When to take your child to the ER
Watch your child’s behaviour, not just the thermometer, to know if visit is necessary
Every year in late December, a perfect storm hits children’s emergency rooms all over the GTA. Two nasty viruses reach their peak in the population just as family doctors reduce their hours so staff can enjoy the holidays.
At the Hospital for Sick Children (Sick Kids), where I’m an emergency physician, our volume increases by up to a third between Christmas and New Year’s Day, mostly because of high fevers and worried parents who don’t know where else to go. The misery of sickness is compounded by unusually long waits caused by the overload.
It can be confusing for parents to know what a true emergency is and when it’s OK to wait and keep an eye on a sick or injured child. I hope these tips help you and your family have a happier holiday season — but remember, if you need the ER, don’t hesitate. It’s your right to seek and receive help if you feel it is needed.
Fever: the No. 1panic-inducer
I’m much more interested in how a child with a high fever is behaving than the number on the thermometer. If an otherwise healthy and fully vaccinated 2-year-old boy is running around the house happy, I’m not worried that his temperature is 39 C. But if that same child is lethargic and not taking in fluids, I want to see him.
Babies are different. If yours is younger than 2 months old and her temperature is higher than 38 C, she should be seen that day by a doctor, walk-in clinic or, if all else fails, the local hospital emergency room. If she’s older than 2 months old, but younger than 6 months, take action when her temperature hits 39 C to rule out a bacterial infection that requires antibiotics. Again, if her doctor is unavailable, walk-in clinics are fine.
Breathing seems laboured
If a young baby is breathing very fast — more than 60 times a minute — or rapid breathing is making it hard for him to drink, see a doctor that day to check for pneumonia. An older child with laboured breathing that does not resolve with rest, or if accompanied by high fever or chest pain, should be seen that same day as well. Vomiting: how much is too much? Babies or children with a bad cough will probably also vomit intermittently because the two impulses are connected by the same nerve. And kids with the flu vomit too — all normal. Symptoms that warrant sameday attention: if a child is vomiting so much that bile starts to come up (i.e. bright green or bright yellow discharge), or if they’re vomiting blood. If she hasn’t been able to drink in many hours, or hasn’t urinated in the previous eight to 12 hours, see a doctor.
Injuries: is it broken?
If the bleeding has stopped, nothing feels numb, the child can move the injured body part and the pain can be controlled with over-the-counter medicine, skip the ER and see a doctor in a couple of days if you’re still concerned. If, however, there’s any numbness (the child can’t feel his fingers, for example), or there’s a lot of swelling, severe pain or the body part looks deformed, get the child evaluated immediately.
When a child hits her head, there are a few things to consider. If she fell down from a standing height (i.e. she didn’t fall off something, she just fell down), this is typically not a highrisk situation. You would expect a bump or bruise, pain and crying — or possibly even vomiting once. If you treat with ice and ibuprofen, and an hour later the child is running around like normal, there’s no reason to worry. If she seems fine, can respond verbally, can use her muscles and there’s nothing wrong with her vision, hearing or walking, skip the ER.
I become concerned about head injuries when a child falls from a height of 1.5 metres or more, or when the injury appears to be getting worse, not better. Also, if the child vomits more than once, a doctor needs to see her that day. If her pain is getting worse, or if she seems not herself, if her vision, hearing or walking seem off, or if she can’t use her limbs properly, get her evaluated.
Any baby younger than 3 months who hits his head hard enough to get a visible bump should be seen that day.
As parents, you don’t need to be experts in emergency medicine, but you are experts in your child. Listen to your instincts in determining whether something is urgently wrong with your child’s health — you are almost always right.
For further help, check Sick Kids’ website aboutkidshealth.ca or the emergency information published by the American Academy of Pediatrics (patiented.solutions.aap.org/handouts.aspx). You can also call Telehealth Ontario to speak with a nurse: 1-866-797-0000. Dr. Stephen Porter is an emergency room physician at the Hospital for Sick Children and associate professor in U of T’s Department of Paediatrics. Doctors’ Notes is a weekly column by members of the U of T Faculty of Medicine; email doctorsnotes@thestar.ca.