How to determine if you have an emergency on your hands.
Dealing with Possible Emergencies
It was 3 a.m. on a Saturday, and my 9-month-old daughter, Mira, had been vomiting for hours. My husband called his sister, a veteran mom. "It's a stomach bug," she said. "You just have to ride it out." But wasn't there more we could do? We called the pediatrician to find out. The answering service paged the doctor on call, someone I didn't know. "How old is she?" he asked. "What's your insurance company?" His remedy: Go to the emergency room.
When the ER's doctors gave us my sister-in-law's advice, I felt ashamed. Weren't there more questions that the on-call pediatrician could have asked to prevent the hours-long wait at the ER? Telephone triage has its limitations, and doctors readily admit that if they can't make a confident diagnosis over the phone, sending patients to the ER may be the safest solution. "Most pediatricians err on the side of caution," says Sara DuMond, a pediatrician in Morrisville, North Carolina.
Why Should You Call Your Doctor First?
Contacting your pediatrician should be your initial step, says Thomas Krzmarzick, MD, medical director of The Children's Medical Center's emergency department, in Dayton, Ohio. "Many ER visits could be avoided if parents called the family doctor and he said, 'Give him Tylenol and I'll see him at 8 a.m.,'" he says.
Studies back up his experience. Fever, colds, sinusitis, ear infections, and stomach bugs are some of the conditions most often seen in infants who are brought to the ER, according to the Centers for Disease Control and Prevention (CDC). And researchers at Johns Hopkins University, in Baltimore, found that nearly half of the patients under age 18 who visit the ER have illnesses that could have been treated in a doctor's office. Kids ages 1 to 4 were the most commonly treated group.
Information to Have on Hand
Always call your pediatrician if you think you're dealing with an emergency, but before you dial, write down this information:
- Your child's temperature and when his fever began.
- Over-the-counter medications you have given him, when you started, and when he had his last dose.
- When and what he last ate and drank.
- Time of his last wet diaper or trip to the bathroom.
- How much and how often he is vomiting and/or experiencing diarrhea.
- Any other symptoms that concern you.
Call Your Pediatrician First
If a condition isn't an emergency, the best care will come from your pediatrician. The ER doesn't have your child's medical history on file. Unless you seek care at a children's hospital (most of them are in metropolitan areas), your baby probably won't be seen by a pediatrician. And then there's the wait: on average, three hours until discharge, including 47 minutes to see a doctor, according to the CDC.
Risks of ER Visits
Unnecessary tests and treatments are also a risk of rushing to the ER, says Dr. DuMond. Jessica Isaacs, of Brooklyn, New York, learned this firsthand when her 18-month-old daughter, Grace, was awake half the night crying while holding her stomach. At 6 a.m. Isaacs called her pediatrician, who gave her two options: Wait until 10 a.m. for the office to open or go to the ER. "I would have been a bad mom if I sat and waited with a crying baby," she says.
Once at the ER, Grace started hyperventilating and wheezing from the ceaseless sobbing. The doctor assigned to her ordered an asthma treatment even though she had no history of the disease. The medication made her vomit, which was just the thing her belly -- full of too much broccoli from the night before -- needed. And by the time Isaacs and her daughter left the emergency room, it was 10 a.m. anyway.
Keep in mind that there isn't always an easy or quick remedy for what is ailing your child. Mira, who is now 20 months old, has had several colds since her stomach virus nearly a year ago. Recently, she woke up one night with a fever of 103 F. The mother in me panicked, but then I remembered: If she is breathing fine, looks fine, and has good circulation, odds are that all she needs is rest, fluids, and Tylenol. I rocked her to sleep, and by morning her fever had broken, and she was running around the living room. Without having to spend the night in the emergency room, even I was well rested!
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.
When You Should Call 911
When you can't get in contact with your pediatrician, head to the ER if your child displays any of the following symptoms, says Francisco Medina, MD, associate medical director of the emergency department at Baptist Children's Hospital, in Miami. If your kid displays more than one symptom, immediately call 911.
Symptoms include: Slurred or garbled speech, inability to walk straight or stand up, limpness, extreme lethargy, or a blue-tinged complexion.
Possible causes: Bacterial infection, head trauma.
Symptoms include: Inability to breathe, abnormal breathing sounds or the rib muscles retract with each breath.
Possible causes: Asthma or severe respiratory infection such as pneumonia.
Symptoms include: A very fast or very weak pulse, skin that turns purple, red, blue, or completely pale. Another concern: A white spot shouldn't linger on the palm after it has been pressed; normally, color quickly returns.
Possible causes: Bacterial infection or dehydration.
Cynthia Ramnarace, a freelance writer, lives in Brooklyn, New York.
Originally published in American Baby magazine, March 2006.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.