So, Should You Go?
Look for Red Flags
When you're faced with an ill or hurt child, try not to panic. Call your pediatrician and tell her what you've observed. If you can't get your child's doctor or the office's answering service, here are some guidelines to help you make the "Should I stay home or go to the ER?" decision.
- Fever: Seek immediate care for a rectal temperature over 100.4 F in a baby 2 months or younger, says Jeffrey Avner, MD, director of emergency services at The Children's Hospital at Montefiore, in the Bronx, New York. Otherwise, fevers require urgent care only when they are combined with behavioral changes, such as if a baby is also extremely lethargic or cries when you move his neck.
- Crying: Nonstop crying can be a mystery. Babies with colic can scream for hours without risk. Most infants will relax after they are held and rocked; however, says Dr. Avner, crying is most serious if it intensifies or changes pattern when you pick up the baby.
- Vomiting: Often parents are concerned about dehydration and try to feed the baby too much too fast, says Francisco Medina, MD, associate medical director of the emergency department at Baptist Children's Hospital, in Miami. Instead, he advises, give your baby an ounce of Pedialyte every 30 to 60 minutes. Then, only if he shows symptoms relating to appearance, breathing, or circulation does he need immediate medical attention. Also, green vomit signals an emergency, as does a newborn who's throwing up.
- Trouble breathing: Don't worry about the stuffy nose that can be cleared with an aspirator. But if your baby is wheezing or making a high-pitched noise when breathing, that's serious. Other signs to look for, especially in newborns: noticeable chest retractions or a blue or pale tinge to the skin.
- Injuries and falls: If a child gets a bump on the head, is crying, but otherwise acts normal, he probably just needs an ice pack. But if he vomits, becomes lethargic, can't maintain his balance, or if the injury was to the abdomen and he complains of a stomachache, then there is cause for alarm. With infants, consider the height of the fall and the surface. Less than 2 feet onto a carpet usually isn't cause for alarm, Dr. Avner says, but 4 feet onto a tile floor is. A bruise to the head of a baby less than 2 months old always needs to be checked. While bleeding wounds to the head (and other deep cuts) are emergencies, your pediatrician often can arrange for a plastic surgeon to meet you at the ER, says Dr. DuMond. That will lessen your wait too.