If you have ever spent long, anxiety-filled hours waiting for your child to be seen in an emergency department, you are not alone. Emergency departments see more than 30 million children every year. They have become a safety net, caring for increasing numbers of more complex patients because they are accessible, open around the clock and available without appointment or regard to social or economic status.
Although hospitals and caregivers struggle to provide high-quality, efficient, patient-oriented care, it appears, at times, that they are losing the battle. Too often, providing that care involves waits in overcrowded environments. For true emergencies, hospital ER visits are necessities. But in many situations, knowledgeable parents may be able to provide care at home or through their pediatricians' offices.
The American Academy of Pediatrics says that a true emergency exists "when you believe a severe injury or illness is threatening your child's life, or may cause permanent harm." The emergency may follow an accident, drowning, choking, poisoning, a newly emerging medical illness, or deterioration of a chronic disease process.
The following information may help a nervous parent safely differentiate a true emergency from a routine accident or illness. Always have your child seen urgently if the following conditions exist:
ÔÇ¢ Loss of consciousness, progressive loss of alertness and decreasing responsiveness.
ÔÇ¢ Unexpected or increasing difficulty breathing.
ÔÇ¢ Bleeding that does not stop after five to seven minutes of pressure.
ÔÇ¢ Loss of consciousness and severe shaking or seizures.
ÔÇ¢ A serious and deep cut or burn.
ÔÇ¢ Severe pain that gets worse over time rather than improving.
ÔÇ¢ Loss of use of an arm or leg
ÔÇ¢ A severe headache, with vomiting that persists and worsens.
When these symptoms exist, call your physician and make plans to head to an emergency room. Consider calling 911 if you feel you cannot safely transport your child, believe he or she may deteriorate en route, or when traffic or weather conditions could unduly delay arrival at the hospital.
Fever, vomiting, and/or diarrhea are not, in most cases "true emergencies," and deserve thoughtful consideration before heading to the ER. Consider the following:
ÔÇ¢ Until a temperature exceeds 100.4 degrees, it is not considered a fever. Fevers, even at 104 degrees, do not by themselves cause harm and are, in most cases, related to viral infections.
ÔÇ¢ When a fever does exist, unless the symptoms listed above are present, treat with acetaminophen or ibuprofen.
ÔÇ¢ If a fever persists for 24 hours, call your pediatrician for advice.
ÔÇ¢ Vomiting and diarrhea are very common, especially in the summer months, and usually respond to frequent feedings of clear liquids. Avoid grape and apple juice, as these clear liquids may cause an increase in diarrhea in some children.
ÔÇ¢ If clear liquids aren't tolerated, and the vomiting and diarrhea are unremitting, call your pediatrician or go to the emergency room.
ÔÇ¢ If however, baby's diapers are dry for six to eight hours, his or her tongue and mucous membranes are dry and eyes are sunken, go to the emergency room.
Worried parents, anxious to err on the side of caution, too often unnecessarily join those waiting for care in emergency rooms and actually expose their children to infectious diseases. For true emergencies, call 911 or get to an emergency room quickly. If not, think things through and, if uncertain, call your pediatrician for advice.
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Dr. Edward Bailey is chief of pediatrics at NSMC North Shore Children's Hospital and is on staff at Massachusetts General Hospital for Children. He is married and the father of three. You can contact him at enbailey@aap.org.
