Whatcom doctor’s advice on when to wait, when to talke child to the ER

It’s parent’s worst nightmare. It’s midnight. Your child is sick or injured. The decision needs to be made — go to an emergency room or wait until morning to see your regular pediatrician.

Dr. M. Greg Thompson, a pediatrician with PeaceHealth Medical Group in Bellingham, said there are some guidelines to follow to help parents rest easier when trying to decide if an illness is serious enough for a trip to the hospital ER.

How to evaluate whether a child needs immediate emergency care

Thompson said parents of children with ongoing or chronic illnesses, including those with immune deficiency, should speak frankly with their doctors before an emergency to know when their child will potentially need immediate care. If your child is otherwise healthy, the decision may be murkier.

Thompson said in his practice it’s often best to talk to your doctor’s nurse triage phone line first if it is not clear that the child is in a life-threatening or imminent emergency.

When in doubt, getting in touch with the doctor on-call through a pediatrician’s message service or insurance company’s “nurse-advice” line is a the best way to determine whether your child is in a true emergency.

Why wait?

Going to the emergency room isn’t always the best option, even just as a safety precaution, Thompson said. If a child is not truly in need of immediate care, you and your sick child could wait for several hours to be seen by a doctor as they take the most serious cases first, Thompson said. And, bringing an ill child to a hospital could expose your own child to other illnesses in the waiting room as well as leave others exposed to a the bug from which your child is suffering. There’s also a hefty price tag on emergency care and potentially frightening scenes for children as people are brought into the ER in for traumatic injuries, intoxication or out-of-control behavior.

Thompson offers some advice in the case of several common medical concerns:

Fever: For infants younger than three months old, an emergency may creep up quicker than for older children. A fever of 100.4 degrees or higher in a newborn is an immediate sign of an emergency, Thompson said. “They should be evaluated right away,” he said.

Physicians need to rule out potential illnesses like meningitis, a kidney infection or sepsis, Thompson said. It’s often confusing for parents dealing with older children who are feverish, or vomiting, or generally unwell.

“If they are older than three months and have a fever, but are eating and drinking normally, breathing comfortably, and don’t appear lethargic or dehydrated, we usually don’t need to see them that quickly,” Thompson said. If they seem lethargic — which Thompson said means they are not responding or have trouble waking up — they should be seen immediately to rule out more serious issues. Symptoms of dehydration can include cold hands and feet, not urinating at least three times in a day, or a sunken in spot on an infant’s head.

Asthma: If a child is having trouble breathing, wheezing or making a high-pitched or whistling sound when breathing, they might be in the midst of their first asthma attack. “If it’s their first time experiencing asthma, they should be seen right away — either in the ER or their regular doctor’s office if they can get in quickly,” Thompson said. Other symptoms include a bluish color on their lips, seeing their chest pull in as they breathe or a frightened look on a child’s face as they struggle to take a breath. If a child turns blue or does not respond, call 911.

Animal (including human) bites: A doctor should evaluate any animal or human bite that breaks the skin, Thompson said, especially bites to the face or hands. While most bites can be seen in a doctor’s office or a clinic, the bite mark and the situation must be evaluated to determine if the wound is a high risk for infection or the child was exposed to rabies, mostly in the case of wild animal bites.

Sprains, strains and breaks: Generally, Thompson said, parents should be concerned that a leg injury might be a break, not a sprain, if the child is not able to bear weight on the leg or cannot take at least four steps within a few hours of the injury.

In his own practice, Thompson said the only patients who would need to be treated in the ER are those who need surgery or sedation to set the bone. If you are unsure if an injury is a sprain or break, it’s not necessarily a problem to wait a few hours until your regular pediatrician’s office is open before getting treatment. But if a bone or limb seems misshapen or is protruding from an injury, an emergency room visit is necessary.

Cuts and wounds: A cut or wound that is gaping open needs to be seen by a physician immediately, Thompson said. And any wound that does not stop bleeding after five to 10 minutes of direct pressure should be seen by either their regular doctor, or if during off-hours, an emergency room physician. A cut that exposes muscle or bone also needs to be seen by a doctor immediately since more extensive care is likely needed.

Head injuries and headaches: Parents need to monitor sports injuries or simple accidents that result in head trauma. The biggest concern, Thompson said, is both the possibility of concussion or bleeding inside the brain. After the injury, parents should look for confusion, crossed eyes, slurred speech or persistent vomiting. Vomiting just once is not necessarily an indication of a concussion, Thompson said. Very rarely, symptoms of bleeding in the skull can show up several days after the initial injury.

Headaches can also be a concern if the pain of the headache continues to intensify and is not relieved with over-the-counter medication. Vomiting persistently in association with the a headache or unrelenting pain may require a clinic or emergency room visit, particularly if they do not have a history of migraine headaches.

Seizures: A child who has a first-time seizure should be seen by a doctor within a few hours, Thompson said. Seizures are often benign, and sometimes occur when a child has a fever, usually in children under five years old. EMS should be called if a seizure does not stop after a few minutes or if a child is not breathing during or after a seizure. If you child does have a seizure, Thompson said they should not be restrained and nothing should be put in their mouth.

Poison: Calling the American Association of Poison Control Centers at 1-800-222-1222 connects a person directly with trained staff who can help evaluate what a child has swallowed and determine if they need medical treatment. The call should be the first step if a child swallows an unknown or poisonous substance, even if they are acting normally. Call 911 if a child has trouble breathing, has mental confusion or persistent vomiting after swallowing a hazardous substance or has potential food poisoning, Thompson said.