When to Take a Child to the ER

Worried mother of two little girls phones doctor about their fever, asks if they need to go to the ER.

Should you take your child to the ER, call the doctor, or wait and see? When you’re just not sure, call the doctor. Even if the pediatrician can’t speak with you, someone in the office should be able to advise you. And if you do need to take your child to the ER, the doctor’s office can call ahead and let them know you’re on the way. That’s a plus.

But let’s back up a bit to the original question: ER or pediatrician? It’s a dilemma just about every parent wrestles with at one point or another. And it’s so hard to think straight when your child is injured or ill.

To the ER or Not? Three Deep Breaths

Even when you’re frightened and anxious, sometimes you can figure things out on your own. That is if you can calm down enough to do a proper assessment of your child’s condition. To help calm down, take three deep breaths. Then remember that being calm and in control of your emotions means you’ll be better able to take care of your child.

Sometimes making decision of what to do next is easy. If your child is just lying there completely out of it, or has severe injuries, don’t wait. Call 911. Ditto if your child’s lips are turning blue. That’s not only the ER, but a ride in an ambulance, most likely. So pick up the phone and dial 911.

Just do it.

Going to the ER Means a Long Wait

But let’s say none of this applies to your child’s condition and it’s the middle of the night. And you know that going to the ER is unpleasant, with a long wait and procedures that might make your child cry. Your child is uncomfortable enough. Do you really need to add to her discomfort? How do you know whether to wait until morning when you can have the doctor decide for you, or whether you need to get moving to the ER now?

Let’s take a look at some common events that may mean a trip to the ER:

Dehydration

Lots of viruses cause diarrhea and vomiting in children. When your child gets a bug with these symptoms, you have to worry about dehydration. Dehydration is definitely a reason to visit the ER, even in the middle of the night. But it usually takes about 24 hours of vomiting and diarrhea to cause dehydration. So the first thing you want to consider is how long your child has been vomiting and experiencing diarrhea. If it’s under 24 hours, you can probably wait.

If your child has been sick for over a day with symptoms of vomiting and diarrhea, you need to watch for signs of dehydration such as:

  • Cracked lips
  • Cold skin
  • Dry mouth
  • Decreased urination
  • Low energy

If your child’s tummy trouble persists, and she can’t keep down even small amounts of liquid, call the doctor. You should try to get the child to take two teaspoons of fluid every 30 minutes. If your child has almost no saliva, can’t make tears when crying, and isn’t peeing at least twice a day, it’s time to go to the ER.

Fever

In small infants (newborn to three months), a rectal temperature of over 38C or 100.4F means: go to the ER now. In this case, don’t give your baby medicine to reduce the fever. The ER doctor will want to see the baby as is, without the effects of medication.

Babies and children three months and older can be given a dose of acetaminophen or ibuprofen for fever according to the dosage instructions on the bottle. Then wait 30 minutes. If your child looks a lot better, is responding to you, and is drinking fluids, you can continue to treat the child at home.

If the child’s symptoms continue, the fever continues past 72 hours, or there’s wheezing, a strange rash, or extreme lethargy, call the doctor.

Breathing Issues

When a child is wheezing or grunting, or her breathing is noisy, fast, or high-pitched, it means your child is having trouble getting air. This can happen when there is a respiratory infection or during an asthma attack. But panting or fast breathing can also occur when kids get fevers. So if your child has a fever, give fever-reducing medication like acetaminophen or ibuprofen and wait 15 minutes. If the fever goes down, and her breathing settles, you can stay home.

If your child has a cough so severe that she cannot sleep or eat, or she has a barking cough, call the doctor.

If the child has so much trouble breathing that she cannot speak, go to the ER.

If the child’s lips are turning blue, call 911.

Odd Rash/Stiff Neck

Does your child have a rash? Press on it. The rash should go back to normal skin color for a second or so. If it does, this means your child has a simple virus and will get better in a couple of days. You can stay home.

If the rash doesn’t pale when you press on it and your child has a fever, this may mean a more serious illness, for instance meningitis. Call the doctor. If your child has neck pain, finds it hard to move his neck, and also has a fever, go to the ER now.

Bad Cuts

Clean the cut well with soap and water. Put pressure on the cut with a clean towel for 10 minutes and then reassess. If the bleeding is under control, but the cut is deep, call the doctor.

Go to the ER if:

  • The child can’t move the injured part
  • There’s lots of bleeding
  • There’s numbness
  • There’s severe swelling

Bump On the Head

A bump on the head isn’t always an emergency. If your child has no dizziness, headaches, or vomiting, you can stay home and the child can return to normal activities. But if your child passes out within a couple hours of bumping his head, call the doctor. Check the child’s head with your hands. If there is a part that seems squishy, go to the ER. If the child can’t stop crying, vomits more than once, or you see blood or fluid coming from the ears or nose, or bruising around the eyes or ears, go to the ER.

Remember that your child takes her cue from you. If you remain calm as you assess your child, your child will feel less anxious and find it easier to cope with the fear and pain of illness. Cuddle your child, and do what you can to distract her from her worries and discomfort.

Mother feels little girl's head for fever, keeps her calm

Next week: Taking Your Child to the ER

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Author: Varda Epstein

Varda Meyers Epstein is a mother of 12, communications writer, and education blogger at the Kars4Kids blog.

2 thoughts on “When to Take a Child to the ER”

  1. Hi Mrs. Epstein!
    I have missed coming and sharing your wonderful, insightful knowledge.
    We are so Blessed with having our Role Model and Mentor Mother/GrandMother so near.
    This is a subject that few Parents give much fore-thought, although it should be, so I am sharing it with #OurCircle.
    I hope you and your Dear Family are doing well.
    Sincerely,
    Aida

    1. Thank you for your lovely note, Aida! Glad you stopped by for a visit and appreciate your sharing my latest article with #OurCircle.
      We are all well. Hope the same is true of you and Robert!
      Warmly,
      Varda

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