A recent study involving more than 1000 children from KKH & NUH. The study examined head injuries in children and found that seven in 10 head injuries had been sustained in a fall.
All children take a tumble every
now and then. While most knocks
can be brushed off, some could end
up with serious consequences.
Every year, about 4,700 to 5,500
children show up with head injuries
at the emergency department of
KK Women’s and Children’s Hospital.
A recent study involving more
than 1,000 of these children from
two local hospitals found that
seven in 10 head injuries had been
sustained in a fall.
The study, reported in The Straits
Times earlier this month, was
conducted by doctors from the
KKH and the National University
They examined head injuries in
1,049 children between 2011 and
The children were all under 16
and needed a computerised tomography
(CT) scan or admission to
hospital for further monitoring.
Even though falls tend to result in
less severe injuries – compared to
traffic accidents, for instance –
doctors said that parents should
still take them seriously.
In fact, “the likelihood of a severe
outcome increased by 1.4 times
with every metre increase in the
height of the fall”, said Dr Chong
Shu-Ling, a staff physician at KKH’s
emergency medicine department.
She added that adults should pay
particular attention to children
under the age of two, as these are
the crucial years of rapid brain
Half the falls – or around 400
cases – happened at home, with the
majority tumbling off a sofa or an
The relatively large size of children’s
heads, in comparison to
their bodies, predisposes them to
head injuries in the event of a fall,
Besides falls, the other head
injuries were attributed to traffic
accidents, sports, interpersonal
violence and non-accidental
trauma, or grouped under a general
category called “others”.
The worst injuries came from
vehicle accidents and were often
preventable, for instance, by not
putting young children in the front
passenger seat or making sure they
used child seats in cars and wore
helmets when on bicycles.
Only 11.7 per cent of the head
injuries in the study were found to
be caused by vehicle accidents. But
these had the worst outcomes,
including long-term disability or
“The study found that road traffic
collisions were associated with
severe paediatric head injuries,
where the child required neurosurgery
or airway intervention, or
died,” said Dr Chong.
The study also included children
who subsequently died from their
injuries. It excluded those whose
injuries were relatively minor.
Dr Chong said the main impetus
of the study was to understand the
main causes of severe head injuries
among children, in order to help
Among the 123 children in the
study who were involved in a traffic
accident, over half of them were
The remainder were passengers
in or on vehicles – including cars,
bicycles and motorbikes. Dr Chong
said three-quarters of this group
were not using car restraints or
wearing helmets at the time of the
In addition, Dr Lim Yang Chern,
an associate consultant in NUH’s
children’s emergency department,
said nearly a fifth of the children
under 10 were found to have been
in the front passenger seat.
Children below 12 should ride in the rear, he pointed out.
Paediatrician Low Kah Tzay, who
is with Mount Elizabeth Hospital,
said parents may put their child at
risk by overlooking dangerous situations.
For example, they may hold their
baby in their arms during a car ride.
“When there is an accident or when
the emergency brakes are suddenly
applied in the vehicle, the baby
would be thrown out of the caregiver’s
Some parents forget to ensure
that their child wears a helmet
when riding a bicycle with training
wheels, while others fail to fasten
the restraints in a pram.
What makes the difference in the
severity of an injury is the force of
impact, said Dr Lim. In falls, this
force is relatively minor.
“However, many road traffic
accidents often occur at a high
velocity and result in more severe
KEEPING KIDS SAFE
How can adults prevent children
from getting head injuries?
Dr Chong Shu-Ling, a staff physician
at KK Women’s and Children’s
Hospital’s emergency medicine
department, gives some tips.
BABIES AND TODDLERS
- Do not leave them unattended
for any amount of time on
an adult bed or a baby cot
with no proper barrier to
prevent them from falling.
- Do not use a sarong cradle.
Many head injuries – and even
deaths – occurred when
infants fell out of the sarong
or when the cradle broke.
- Do not use a baby walker.
Falls from walkers are not
uncommon and have been
documented both in
Singapore and overseas.
- If your child is seated in
a high chair, make sure that
it is sturdy. Always fasten
the seat belt.
- Use a car seat that is
appropriate for his age.
Make sure they are closely
supervised in playgrounds.
Do not let them play in unsafe
playgrounds, for example,
those that are poorly
maintained and with
equipment that are rusty or of
an unsafe design.
- Make sure they use properly fitted
helmets when taking
part in activities such as
cycling and rollerblading,
or when using a kick scooter.
- Make sure they use proper
restraints, such as seat belts
or booster seats, in a vehicle.
- Do not allow them to go on the
roads unsupervised. Teach
them road-safety habits.