A 7-month-old infant who suffered a fall from a washing machine and sustained a frontal epidural hematoma is reported from the Division of Neurosurgery, Oregon Health Sciences University. The infant had been placed on an engaged washing machine strapped in his car seat and left unattended. Within 2 hours of the fall, the infant became more irritable, vomited, was listless, and had a generalized seizure. CT showed a fracture of the skull and a epidural hematoma. He was discharged on postoperative day 3, and his development at 13 month of age was normal. Awareness of the potential consequences of this apparently popular and physician-endorsed child-consoling practice is important for physicians who must distinguish accident from abuse. 
COMMENT. Placement of infants in car seats on vibrating elevated surfaces might have a desired soporific effect but the practice carries the risk of falls and serious head injury. More than two-thirds of brain injuries in infants are attributable to falls, and epidural hematomas occur in 3%. (Ped Neur Briefs Sept 1992). The rule that children falling from elevated household surfaces do not sustain serious injuries does not apply when an infant is buckled into a car seat. Righting reflexes are vitiated and the weight of the car seat adds to the impact.
Brain injury due to amniocentesis is reported in 4 children with hemiparesis and porencephalic cysts evaluated at Bowman Gray School of Medicine, Winston-Salem, NC.