When to take your child to the emergency room

Sometimes it’s hard to tell what to do when a child gets sick at night or on weekends. Should you go to the emergency room, or wait until the pediatrician’s office is open again?
Aug 27, 2014

Sometimes it’s hard to tell what to do when a child gets sick at night or on weekends. Should you go to the emergency room, or wait until the pediatrician’s office is open again?

“I deal with that question as a doctor who takes care of children, I deal with it as the parent of three young boys, and I sometimes even hear from friends who are concerned about a sick child during ‘off hours,’” said Maya Neeley, M.D., assistant professor of Pediatrics at Vanderbilt University Medical Center.

The first thing to know is there are clearly times when a child needs to get emergency attention immediately. The American Academy of Pediatrics says to seek emergency care immediately if your child:

• is acting strangely or becoming more withdrawn and less alert.

• is becoming less and less responsive.

• is unconscious.

• has rhythmic jerking and loss of consciousness.

• has increasing trouble breathing.

• has a change in their skin or lip color to dusky or blue/gray.

• has neck stiffness or rash with a fever.

• has uncontrolled or persistent pain.

• has a severe cut or burn, especially on the head.

• has bleeding that does not stop after applying pressure for 5 minutes.

• has a head injury accompanied by loss of consciousness, confusion, severe headache or vomiting.

• has been the victim of sexual abuse.

Other conditions that require emergency care are compound fractures ( a broken bone that is visible), smoke inhalation and poisoning.

But most situations are less serious than these examples, and for those borderline situations, here are some things to think about.

Your pediatrician or family practitioner knows your child and his or her medical history well and can handle most illnesses. Most offices also have after-hours doctors or nurses on call that can help you decide what to do in the middle of the night or on a weekend.

“Your primary doctor also has continuity of care with your child. Recently, one of my sons was diagnosed with bronchiolitis; our pediatrician called the day after our visit to check on him and we followed up in the office again a few days later. If you go to an emergency room, you’ll probably see different providers on different visits,” Neeley said.

The Monroe Carell Jr. Children’s Hospital at Vanderbilt also has several After Hours clinics in Hendersonville, Mt. Juliet and Spring Hill to help bridge the gap when your pediatrician does not have office hours, but you don’t want to make a trip to the emergency department. And sometimes your doctor might see you in the office and refer you to an emergency department anyway if the situation is serious.

But keep in mind the emergency department also has advantages that most local pediatricians’ offices do not, such as imaging equipment, the ability to perform complex procedures, check blood work, easily start IVs and provide medications. Moreover, the doctors there have specific training in emergency medicine.

“One recent weekend I received a call from a friend asking if she should take her daughter who was ill with a fever and cough into the emergency department or wait it out and go see her primary care doctor on Monday,” Neeley said. “I basically applied these guidelines, and after asking a few questions, I recommended that she continue supportive care (fever reducer, fluids, rest and extra cuddle time) over the weekend and take her into the pediatrician’s office Monday morning.”

Neeley also offered these tips:

Every parent should have (800) 222-1222, the number of the poison control center, on hand, and should call immediately if you suspect your child has ingested a poison or medication.

Sometimes you can bring your child to the emergency department by car, but if there is serious danger, call 911.

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