The first time I ever went to the emergency room with one of my kids, I stopped and picked up food for us on the way. It was almost dinnertime, and who knew how long we'd be waiting? Bad move. It turns out that some E.R. physicians won't give a child any kind of sedation unless her stomach has been empty for at least four hours. For anesthesia, they may prefer to wait as long as eight. Although my 4-year-old daughter Stella's situation wasn't urgent -- she had pushed a plastic bead up her nose -- the doctor wanted to sedate her before removing it. Because we had just eaten, that was out of the question unless we wanted to hang around for hours. Luckily, the doctor agreed to try the procedure without sedation, and he was able to extract the bead. But what could have been a simple removal was difficult and more painful for Stella than it had to be.
Going to the E.R. can be an overwhelming experience for the whole family -- especially if you don't know what to expect when you get there. So we asked doctors and nurses how to make sure your child gets the fastest and best possible care. Read their insiders' advice before an emergency strikes.
If your child is suffering from something potentially life-threatening, head straight to the closest E.R. But if the situation is less urgent (like my daughter's bead accident), it's worth going a little farther to a children's hospital or a hospital that has a pediatric emergency room. It will be more likely to have surgeons and other specialists with expertise in pediatrics, as well as child-size medical equipment and extras such as cartoons on TV that can make the experience a little less traumatic.
Call your child's doctor before you go (or even from the waiting room). He can tell you whether an E.R. trip is really necessary and, if so, he can alert the hospital that you're coming, says James Chamberlain, M.D., division chief of emergency medicine at Children's National Medical Center, in Washington, D.C. "This really can make a difference; the staff will be more prepared for your arrival. And if the pediatrician says he's very worried about your kid, they'll probably be able to get you into a room faster."
If your child takes any regular medication, or if you've given her any drug in the past 24 hours, carry it with you, advises Denise King, R.N., past president of the Emergency Nurses Association. In the heat of the moment, parents often can't recall the name of a drug or its dosage. It's a smart idea to jot down info on any chronic conditions or allergies your child has, as well as any medications she takes, and keep that list in your wallet so you always have it on hand. Leave a copy at home with your sitter too, even if you're just going out for the evening. You can print a form that you can fill out with all the important details at parents.com/babysitterlist. Just remember to update it as your child grows or as her information changes.
Whether it's an adult medication or a household cleaner, the information on the container will help the doctors decide the treatment your child needs, says Anne Stack, M.D., clinical chief of pediatric emergency medicine at Children's Hospital Boston. If he's swallowed something like a puzzle piece or a disk battery, try to come with an example. "That can help us tell if it will be visible on an X-ray and gives us a better idea of the size so we know if it could pass on its own," says Dr. Stack.
With most emergencies, you'll need to get to the E.R. right away, but if your situation is less dire, try to avoid early evening (around 7 p.m.), which tends to be the busiest time, according to the Centers for Disease Control and Prevention. Pediatric emergency rooms are also crowded in the afternoon after school lets out, says David Beiser, M.D., an emergency-medicine physician at the University of Chicago Medical Center. Shift changes, typically at 7 a.m., 3 p.m., and 11 p.m., can be hectic as well.
Many pediatric emergency rooms have toys and books, but it's better to take your own. "We can't always adequately clean toys between patients, and children often find more comfort with their own toys," says Joni Thornton, R.N., a pediatric nurse at Blank Children's Hospital, in Des Moines. Books, paper and crayons, and handheld games will help you pass the time. It's also a good idea to take along your child's lovey -- whether it's a stuffed animal, a pacifier, or a blanket.
Unfortunately, long waits are inevitable -- in fact, a new study in Archives of Internal Medicine found that the average wait went up from 22 minutes in 1997 to 33 minutes in 2006. But if something about your child's condition changes -- her pain gets worse, the bleeding starts again, she's having more trouble breathing -- ask to have her reassessed. If the person at the front desk doesn't seem to take you seriously, tell her that you'd like to speak to the charge nurse or the physician, says Assaad Sayah, M.D., chief of emergency medicine for the Cambridge Health Alliance in the Boston area. And if you're still not satisfied? Ask for the patient advocate -- most hospitals have one on call 24/7. "You can always pick up a phone, dial 0, and ask to have her paged," says Dr. Sayah. "There's a phone in every waiting room."
Doctors advise leaving your other kids at home, if possible, even if that means your husband has to stay behind with them. They can pick up infections at the hospital, and you need to be able to devote your full attention to your sick kid. If your child's condition is serious and your spouse needs to stay home, ask a friend to meet you at the E.R. "It's always better for two people to listen to what the medical staff is saying," Thornton says. "When you're under stress, you don't always hear things accurately."
Many parents hold off because they want the E.R. staff to see the temperature reading for themselves, but you should go ahead and give your child medicine to bring it down. Otherwise, you'll just increase his risk of dehydration and make him more uncomfortable, which can make the exam itself difficult. "Don't be concerned that the medical staff will not take your child's fever seriously if it's lower than it was at home," says Thornton.
That video recorder or camera on your cell phone can come in handy. If you're bringing your child to the emergency room because she's having regular seizures or episodes, try to make a video of one and take it with you. Or if she has a sudden injury such as one caused by a fall, try to snap a photo of the scene. "It might sound far-fetched, but you won't believe how helpful it can be," Dr. Stack says. "If we're waffling about whether to take a scan of a child's brain, we can look at the mangled bike or see how far she fell and say, 'Absolutely.'"
Of course, it's much easier said than done, but doctors and nurses say this is their number-one piece of advice. "Kids pick up cues from their parents," says Dr. Chamberlain. "If you're anxious, then your child will be even more scared." Remember, the emergency-room doctors have probably seen your child's particular situation dozens, if not hundreds, of times. So try to focus on what you're best at -- reassuring and consoling your child -- and know that he's in good hands.
If your child has any of these symptoms, don't check with your pediatrician -- go immediately to the emergency room.
1. Unconsciousness or no response when you speak to her
2. A burn that's larger than your child's palm or involves the hands, feet, groin, chest, or face
3. Rhythmic jerking, with or without loss of consciousness (a seizure)
4. Difficulty breathing
5. Skin or lips that look blue, purple, or gray
6. Neck stiffness or a rash with tiny red dots or purple splotches anywhere on the body, along with fever
7. Increasing or severe persistent pain
8. A cut that is large, deep, or involves the chest or abdomen
9. Bleeding that doesn't stop after you've applied pressure for ten minutes
10. Any confusion, headache, vomiting, or loss of consciousness, after a head injury
11. Continuous vomiting or diarrhea and dehydration (a sign: she hasn't urinated at all for ten hours)
12. Possible broken bones
13. Severe allergic reaction (swollen lips or tongue)
14. Swallowing an object or a dangerous substance
Originally published in the February 2010 issue of Parents magazine