When Should Your Child Go to the Hospital?

How Can You Tell If Your Child Needs to Go to the ER?

Sometimes the need to call 911 is only too clear: a child is unconscious, blue, or badly injured. Other urgent situations aren't so obvious. "It helps to consider potential emergencies the same way doctors and nurses do, with ABCD," advises Milwaukee pediatrician Marc Gorelick, MD, a member of the American Academy of Pediatrics' committee on emergency medicine.

  • Airway: If the passage to the lungs is blocked -- for example, your child is choking -- have someone call 911 while you try to clear the airway. If you're alone, attend to your child first. To be prepared for such situations, take a course in CPR.
  • Breathing: Noisy, high-pitched, and rapid wheezing or grunting indicates a child is struggling for air, usually during a respiratory infection or an asthma attack. "You'll see the chest sucking in and the belly moving," says ER physician Joan Bothner, MD, chief medical officer at the Children's Hospital of Denver. It's just as hard -- if not harder -- to exhale as it is to inhale, which means your child's condition will deteriorate fast. Get emergency aid for a baby taking in more than 60 to 70 breaths per minute, a 1-year-old taking in 40 or more, or an older child taking in 30 or more (the normal rate slows with age).
  • Circulation: This applies not only to blood loss from trauma but also to dehydration from vomiting or diarrhea, which prevents blood from properly nourishing the body. Signs that your child needs intravenous fluids include decreased urination (fewer than two soaked diapers a day), a sunken soft spot on the head, a sticky mouth, tearless crying, sunken eyes with dark circles underneath, listlessness, paleness, and clammy skin.
  • Disability: Get immediate help for a child who's unconscious or having a seizure that involves going limp or stiffening and jerking, with eyes rolling back or staring. About 5 percent of young children are prone to febrile seizures. This frightening response to fever is almost always harmless, but a child's first seizure should be treated as an emergency to rule out a more serious problem. For subsequent episodes, there's no need to call 911 unless it lasts longer than the typical 5 minutes (but always report it to a doctor ASAP).

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