When is it appropriate to visit the Pediatric Emergency room and when is it not!

When should I take my child to the Emergency Room?

As parents, there are occasions when we have a child who becomes ill or our child has an accident. We are left with the decision as to what to do now. Should I call my pediatrician?  Maybe it is after the pediatrician office hours. Should I take my child to the emergency room or wait until the morning for an office visit? 

The following general guidelines apply to most children. They may assist you in taking the appropriate action the next time your child is not feeling well. 

Your Child Is Running a Temperature Higher Than 103
Go to the ER? Rarely

Fever  alone is rarely a reason to go to an ER. The exception is a child less than six weeks old with any temperature 100.5 or more. An older child or infant with fever can almost always be managed at home. For the best indicator of how sick a child is, wait to see how your child looks when the fever goes down. All children tend to look listless and miserable when the fever is high, but if you bring the temp down, and your child perks up and looks much better, you can continue to control the fever and see your pediatrician the next day in the office. Reasons to go to the ER for fever have only to do with other symptoms accompanying the fever, not the fever itself. If the fever persists for 3 days or more, contact your pediatrician.

Your Child Is Vomiting and Has Diarrhea
Go to the ER? Rarely

This can generally be managed at home. If your child has just vomited, wait at least 30 minutes and then offer small sips of clear liquids (rehydrating solution is best). Your child should drink slowly to assist them with keeping the fluids down. Reasons to head to the ER would include vomiting after head trauma; vomiting accompanied by severe abdominal pain with or without fever; or green vomit, which could mean there is something deeper than just belly issues. Diarrhea is rarely a reason to go to the ER; go only if your child has high fever, refuses to drink, is listless, or has a bloody stool. Diarrhea usually just has to resolve itself. Hydration is key, however refrain from juices for this will make the stool looser.

Your Child Is Having Trouble Breathing
Go to the ER? Yes

Difficulty breathing is an appropriate trip to the ER. Severe nasal congestion that makes it hard for your child to sleep is not ‘trouble breathing.’ If your child is struggling, especially if the spaces between the ribs are sinking in, nostrils are flaring, or skin is pale or gray, the child needs to be seen right away. 

Child Has Broken a Limb
Go to the ER? Yes

Broken limbs are a reason to go the ER. If the pain is severe, or if the limb is not straight, or accompanied by an open wound, that is an appropriate ER visit. If your child falls while playing and then complains of pain, treat first with ice and pain reliever. If your child settles down and is fairly comfortable, he can be seen by the pediatrician the following day. 

Child Is Bleeding.
Go to the ER? Rarely

Cuts and lacerations only need to be seen at the ER if 
the bleeding cannot be controlled, the wound is deep and requires stitches, or if it’s significant and to a soft body part like the eye, back of the throat, or genitalia. Milder wounds can be treated with soap and water, application of antibacterial ointment, and a bandage as needed. 

Child Is Bleeding From an Animal Bite
Go to the ER? Rarely

Animal bites that are not actively bleeding can be seen in your pediatrician’s office the next day for possible antibiotic treatment and tetanus booster, if needed. Violent animal bites with torn flesh, especially to the face, should be treated at the emergency 

Child Is Coughing a Lot
Go to the ER? Rarely

A cough does not need to be seen in the ER unless accompanied by signs of respiratory distress. If your child has a bad cough, but his breathing is okay in between, you are okay to see your pediatrician the next day.

Child Has Allergic Reaction
Go to the ER? Rarely
An allergic reaction that involves rashes to the skin should be treated with Benadryl. You only need to go the ER if the reaction includes respiratory symptoms such as coughing, wheezing, swelling of the mouth or tongue.

Child Loses Consciousness (Faints, Trauma, Sports, Etc.)
Go to the ER? Yes

If your child has an episode of unconsciousness after head trauma, they need to be seen in the ER. If they faint but are fine afterward and is otherwise healthy, your child can be seen by the pediatrician the next day.

Child Ingests Foreign Object
Go to the ER? Rarely
Unless your child is drooling uncontrollably or having difficulty breathing, a child who has swallowed something can be seen by his doctor the next day. However, swallowing a small watch or camera battery is especially dangerous, and the child should be watched closely to ensure it passes in the stool. Your pediatrician should know this has happened and may do an X-ray to make sure the object has passed or will pass.

Child Gets Burned
Go to the ER? Rarely
Small burns can be treated with pain medicine. Larger burns on small children or any third-degree or electrical burns should be seen in the ER.

Burn Classifications
Burns are classified as first-, second-, or third-degree, depending on how deep and severe they penetrate the skin's surface.
First-degree burns affect only the epidermis, or outer layer of skin. The burn site is red, painful, dry, with no blisters. 
Second-degree burns involve the epidermis and part of the dermis layer of skin. The burn site appears red, blistered, and may be swollen and painful.
Third-degree burns destroy the epidermis and dermis. Third-degree burns may also damage the underlying bones, muscles, and tendons. The burn site appears white or charred. There is no sensation in the area since the nerve endings are destroyed.
Burns affecting 10 percent of a child's body and those affecting 15 to 20 percent of an adult's body are considered to be major injuries and require a trip to the ER.

Child Has Severe Headache
Go to the ER? Rarely

Headaches should only be seen if accompanied by persistent vomiting, following head trauma, or if there are associated neurologic symptoms, such as blurred vision or weakness in an extremity. A headache with a seizure should be seen in the ER.

If you cannot get in touch with your pediatrician within 48 hours of your child’s illness and symptoms persist, it may be time to consider other medical advice. 

As always, Dr Atousa and the staff at Healthy Kids Care are here to assist you and your child. We are available to answer your questions , concerns or to schedule an appointment.