Puppy Fell Off the Couch and Hit Its Head: What to Watch

Puppy fell off the couch and hit its head? Check the ER signs below first, then watch closely for a couple of days; some injuries show up late.

Go to an emergency vet now if your puppy lost consciousness, had a seizure, has pupils of different sizes, has blood in the eyes, nose, mouth or ears, cannot stand or walk normally, is struggling to breathe, vomits, or seems dull, confused or hard to wake.

Puppy fell off the couch and hit its head: why a short fall still matters

A couch does not look very high to us. To a small puppy it is a real drop, and the landing is often a hard floor. VCA Animal Hospitals' first-aid guide to falls in dogs notes that "Small dogs can incur injuries from falling much smaller distances." The same guide adds: "Toy breeds have been known to break one or both legs when simply jumping down from the sofa."

A puppy that yelps and then goes straight back to playing may well be fine. Even so, VCA advises that you "observe him carefully for a couple of days", because "Some injuries are immediately obvious, while others are not apparent until hours or days after the fall."

Emergency signs: go to an ER now, not a video call

If any of these are true, go to an in-person emergency vet now. Do not wait to see whether it passes, and do not stop to book a video call first.

Your puppy lost consciousness, even briefly.
Your puppy had a seizure.
The pupils are different sizes.
There is blood in the eyes, nose, mouth or ears.
Your puppy cannot stand or walk normally.
Your puppy is struggling to breathe.
Any vomiting after the fall.
Your puppy seems dull, confused or hard to wake.

VCA's article on brain injury in dogs explains, "The dog may have seizures, some evidence of trauma on the head or other part of the body, bleeding into the eyes, or bleeding from the nose or ears." It also notes, "The pupils of the eyes may be uneven in size and may react abnormally to light."

VCA's falls guide is just as direct: "Blood in the eyes, nose, or mouth means possible head injury." And for breathing: "If your dog is struggling to breathe, immediately go to the nearest emergency hospital."

If you are unsure whether what you are seeing counts, our pet emergency checklist for dog and cat owners walks through it. A household tumble is different from a car accident or a fall from a balcony or a flight of stairs; for that kind of major trauma, see our guide to pet trauma emergencies in NYC and go in right away.

The first few minutes after a fall

Take a breath and keep your voice low.

Keep your puppy on the floor. Not back on the couch, the bed or your lap on a high chair. A dazed puppy can fall again.
No jumping, running or play. Keep it quiet in one room with you.
Keep the room calm but well lit. You will want good light to check its eyes.
Nothing by mouth. Do not give food, water, treats or anything else to a dazed puppy until a vet has checked it.

If your puppy cannot get up, do not try to stand it up or coax it to walk. VCA warns, "A dog that cannot get up at all could have a back injury and should be kept as still as possible." Its advice is to "Slide the dog onto a rigid object like a board (for large dogs) or baking sheet (for small dogs)." A puppy that cannot get up goes to an emergency vet now.

If you need to move a puppy that is standing on its own, pick it up with two hands. VCA's guidance: "For small breeds, support your dog behind the front legs and in front of the back legs."

A simple at-home check you can do now

If none of the emergency signs apply, sit on the floor with your puppy in good light and go through these questions slowly. You are looking, not examining. Do not press on or bend its neck or back.

Alertness. Is your puppy alert, watching you and responding to your voice as usual?
Eyes. Are both pupils the same size? If the pupils are different sizes, stop here and go to an emergency vet now.
Blood. Look at the eyes, nose, mouth and ears. Any blood means go to an emergency vet now.
Walking. If your puppy gets up by itself, watch it walk across the floor. Is it walking straight, or is it circling, stumbling or holding its head tilted? If it cannot stand, do not make it walk; go to an emergency vet.
Pain. Notice whether your puppy cries when touched or picked up, or limps.

VCA's falls guide lists signs that a dog may have been hurt in a fall, including:

"Reluctance to stand or walk"
"Pain when lying down or rising"
"Stiff gait"
"Limping"
"Difficulty breathing"
"Whining"
"Lethargy"
"Decreased appetite or difficulty eating"

While things are calm, record a short video on your phone of your puppy walking toward you and turning around. Add a close, well-lit shot of its face and eyes. That footage helps any vet later.

You cannot tell at home whether a puppy has a head injury, and you do not need to. Any change from normal is a reason to call a vet or go in; a vet decides whether it is a head injury.

Watching your puppy over the next couple of days

A puppy that looks fine right after a fall still needs watching. VCA explains why: "Sometimes, dogs appear normal after a fall and will walk around and play, but later they become lethargic and weak or develop difficulty breathing." Its brain injury article adds that "The overall function of the nervous system may be altered in some way, and those abnormalities may change over time."

For the next couple of days:

Keep your puppy calm, with short, gentle potty trips and no rough play.
Block stairs and keep it off couches and beds.
Let it sleep near you, so you notice changes.
When it wakes, check that it wakes normally, knows you and moves the way it did before the fall.
Notice whether it is eating and drinking the way it usually does once it is fully alert.

If your puppy becomes dull, weak or unusually sleepy at any point after the fall, is hard to wake, seems confused or does not seem to know you, or is struggling to breathe, go to an emergency vet now. For a new limp or eating less, get your puppy seen in person today.

