Fatal falls in childhood. How far must children fall to sustain fatal head injury? Report of cases and review of the literature.

The question of whether fatal head injuries may occur from short-distance falls is one that continues to cause controversy. The records of the Sacramento County Coroner's Office from 1983 to 1991 were reviewed for cases of fatal head injury in children aged < or = 5 years, where a history of a fall was initially given. During this 9-year period, three cases of witnessed falls from heights of > 10 ft (3 m) were found. At autopsy, all children had multiple complex calvarial skull fractures, basal fractures, or both; subdural and subarachnoid hemorrhage was found in all cases, and two showed severe cerebral contusion. None had retinal hemorrhage or axonal injury. These are compared with 19 fatalities initially alleged to have occurred from short falls of < or = 5-6 ft (1.5-1.8 m). As others have found, most of these "minor fall" fatalities occurred under circumstances where there were no unrelated witnesses to corroborate the initial history. Autopsy findings in these cases tended to be of unexpected severity for the initially proposed mechanism of injury, and a number of cases showed evidence of accelerative injury (retinal hemorrhage and/or diffuse axonal injury) where no such mechanism was accounted for by initial history. After sufficient investigation, most of these cases (74%) have ultimately been proven to represent inflicted trauma. A thorough literature review on the subject identifies two major viewpoints. One is that short falls have a significant potential for fatality. The other, more widely espoused view is that short falls rarely, if ever, cause serious injury or death.(ABSTRACT TRUNCATED AT 250 WORDS)