On any given evening one of the most frequent questions I am asked by parents at the end of a call is, “When or what about my child would need to be treated in the emergency room?” Although it seems like a simple question, answering it is often difficult. As a trained pediatrician my idea of an emergency can vary significantly from worried parents watching their child. On every occasion, I consider the parent and their child’s symptoms carefully and hope that I am able to convey a sense of reassurance while at the same time giving a few specific instructions that would indicate an emergency. As a fail-safe I always end my advice with an open invitation for the parent to call back with any further concerns or significant changes in their child.
In general, emergency rooms across the country are suffering from overuse, which sometimes leads to lengthy delays in care and a shortage of supplies. This problem stems from ongoing issues in healthcare related to both accessibility and continuity in care. Many patients today do not identify with one care provider and, therefore, are not vested in maintaining this relationship for the health of their child. Any care becomes acceptable, rather than care by a person that knows their child and their family history. In our practice we strive to avoid this type of alienation and ambiguity in care. And, in most cases, we are able to successfully treat our patient’s problems without emergency room visits. However, there is a time and a place for the help of emergency medical personnel.
Fever is probably the most common variable that parents have questions about. In general a fever is considered to be a temperature of greater than 100.4 degrees Fahrenheit. In newborns and infants of less than three months of age this alone is a reason to speak to a physician and may warrant a trip to the hospital. Children tolerate fever better than adults, and as pediatricians we are more concerned with a child’s appearance and behavior than a fever in most circumstances. A temperature of 105 degrees and above should warrant emergency care and active cooling measures. Below this level a fever is a normal part of most illnesses for children that may be viral or bacterial. In short, most fevers will remit within a few days and respond well to antipyretics such as Acetaminophen or ibuprofen.
Breathing problems are another frequent flyer that will lead to emergency room visits. Parents of children with asthma or any chronic lung disease such as that found in many premature infants must be especially alert to their children’s respiratory status, particularly in these virus laden winter months. If a child cannot speak a full sentence without taking a breath, has nostril flaring or pulling in between their ribs or above their shoulder bones, this indicates distress. Also, if rapid breathing ensues following a bee sting or exposure to a new food product, particularly shellfish or nuts, this may well indicate anaphylaxis, a medical emergency.
Certainly, any major trauma related to a motor vehicle accident, sports injury, or significant fall will require the services of the emergency room. With toddlers frequent falls are common, even to the extent that they may bump their head. If there is any loss of consciousness, or persistent vomiting this should be evaluated in the emergency room. But, speak with your physician first. Most of these falls simply require close observation and a big hug.
Rashes are tough to describe over the phone and usually need to be seen in the office, but rarely in the emergency room. Rapid swelling in the eye and lip area is an emergency since this may be the precursor to swelling of other mucous membranes that may affect breathing. Also, any rapidly emerging pinpoint red rash should be brought to the attention of a physician, especially if coupled with any significant illness or change in behavior.
These are just a few very common and general indications for emergency room care. However, they should be the exception, with the rule being that your pediatrician is consulted first and can work with you to make the best decision for your child‘s health.