As both a pediatrician working in an emergency department and as a parent, I’ve heard, answered and even asked the age-old question: “When should I take my child to the ER?” No doubt, being caught in the grip of a situation that prompts this question can be particularly confusing for first-time parents and those with newborns, as well as in extreme conditions when fear, fatigue and frustration tend to emerge.
While not an uncommon question, the answer is rarely clear and common. There’s no real one-size-fits-all response, regardless if your child is an infant, toddler or adolescent. Rather, I advise parents to trust their instincts and never hesitate to visit the ER when in doubt. As a health care provider, I recognize it’s in the parental nature to seek out a higher, more immediate level of care in times when emotions are heightened.
Your pediatrician or family physician can best educate you about telling symptoms to look for when discerning a true medical emergency. However, you should be aware there are incidents when such symptoms can surface, albeit not as obviously or quickly, and may even appear non-threatening. These less-than-obvious times should prompt a parent to seek emergency treatment at the ER for their child, as they could be potentially serious in nature.
Recognizing some of the less recognizable symptoms
For example, a child can accidentally ingest water from a brief submersion in a swimming pool or bathtub. It happens all the time and a parent might not even realize it. Everything seems perfectly normal. But hours later, a coughing spurt begins—a huge red flag. This could be a sign of “delayed drowning” that manifests eight hours or longer after. In addition to coughing, a parent should look for signs of extreme fatigue or change in skin color to a pale/bluish hue. If left untreated, inflammation of the lungs can occur. But if caught on time, treatment can be as simple as receiving supplemental oxygen.
Recently, I cared for a young girl who had signs of delayed drowning when brought to the ER. She went underwater, came up and choked briefly. She was seemingly fine. Many hours later after returning home, she became very lethargic, followed by rapid breathing and coughing. Thankfully, she was brought to the ER in enough time to receive respiratory support. But, if she didn’t come to the ER or did so much later, there could have been far more extreme complications and required treatment. Time can often be of the essence.
Abdominal trauma or chest pain in children– more common than you may realize
We all know that children sometimes play rough. Contact sports, such as football or wrestling, leave kids prone to abdominal injuries. But so too can even riding a bicycle. I’ve seen so many children brought to the ER who’ve toppled over their bike’s handlebars. They get an ache that’s not immediately strong. But time goes by and the pain continues. In this instance, bring your child to the ER as quickly as possible. A simple ultrasound or other imaging will prevent or uncover a potential injury to the spleen, liver or other internal organs.
This also goes for chest pains in young children of all age groups. Simply put, do not ignore them. Bring your child to the ER and we can check for anything from a routine chest cold to severe pneumonia or potential heart abnormalities such as an arrhythmia or inflammation. With both abdominal and chest pains, better safe than sorry. A trip to the ER when symptoms arise is a trip well spent.
Not just isolated to adults – listen to and watch your child’s symptoms
While certainly more common in adults and adolescents, when it comes to young children you can’t ignore certain symptoms more specifically associated with gender. For example, if your son is experiencing testicular pain, do not wait to bring him to the ER. In a condition known as testicular torsion, blood supply to the affected testicle can become compromised. If not taken care of within hours, severe permanent injury can occur to the organ.
Similarly, lower pelvic pain that your daughter complains of that is severe in nature should be evaluated immediately at the ER. The condition known as an ovarian torsion, where blood supply to the ovary is compromised, is something we would have to rule out quickly to prevent permanent loss. In addition, an ovarian cyst can present in even pre-pubertal females. Diagnosing this is very important, as large cysts could potentially affect the ovary.
Often, an isolated symptom—such as fever, cramping or body aches—might not always require a trip to the ER. But when multiple or persistent symptoms arise at the same time, let those parental instincts take charge. For instance, watch out for: severe headaches or head injuries with associated vomiting; severe fever, plus vomiting and neck pain; or persistent vomiting after exposure to a new food group, along with a rash and difficult breathing which could be a sign of a severe allergic reaction. With newborns, a fever of 100.4 degrees or higher is a clear signal to visit the ER, as is excessive lethargy or inconsolable crying.
Sanjay Mehta, DO, FAAP is a board-certified pediatrician who serves as division chief of the Pediatric Emergency Department at CentraState Medical Center and a physician at Central Jersey Emergency Medicine Associates. Dr. Mehta can be reached by calling 732-294-2666.