Falls: The Humpty Dumpty Hypothesis

Image via Flickr user aturkus by Creative Common License

From the International Conference of Pediatric Psychological Trauma in Infants & Young Children in Los Angeles

Humpty Dumpty sat on a wall,

Humpty Dumpty had a great fall,

All the King’s horses and all the King’s men,

Couldn’t put Humpty together again.

Serious falls are among the most common injuries to children, representing 52% of injuries in infants and 43% of injuries in children aged 1-4, according to recent figures from the Centers for Disease Control and Prevention. Fortunately, most children who fall can be physically put together much better than hapless Humpty Dumpty, but new findings from Duke University suggest that their psychological sequelae may be harder to heal.

Dr. Helen Link Egger of the Center for Developmental Epidemiology in the Department of Psychiatry and Behavioral Sciences reported that preschool children (ages 2-5) who suffer any injury serious enough to require medical attention were 2.7 times more likely to meet criteria for separation anxiety disorder, based on findings of a longitudinal study of 666 children.

Those who suffered a fall were also 5.8 times more likely to meet criteria for depression.

“Now that’s a big odds ratio,” she said, explaining that the data translated into nearly 1 in 5 children who had fallen.

In well over half — 58%, the fall occurred prior to any depressive symptom.

The powerful link to depression was not seen in children who had endured other traumas, such as serious illnesses or injuries that required hospitalization. 

The chicken-and-egg question, which Dr. Egger said requires urgent research, is whether the falls themselves or the circumstances leading to the falls are most salient with regard to associations with depression.

“Are these children with depressed mothers? Children living in a household where no one is looking out for them?”

Even if it takes all of the King’s horses and all of the King’s men, it’s something we need to find out. 

—Betsy Bates
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1 Comment

Filed under Emergency Medicine, Family Medicine, IMNG, Pediatrics, Primary care, Psychiatry, Uncategorized

One response to “Falls: The Humpty Dumpty Hypothesis

  1. Dr. Melvin Fishbinder

    Fascinating and well-written!

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