How Do You Know When a Child Needs the ER?

At one time or another, most children make a trip to the local Emergency Room. Cuts that require stitches, broken bones, and increasingly, asthma attacks bring children into the ER at all hours of the day and night. But how do parents or caretakers decide whether a child needs to make that visit?

Edward Muellerleile, MD, a pediatrician with Pavilion Pediatrics (part of Children’s Medical Group), reports that one of the most important ways to determine whether a child needs to be taken to the ER is to make a call to your pediatrician. Unless time is of the essence, the vast majority of childhood injuries and illnesses can wait 10 or 15 minutes while the case is discussed with their health care provider.

Having stated that, Dr. Muellerleile recognizes that there are times when a physician is unavailable, or a parent is just too anxious to wait. In these cases there are several important things to watch for when making a decision about going to the ER.

In the case of an injury resulting in a probable fracture (with indicators such as significant pain or swelling at the point of injury, deformity of a limb or an obviously broken bone), a child should certainly be brought to the Emergency Room as soon as possible. Other indicators that probably call for a trip to the ER include wounds that don’t stop bleeding, cuts that are obviously too deep to heal without stitches, limping after an injury or pain that doesn’t go away even after pain medication has been given.

Head Injuries
Head injuries are another point of concern for many caretakers; especially those with toddlers and young children – not only are they in the injury-prone stage of learning to walk and climb, but most are too young to communicate any specifics about pain or injury. “Any loss of consciousness, even for a few seconds, should be evaluated by a physician,” says Dr. Muellerleile. “Additionally, vomiting, lethargy or any change in behavior or mood after a head injury warrants an evaluation.

An injury resulting in a hematoma (a large bump or “goose egg”) on a child’s head can sometimes be nothing more than a simple lump, leading to tears and the need for some down time. In these cases, physicians usually recommend that the child be monitored at home. If it’s a more serious injury, your health care provider might tell you to wake the child every few hours and ask questions such as, “Who am I?” and “Do you know where you are?” to be sure that there are no indicators of brain trauma. If any of these signs are present, by all means bring the child in right away, says Dr. Muellerleile.

Burns
Regarding burns, Dr. Muellerleile says that first-degree burns – which look like sunburn and do not blister – can usually be observed at home; any burns that form blisters, however, need to be examined by a physician. He reminds parents and other caretakers that the most important factor in burn care is prevention. Stoves, ovens, hot pots and pans, space heaters or any sources of flame should be kept well out of the reach of children. “Water heaters, especially, can be problematic as far as burns, and should be set at 110 degrees or less so that children aren’t scalded by hot water in the sink or bathtub.”

Abuse
Dr. Muellerleile advises bringing any child who shows evidence of physical or sexual abuse – whether at home, on the playground, or out in public – to the Emergency Room. Any indication of non-accidental trauma, even a verbal communication between children, has to be taken seriously. “These children need to be evaluated right away,” he stresses.

What About Illness?
In addition to injuries, childhood illnesses are the source of many Emergency Room decisions. Dr. Muellerleile offers some guidelines for parents whose children are ill: First of all, much of the decision to bring children in for evaluation has to do with their age. The younger a child is, the more serious an illness can become. “In an infant younger than 30 days,” says Dr. Muellerleile, “be on the lookout for vomiting, a cough, lack of appetite, irritability or lethargy.” He points out that if the infant has a fever of 100.4 degrees taken rectally, or 99 degrees taken under the arm, the baby should see a doctor or be brought into the Emergency Room for assessment. For older children, however, fussiness and a fever do not always mean a serious illness. “A six-year-old with a stuffy nose and a fever probably doesn’t need to be seen,” he says.

Some illnesses involve an element of respiratory distress. While any breathing difficulties are frightening for children and their caretakers, Dr. Muellerleile says that adults should be on the lookout for fast or heavy breathing in a child with a cold or the flu – this could be a sign that treatment is needed. In asthmatic children, labored breathing that continues even after the child has received his or her medication should also be appraised by a health care provider.

It’s important to know that if a sick child of any age shows significant changes in mental or emotional status, is unable to eat for several days, or shows signs of serious pain or distress, then the child should be seen by a physician.

Poisons
One of the most frightening events in the life of a child or caretaker can be an encounter with poison. If there is any possibility that a child has ingested a poisonous substance, says Dr. Muellerleile, call a poison control center immediately. (In Wisconsin, that number is 1-800-222-1222.) The advisers can recommend the next step you should take or direct you to the appropriate resources. If you are certain that a child has ingested a poisonous substance, call 911 or bring the child directly to the Emergency Room.

What to Have Handy at Home
How about emergency treatment at home? Dr. Muellerleile recommends a few items for every parent’s medicine cabinet: “Certainly a good first-aid kit with bandages and sterile gauze to stop bleeding should be in every home. Splinting devices can also come in handy for finger sprains and the like. A bulb syringe is important for suctioning mucus out of a young child’s nose or throat, and syrup of ipecac should be kept on hand, but only used if recommended by the Poison Control center.”

General medications such as ibuprofen, acetaminophen, and cold medications can be kept handy for parents but out of the reach of children. You should also have an oral rehydration solution available in case your child develops an illness that involves vomiting or diarrhea. “Pedialyte is never a wrong thing to give your child,” says Dr. Muellerleile. “If a child likes the taste, it can be given with food or by itself. Otherwise, any clear liquids without too much sugar will help keep your child hydrated.”

Use Your Instincts
“Ultimately,” says Dr. Muellerleile, “parental anxiety and concern is the key here. I would never tell a parent not to bring in a child.” He stresses the importance of calling your health care provider first whenever possible. Often, a child can be seen by that physician or the physician on call, avoiding costly and time-consuming Emergency Room visits. His advice? “Don’t assume a trip to the ER is warranted unless time is of the essence, or there is no doubt in your mind that it’s necessary.” And of course, “Prevention is the best medicine of all. Look around your house, around your yard. Ask yourself how you can prevent injury or illness to children.”

Prevention is Essential
Prevention in general is an essential part of avoiding serious childhood health problems. These guidelines can help you keep children and their environments safe.

• An assortment of products that help to “child-proof” the home – such as outlet covers and stair blockers – are widely available and should be used as needed.
• Keep all medications out of the reach of children.
• Any sources of flame or intense heat should be kept well out of the reach of children. Set hot water temperature at 110 degrees or less so that children aren’t scalded in the sink or bathtub
• Call a poison control center immediately if there is any possibility that a child has ingested a toxic substance
• Make sure that children on bicycles, skateboards, scooters (“or anything that moves”) wear protective gear; helmets are a must at all times, and kneepads and wrist guards are also important in injury prevention
• Adults should always be sure that children are properly restrained when riding in cars. Child safety seats, booster seats and seat belts will protect children from harm
• Monitor children carefully during an illness or after an injury. A health care professional should evaluate any unusual or persistent signs and symptoms.

Every child gets sick or hurt on occasion. But by following reasonable guidelines and trusting your own knowledge of your child, injuries and illness don’t have to be traumatic. Let common sense prevail, and when in doubt, call on the experts.

P.J. Early
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.