cases of intracranial haemorrhage and linear skull fractures without intervention. Kolulu et al observed significant injuries, including skull fractures and cerebral contusions, in 10.2% of infants. CONCLUSIONS: Falls from beds are frequent in infants under 1 year, with most resulting in minor outcomes. However, serious injuries occur in around 5% of infants below 1-year old, emphasising the need for prevention strategies and clinical guidelines for managing post-fall assessments. Further research is required to refine understanding and improve prevention and management practices. PROSPERO REGISTRATION NUMBER: CRD42024626255.

References

1. 1.Campos, O., Barros, C. L., Evangelista, de Farias, Carneiro, G., Alves, L. V., & Alves, J. G. (2026). Injuries from falling out of bed in infants under 1 year of age: a systematic review. Injury Prevention. https://doi.org/10.1136/ip-2025-045660