Toy breeds and very young puppies: a lower bar for going in

Size matters here. Remember VCA's point that small dogs can be hurt by much shorter falls than you would expect, and its warning that toy breeds have broken legs just jumping down from a sofa.

That is why Chihuahuas, Yorkies, Pomeranians, toy poodles and other tiny puppies get a lower bar. For toy breeds and very young puppies, get an in-person exam after:

any fall with a yelp and a limp,
any head knock followed by a change in behavior, or
any time you are unsure.

If your tiny puppy is whining, reluctant to move or holding up a leg after the fall, get your puppy seen in person.

Preventing the next fall at home

Puppies love to jump off furniture. A few changes at home can help:

Pet steps or a ramp. Pet steps or a ramp let your puppy get down from the couch or bed without jumping.
No solo time on high furniture. Do not leave a puppy alone on a couch, bed or table, even for a moment.
Two-hand carrying. Carry your puppy the way VCA describes, supporting it behind the front legs and in front of the back legs, and crouch down before you set it on the floor.
Baby gates at stairs. Gate the top and bottom of any stairs until your puppy is bigger and steadier.
Watch small-space hazards. If you live in a New York City apartment with a lofted or high bed or a steep staircase, gate or block those spots first.

For a fuller list of setup steps for a new dog, see our puppy care checklist.

What a RexVet online vet can and cannot do after a fall

If you saw any sign in the emergency list, go to an ER instead. A video visit is for the puppy that seems okay but that you are still worried about.

On video a veterinarian can watch your puppy move, look at its eyes in good light, check alertness and breathing effort, and ask how the fall happened. They can then help you decide between the ER now, a clinic visit today or watching at home, with a written list of signs to look for.

A video vet cannot do a hands-on neurological exam, X-rays or other imaging, or check blood pressure, and cannot give any treatment. That is why the in-person signs in this article still apply after a video visit. The short video you recorded, plus a clear photo of your puppy's face, helps a lot; our guide on how to upload pet photos and videos for an online vet review shows how to share them.

If the veterinarian decides medication is appropriate, they can prescribe where state rules allow. In Florida, a veterinarian who has seen your pet only by video may prescribe only FDA-approved animal drugs used as labeled, for up to 14 days (1 month for flea-and-tick-only products), and cannot renew without an in-person exam.

RexVet is a 501(c)(3) non-profit, and RexVet's veterinarians are licensed in Florida, New York and Virginia. If you are in one of those three states and your puppy shows none of the emergency signs, you can book a RexVet video visit for $64.99, available 24/7, including nights, weekends and holidays.

When to be seen in person in Florida, New York or Virginia

Get your puppy examined in person if:

any emergency sign from the list above appears, at any point (go to an emergency vet now),
a limp does not settle,
your puppy cries when picked up,
your puppy is not eating,
you notice any change in alertness over the next days, or
your puppy is a toy breed or very young and you are unsure; for tiny puppies, go sooner.

If the main worry is a leg rather than the head, our guide to dog limping causes and treatment explains what a vet looks for.

In Florida, a telehealth vet must also point you to local help: under Florida Statutes section 474.2021, the veterinarian must give "the contact information for at least one physical veterinary clinic in the vicinity of the patient's location."

For how video visits work in your state, see our pages for Florida, New York and Virginia.

Frequently Asked Questions

How do I know if my puppy is okay after hitting its head?

Start with the emergency list: loss of consciousness, a seizure, uneven pupils, blood in the eyes, nose, mouth or ears, trouble standing or walking, trouble breathing, vomiting, or seeming dull, confused or hard to wake all mean go to an emergency vet now. If none apply and your puppy is alert, walking normally and responding to you as usual, keep watching closely for a couple of days, because some injuries show up later. Any change from normal is a reason to call a vet or go in.

Can a puppy get a brain injury from falling off the couch?

It can happen. VCA notes that "Small dogs can incur injuries from falling much smaller distances," and lists signs of brain injury such as seizures, bleeding into the eyes or from the nose or ears, and pupils of uneven size. If you notice uneven pupils, confusion or trouble standing or walking, go to an emergency vet now. Only a veterinarian can decide whether there is a brain injury.

Should I let my puppy sleep after it hit its head?

Yes, rest is fine. Let it sleep close to you so you can check that it wakes normally and knows you. If your puppy is hard to wake, seems confused or doesn't know you, or is struggling to breathe, go to an emergency vet now.

How long should I watch my puppy after a fall?

VCA advises that you "observe him carefully for a couple of days," because some injuries are not apparent until hours or days after the fall. A puppy can seem normal and playful at first and later become lethargic, weak or have trouble breathing. If that happens, go to an emergency vet; for a new limp or eating less, get your puppy seen in person today.

Can I give my puppy something for pain?

No. Never give a human medicine or any pain medicine at home; call a vet. If your puppy seems to be in pain, such as crying when picked up or not wanting to move, get it seen by a veterinarian.

If you see any of the emergency signs above, go to an in-person emergency vet first. If your puppy seems okay but you would like a veterinarian to watch it move and help you decide what comes next, RexVet's veterinarians are licensed in Florida, New York and Virginia and are available 24/7. For pet parents in those three states, you can book a video visit now for $64.99.