When to Bring Your Child to the Emergency Room

May 13 , 2008
When to Bring Your Child to the Emergency Room
Amy Movius MD

What is an emergency?  Aside from the obvious major accident, it can be harder than you’d think to decide, especially for a child who may not be able to clearly communicate how they are feeling.  And let’s face it, emergency room visits aren’t fun.  There’s often hours of waiting involved and significant expense, even for those with health insurance.  Using expensive emergency services wisely is also important for our community as a whole to keep health care costs in check, especially in our state having one of the highest medical costs per individual in the country.

Accidents are a common reason to need emergency room treatment.  Some of these are listed below:

1. Car/bike accident, fall or other accident with major impact (any “big bump”).
2. Poisoning.  In toddlers this is usually accidental, but in older children it may be intentional as well.
3. Large/deep burns or smoke inhalation.
4. Choking.
5. Near-Drowning.
6. Any injury involving a firearm or other weapon.
7. Electrical shock.

Much of the above list may seem obvious, but there are medical illnesses and other injuries which require emergency services.  Some of these are listed below:

1. Any concern for seizure (twitching movements +/- loss of consciousness).
2. Unconsciousness.
3. Lip or skin color that appears blue, purple, or grey.
4. Any burn involving the hands, feet, groin, chest, or face.
5. Any loose or knocked out teeth or other significant mouth or facial injuries.
6. Severe or worsening shortness of breath/trouble breathing.
7. Lethargy or decreased responsiveness.
8. Unusual or strange behavior.
9. Bleeding that doesn’t stop after 5 minutes of constant pressure.
10. Persistent pain that is severe or increasing.
11. Altered mental status, bad headache, or vomiting after a head injury.
12. Neck stiffness with a rash or fever.

Fortunately, it is rare for children to become seriously ill without warning.

With the exception of major accidents, you can usually call your regular doctor first.  For most medical conditions, timely evaluation and treatment can prevent worsening to something more severe and emergent.

It is a good idea to speak with your health provider during a routine visit about what to do and where to go if your child needs emergency services. A true emergency is defined as any condition you feel threatens your child’s life or risks permanent harm.  For this you should call 911 or your local EMS/emergency service. Have a list of these phone numbers at hand including poison control.  If you do need to go to an emergency room, always bring a list of your child’s immunizations and any medications they takes (or may have ingested).  If your child has special needs, it is very helpful to have an EIF, or Emergency Information Form which you should give to the first emergency personnel you see.  Lastly, doing what you can to prepare for the unlikely event of an emergency can be lifesaving; to this end every caretaker could benefit from knowing CPR and basic first aid.

References and Resources:

1. American Academy of Pediatrics Parenting Corner Q & A:  Emergencies (www.aap.org)
2. The Injury Prevention Program (TIPPs); American Academy of Pediatrics (www.aap.org)
3. Poison Control Center 1-800-222-1222
4. For EIF forms American Academy of Pediatrics or American College of Emergency Physicians (www.aap.org or www.acep.org)
5. For First Aid/CPR classes:  Pine Tree Red Cross 33 Mildred Avenue.  Bangor ME 04401 (207) 941-2903