When to go to the Emergency Room

The emergency room at your local hospital is an invaluable resource – for emergencies.  What constitutes an emergency?  When should you take your child to the E.R?  When should you wait it out and see your pediatrician?  Answering these questions can sometimes be a tough call; here are some general guidelines if unsure.

Fever:  Fever is the body’s way of fighting infection.  Fever is defined as a rectal temperature of 100.4 or higher.  Low grade fever is 100.5 – 102.5, and high fever is over 102.5.  When is the fever “dangerous?”  When it causes the child to be so lethargic that he won’t drink and risks dehydration.  When it makes him so uncomfortable that you cannot assess how he’s feeling.  When it comes along with other concerning signs:  difficulty breathing, decreased urination, stiff neck, persistent vomiting, rash.  People often ask about seizures or brain damage; rapid changes in body temperature can bring on seizures, but only in those who are prone to seizures.  And brain damage from fever alone does not occur unless the body temperature remains very high (over 105) for a long time.  So, if you child has a “99,” and is in no distress, but you’re concerned, call the doctor for advice, or make an appointment to be seen.  Save the trip to the E.R. for the prolonged, high fevers with other worrisome signs or symptoms.  *Note: ANY fever in a baby six weeks or younger should be seen immediately.

Cough:  Cough is the body’s attempt to clear the airways.  If the cough is accompanied by fast breathing, shortness of breath, severe chest pain, or color change, the child should be seen right away.  If the doctor’s office is not open or easily accessible, that’s the time to head to the E.R., especially if your child has asthma. However, a mild cough, with a runny nose, in an otherwise happy child, can wait to be seen.  We don’t recommend over-the-counter cough medications for young children, as they often don’t work well and can have side effects.

Allergic reaction:  An allergic reaction that presents as facial/lip swelling, trouble breathing, dizziness/fainting, etc., is a reason to go to the E.R. (or call 9-1-1 if necessary).  However, a localized rash with no respiratory involvement can usually wait for the doctor’s office.  Children with a history of allergy to insect stings, foods, medications, etc., that are severe,  should be seen immediately; those children should also generally have access to epinephrine auto-injectors, to be used in emergencies…and they should always be seen in the E.R. setting immediately after use, as the symptoms can return when the shot wears off.

Fainting/loss of conscious:  If a child passes out, she should go to the E.R.  While many such episodes of fainting are caused by overheating or stress, etc., sometimes the cause is something more serious.  Labwork or imaging are sometimes necessary to determine the cause, and that’s not something that should wait.

Trauma/bleeding:  Any significant trauma, especially head trauma, should be seen in the E.R.  Possible fractures, lacerations, etc. often need emergency care.  Many doctor’s offices are not equipped to handle trauma, so the E.R. is usually the best way to go.

Highly contagious illness:  If you suspect your child has a highly contagious illness, you should call before coming in.  Often, doctor’s offices do not have isolation facilities, whereas hospitals usually do.  Caution:  especially in light of recent events, if you think a highly contagious disease is possible, CALL the E.R. first to determine the best way to go, which entrance to use, etc.  The element of surprise is not a good thing in this type of situation.

Hopefully these brief suggestions will help to guide your decision on whether or not to utilize the E.R.  You can always call your doctor’s office for advice.  Save the E.R. visits for more urgent concerns, but, for safety, always err on the side of caution.


Image via Flickr User Nafis Zebarjadi