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Baby 911: When to Call the Doctor or Go to the ER

When I accidentally snipped the tippy-top of my 3-month-old daughter's thumb while clipping her nails, I freaked. Blood was spurting everywhere, so I called 911. EMT and police officers quickly arrived only to snicker at the tiny wound on my baby, who had cried herself to sleep. Because of her age, they were required to take her to the ER. The doctors met me with a similar chuckle, wrapped her with gauze, and sent us on our way.

The next day, I followed up with my pediatrician, who said I should have called him first. He would have told me to apply pressure to stop the bleeding, wrap the wound, and bring her in. But when I heard her scream and saw blood, I lost my cool. And I know I'm not the only mom who has panicked like this. That's why we asked doctors to look at common first-year emergencies and tell us what's truly 911-worthy.

What if my baby is fussy and feverish?

Evaluate the emergency: Take his rectal temperature -- the most reliable kind. Call your doctor if your baby's 2 months or younger and has a temperature of 100.4 F. or higher. "A fever in the first two months is an emergency that requires timely evaluation by a pediatrician," says M. Douglas Baker, MD, professor of pediatrics at the University of Texas Southwestern Medical Center at Dallas. Your doctor will examine him; run tests; and may even hospitalize him. If your baby is older than 2 months, your pediatrician will probably suggest acetaminophen to lower the fever.

Go to the ER: Seek immediate attention if an infant is having a seizure. Though frightening, febrile seizures are harmless and do not cause long-term health problems, according to the American Academy of Pediatrics (AAP). Also go to the ER if your baby is extremely lethargic or irritable, unresponsive, refuses to eat, seems dehydrated (dry mouth, significantly fewer wet diapers), is having trouble breathing, or has mottled or bluish skin or a rapidly expanding rash. A fever that doesn't respond to acetaminophen may need to be checked out because it could be a sign of meningitis. And if you think his elevated temperature could be related to heatstroke (maybe he was in a hot car for a prolonged period -- which should be avoided at all costs), head directly to the ER.

What if my baby is suddenly acting lethargic?

Evaluate the emergency: Call your pediatrician, who will probably ask: Could your baby have hurt her head? Has she been eating and drinking properly? Has she had diarrhea or vomiting? Just as you need more sleep when you're sick, so does a baby. Double-check any medication you may have given her in case it made her drowsy. "And if you're breastfeeding, remember that medicine and alcohol you ingest will pass on to the baby," says Andrea C.S. McCoy, MD, chief medical officer at Jeanes Hospital, in Philadelphia. "Although most medication is safe to take, antihistamines and pain relievers could make her sleep more."

Go to the ER: "If your baby truly won't respond to you, call 911," advises Dr. McCoy. Take her to the ER if she's had a head injury, seizure, irregular breathing, or a high fever that won't come down with appropriate medication.

What if my baby has a rash on his belly?

Evaluate the emergency: If the rash is red or pink-red, press on it; if it blanches and refills when you release, chances are it's not dangerous. If you can't make it turn white by pressing into the skin that could mean there's bleeding into the skin, and "that's the type of rash you see with dangerous infections or other serious illness, so call your pediatrician," says Dr. Baker. A rash that does blanch is less worrisome, but it's best to have your doctor take a look if it doesn't go away within a few days.

Go to the ER: Hives -- raised, itchy welts -- are a sign of an allergic reaction. Call 911 if his lips are swollen, he's wheezing, or he has trouble swallowing, speaking, or breathing.

What if my baby falls onto a hard surface?

Evaluate the emergency: Wait to scoop her up until you're certain she can use all her extremities, says Dr. McCoy. If she seems okay, pick her up and examine her body and demeanor. If anything appears off, go to the doctor. "It's best to be conservative with a baby who's fallen," says Dr. Baker. A bump on an infant's head definitely needs to be checked -- there could be an underlying crack in the skull or internal bleeding. Look for unusual eye movements, leakage of blood or clear liquid from the ear canal, black eyes, or bruising behind the ears. These require immediate attention by a physician.

Go to the ER: It's an emergency if she loses consciousness, has difficulty waking, or is unable to recognize her surroundings. She should respond normally, reach for you to pick her up, and babble. While it's not unusual to vomit initially from being upset, if it continues it could be a sign of internal bleeding. If she has an open injury, a broken bone, a substantial break in the skin, or prolonged irritability, you should head to the ER.

What if my baby is chewing a pill he found on the floor?

Evaluate the emergency: First try to remove any remaining pieces of the medication from your child's mouth. "We no longer suggest inducing vomiting, since some things are more harmful on the way up," says Dr. McCoy. Wash his hands, face, mouth, and any skin the pill touched. Then immediately call Poison Control (800-222-1222) for advice on what to do next.

Go to the ER: Call 911 if your child is unconscious, is having trouble breathing, or is having seizures, convulsions, or extreme sleepiness -- otherwise call Poison Control first. Have the container of any ingested substances available, and take this as well as any particles from his mouth to the ER. (Note: According to AAP, even if your child has mild or no symptoms, you should still call Poison Control.)

Essential First-Aid Supplies

In the event of a crisis, the last thing you need is to have to head out to the pharmacy in the middle of the night for a fever reducer. Stock your medicine cabinet with these emergency essentials.

  • Acetaminophen
  • Ibuprofen
  • Antibacterial ointment
  • Antifungals (for diaper rash)
  • Bandages
  • Cotton balls and swabs
  • Dosage spoon or cup (for measuring and administering medications)
  • Gauze pads
  • First-aid tape
  • Hydrocortisone cream (for insect bites and stings)
  • Hydrogen peroxide
  • Insect repellent
  • Nasal aspirator bulb
  • Pair of fine tweezers (sterilize before use)
  • Petroleum jelly (for minor burns and abrasions)
  • Rubbing alcohol (or alcohol wipes)
  • Reusable warm/cold gel packs
  • Thermometer (for taking temperature)

Note: Rectal thermometers are recommended for 3-year-olds and younger, while oral and axillary (under the arm) thermometers are an option for children ages 4 and up. Mercury thermometers should NEVER be used under any circumstances according to the AAP.

Should You Call the Doctor After-Hours?

Ever feel uncertain about bothering your pediatrician after regular office hours? You shouldn't. "There's nothing scarier than when your child is sick at 3 a.m., it's dark, and you feel like you have nowhere to turn," says Carol Steltenkamp, MD, associate professor of pediatrics at the University of Kentucky, in Lexington. "That's why I'm on call. Pick up the phone -- it's fine." Your pediatrician will help you sort out whether to take your child to the ER or wait until the morning to bring him in to the office. Even in the event of a crisis, it's smart to touch base with your pediatrician. Dr. Baker says that his first question for parents is: Have you spoken to your regular doctor already and what did he say to you?

Baby Care Basics: Surprising Reasons to Call the Doctor
Baby Care Basics: Surprising Reasons to Call the Doctor

Updated on November 23, 2009

Copyright© 2008. Used with permission from the March 2008 issue of Parents magazine.

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