One of my most frequent questions after becoming a parent is, “Am I overreacting?”
This is usually regarding a medical situation. Does this fever really warrant a trip to the emergency room on a Saturday night? Does this need stitches? Should I keep him home from school for this?
I also live in a relatively rural area, and there is often limited access to non-emergency care outside regular business hours. In fact, sometimes there’s no access, even during business hours.
So, when is it appropriate to take your child to the ER instead of waiting for an appointment?
Broken Bones Or Serious Injury
Even when your pediatrician or Urgent Care is available, they often refer broken bones to the emergency department.
UF Health, an urgent care provider in Florida, says that age is a serious factor when deciding whether to head for the ER or urgent care for a broken bone. Anyone under age five or over age 65 should head straight for the ER because treatment can be more complicated.
Broken bones can be highly emergent, so if your child seems to have suffered a break, feel no guilt about taking them to the emergency room.
Respiratory Distress
In December, my child had a respiratory bug. At some point, the way that she was breathing started to concern me, and I began seeking a second opinion about taking her to the ER. Of course, it was on a Saturday when pediatricians and even our local urgent care center were closed, isn’t it always?
Others encouraged me, and sure enough, she ended up transferred to the nearest big children’s hospital, admitted, and given supplemental oxygen and other treatments.
Memorial Hermann, a healthcare organization in Texas, says to differentiate between ‘difficulty breathing,’ which is mere nasal congestion, and genuine difficulty breathing, and if it’s the latter, get your child seen.
Specifically, watch for “if the spaces between the ribs are sinking in, nostrils are flaring, or skin is pale or gray.”
Serious Lacerations
Urgent Care may be a satisfactory option for stitches in some cases, but facial lacerations, especially if they “gape,” and if you have a child who will need sedation or behavioral support during the stitching, Johns Hopkins says to head straight to the ER.
For other lacerations severe enough to require stitching or any wound that won’t stop bleeding, the best treatment options may vary depending on your area. In some rural areas, the ER is the only real option for getting your child stitched up, and in other areas, there may be a pediatric Urgent Care equipped to handle it.
However, if there’s no Urgent Care available, it’s entirely appropriate to take your child to the emergency department for stitches.
Severe Mental Health Crisis
Ideally, mental health problems are taken to your (or your child’s) therapist or psychiatrist. Unfortunately, like other health emergencies, mental health crises don’t always fall during business hours.
When that happens, some great resources are available by phone or text, including the 988 lifeline available to anyone in the U.S. and the Trevor Project’s phone, text, and chat lines for LGBTQ teens.
However, when a situation is severe enough that you’re concerned your child may harm themselves or others, the University of Chicago Medicine says you should get them to the emergency room.
When Your Child Shows Signs Of Dehydration
Sometimes, relatively mild illnesses like colds and stomach bugs can result in dehydration, especially if your child feels too uncomfortable to drink water or is struggling to keep liquids down.
Under ordinary circumstances, these illnesses might not warrant a medical visit, but if your child is showing signs of dehydration, it’s time to get to the emergency room. Johns Hopkins says to watch out for symptoms “such as parched lips and mouth, absence of urination for more than 12 hours, lethargy and confusion.”
Dehydration is a serious condition, and your child may need IV fluids. Don’t hesitate to seek emergency care.
A Fever That Won’t Stop
A low-grade fever can be typical after some vaccinations, and fevers are a standard part of childhood.
Most of the time, fevers respond to medications such as Tylenol or Ibuprofen. (Always use correct dosages and consider checking with your pediatrician to be sure the medication is appropriate for your child.) It’s pretty standard to give a sick kid a dose of OTC meds and find him bouncing on the furniture within 20-30 minutes.
If the fever doesn’t go away, it’s time to check in with your doctor. Dignity Health in California, says that they begin considering a fever an emergency when it has lasted for 48 hours or is accompanied by any of the following symptoms:
Severe headache
Stiff neck
Abdominal pain
Purplish-red, dotted rash
Shortness of breath, or rapid pulse or heart rate
Confusion or hallucinations
Seizures
Dehydration
Unusual drowsiness or lethargy
A fever over 100.4 degrees in a newborn is also an emergency, the University of Chicago Medicine adds to this. That’s 38 degrees Celsius.
Head And Eye Injuries
When our local Urgent Care didn’t have a provider in the office for the day, and our regular provider couldn’t see my child until much later in the day, the nurse told us to head for the ER instead.
Why? My child’s eye was swollen and red. It turned out to be conjunctivitis — bad enough but simple to treat. However, she said that when an eye is involved, we want to get it checked out as quickly as possible, especially since we couldn’t be sure if there was a foreign object in his eye or if it had been injured somehow.
Dignity Health takes the same position: head and eye injuries, as well as burns, warrant a trip to the ER.
Suspected Poisoning, Accidental Ingestion, Or Overdose
If you think your child has consumed something harmful, contact Poison Control online or by calling 1-800-222-1222 immediately. They’re a fantastic resource for reassuring you, for instance, that diapers are made of non-toxic materials and that you shouldn’t panic if you walk into your child’s room and catch him chewing on the one he’s somehow removed. (No reason!)
However, if you’re pretty confident the substance is toxic or dangerous, like a household cleaner or an adult’s medications, or if the child shows any signs of reaction to the substance, skip Poison Control and immediately call 911 (or your local emergency number).
You’re not overreacting.
Sudden Severe & Concerning Symptoms
A sudden severe pain that isn’t going away, sudden vision problems, including blurry vision, and the sudden inability to speak or move all make Dignity Health‘s list of situations that call for immediate emergency care.
Sudden changes in vision could be signs of a stroke, a bleed inside the brain, or a tumor on the brain or optic nerve. A spinal cord injury could cause a loss of ability to move.
These symptoms, along with fainting or loss of consciousness, are all severe and serious and warrant a trip to the emergency room or a call for an ambulance.
When You’ve Sought A Second Opinion
When in doubt, reach out.
Find out if your pediatrician has a nurse hotline for out-of-hours questions. If not, one may be available in your area, and several are online. Once, when I wasn’t sure if I should head to the ER, I just googled for one and called the first number I found. It was connected to a hospital in Missouri, and I’m in North Carolina, but the kind nurse was happy to help me determine whether my situation was an emergency.
The medical professionals on these lines can help you decide, although they generally will not give medical advice. Once, one told me, “I can’t advise you not to go to the ER for a jelly bean stuck in a child’s nostril, but I can tell you they’re made of sugar and sometimes will just dissolve and fall out if you apply warm water.”
You may even be able to call local emergency services for advice on whether the current situation warrants a visit.
