With some medical issues, the course of action is clear. If your kid is having trouble breathing, extremely lethargic or severely injured, or if his lips are turning blue, you call 911. For other medical problems, however, it can be hard to know whether you should head to the emergency room, call your doctor or just treat it at home (especially when it’s the middle of the night). While we all want reassurance that everything will be OK, sometimes sitting in a waiting room for hours is not the best answer. As a mom, paediatrician and emergency doctor, I’ve experienced medical scares at both home and at work. Here are my guidelines for the most common conditions that might require a trip to the ER.
Many bugs and viruses can cause vomiting and diarrhea in kids. If those symptoms last longer than 24 hours, however, be on the lookout for signs of dehydration: cracked lips, cold skin, dry mouth, decreased urination and low energy. If your kid has persistent stomach upset and has trouble keeping down small amounts of fluid frequently (about two teaspoons every 30 minutes), call your doctor. Head to the ER if your child has minimal saliva, doesn’t produce tears when he cries or is not peeing at least a couple of times a day.
If your child is three months or younger and has a rectal temperature of more than 38C (100.4F), you need to seek immediate medical attention—go to the ER right away. Don’t give fever-reducing medicine, however; the doctor will want to examine your baby and check her temperature before offering treatment. For kids older than three months, I suggest trying the appropriate dose of acetaminophen or ibuprofen and waiting 30 minutes. If your kid looks much better, is more responsive and is able to drink, you can continue to treat her at home. If the symptoms continue, the fever lasts longer than 72 hours, she’s wheezing, she has a weird rash or she is extremely lethargic, see your doctor.
Noisy, high-pitched, rapid wheezing or grunting indicates a child is struggling for air. This usually happens during a respiratory infection or an asthma attack. Keep in mind that many kids pant or breathe quickly when they have a fever. So if your kid does have a high temperature, try giving acetaminophen or ibuprofen and reassessing in 15 minutes. If it’s a severe cough that’s preventing her from sleeping or eating, or a barky cough, she should be seen by her doctor. If your child cannot speak due to difficulty breathing, you need to go to the emergency room. Call 911 if her lips are turning blue.
Stiff neck or strange rash
Press on the rash—it should return to skin colour for a second or two. Rashes that do this generally signal a simple viral infection, which tends to go away in a couple of days. But if it doesn’t pale when pressed and your child has a fever, that could indicate a serious illness such as meningitis. If your child has pain in his neck, cannot move it normally and has a fever, you’ll also want to go to the emergency room right away.
Wash the area with soap and water, and apply pressure with a clean towel or gauze for 10 minutes. Is there numbness or a lot of swelling? Swelling is part of the healing process, but if there’s any numbness, your kid is unable to move the affected area or the bleeding continues with direct firm pressure, you should head to the hospital. Depending on the cut’s depth and severity, the doctor may apply small bandages called Steri-Strips, or glue or suture the wound closed. Some lacerations, such as animal and human bites, are left open on purpose to avoid bacterial infections.
A big bump isn’t necessarily an emergency. But if your child loses consciousness at the time or within two hours of the injury, he needs medical attention. Check to see if there is a squishy area on the skull from the trauma; if there is a squishy part, he should go to the hospital. If your kid vomits repeatedly or is unable to be comforted, or if there is blood or clear fluid coming from the nose or ears, or any bruising under the eyes or ears, you should also go to the hospital. Your child can gradually return to normal activities if there is no further dizziness, headaches or vomiting.
If you do take your child to the ER, it helps to have key information handy to tell the attending nurse or doctor. Keep track of when the illness began, how it has progressed, the duration of a fever or rash, how often the child has gone to the bathroom, any medications she’s taken, who she’s been in contact with and any other health concerns. You may need to wait for several hours, so be sure to bring water, snacks and a toy or stuffie that might comfort your child.
Dr. Dina Kulik is a paediatrician and emergency room doctor in Toronto, and mom to three boys, who are six, four and two. Send your kids’ health questions to firstname.lastname@example.org