When Should I Take My Child to the ER?

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At Westchester Health Pediatrics, we know that parents have a natural tendency to fear the worst when it comes to their children’s illnesses or injuries, often rushing them off to the ER for a minor scrape or sinus infection when they would have been better served at their pediatrician’s office where we personally know their child and his/her health history. (Believe us, we’ve seen it all.)

However, having said that, there are times when you should take your child directly to your nearest emergency room. How do you know which are those times? Hopefully this blog will help.

The ER versus your pediatrician’s office

Lauren Adler, MD, FAAP

Some situations are no-brainers, but many fall in a grey zone of uncertainty. The choice of ER vs. doctor’s office can be particularly tricky when it comes to infants and young children, whose unique physiology dictates different levels of clinical assessment and treatment approaches from older children.

For example, a fever is always considered an emergency in infants under 2 months of age, but it’s less of a concern in toddlers or children.

On the other hand, a fair number of children with broken bones are brought to our WHP offices when they should go to the ER.  We can only deal with the simplest and most minor of fractures, and many fractures (especially ones with a displaced bone) often require realignment under sedation, which is not something pediatricians can do.

The exception are children with chronic conditions, such as asthma, cancer, congenital heart disease or sickle cell disease, which cause patients with even benign viral illnesses to be particularly susceptible to dangerous complications.

The downside of the ER

Sparing yourself and your child an unnecessary trip to the ER is not just a matter of convenience. Here’s why:

  1. A visit to the ER can expose your already sick kid to ever-present hospital germs and other infections carried by everyone there in the ER (not just the patients but also the families waiting for the patients to be seen).
  2. ER care is almost always going to be more expensive than going to your own pediatrician.
  3. Emergency departments are, by definition, designed to care for the sickest or most seriously injured patients first, meaning that those with less severe illnesses or injuries will have longer waits.
  4. In an ER, your child is a stranger, but here at WHP, we know your child personally, as well as his/her health history, family history, record of immunizations, risk factors, mental health issues, STDs and any other related health conditions. We strongly feel that this enables us to give more accurate, more informed and more compassionate care.

First, call your pediatrician

When your child is ill or injured, your first step should always be to call your pediatrician’s office or an after-hours answering service to discuss the symptoms with a qualified physician.

Head straight to the ER if your child:

  • is less than 2 months old and has a fever. Fever is defined as a (rectal) temperature of 100.4 degrees Fahrenheit or higher
  • has a broken bone, particularly if there is visible swelling or unevenness/bumps in the injured area (a sign that the broken bone is misaligned)
  • hits his/her head and appears to pass out or lose consciousness for a few seconds
  • has had a seizure
  • is showing signs of dehydration, such as very dry/cracked lips and mouth, absence of urination for more than 12 hours, lethargy and confusion
  • has heavy, fast breathing, is gasping for air or manages to utter only 2-3 words before taking a breath
  • has gaping cuts on the face, especially younger children who need sedation while the injury is being repaired

Consider your pediatrician instead of the ER if your child:

  • has fever accompanied by cold symptoms and you suspect it may be the flu
  • maybe has an ear infection—symptoms include drainage from the ear, ear ache and pulling on the ears
  • has a sore throat with or without white patches on the tonsils, a possible sign of strep infection
  • has pink eye (conjunctivitis)—symptoms include red, inflamed eyes with or without discharge
  • has had a few episodes of vomiting or diarrhea (without blood in the stool) but has no belly pain or signs of dehydration

For guidelines concerning when to take your child to the ER, please come see us

If you think your child is experiencing a true emergency, call 911 immediately.

On the other hand, if you feel your child needs to be seen right away but it’s not an urgent emergency, come in and see one of our pediatricians at Westchester Health Pediatrics. We will try our very best to see your child as soon as possible, evaluate the symptoms, and diagnose and treat the problem so your child can feel better soon. In addition, if we feel your child should indeed go to the ER, or needs to see a specialist, we’ll speed that process along right away. Whenever, wherever you need us, we’re here for you.

Make an appt

By Lauren Adler, MD, FAAP, pediatrician with Westchester Health Pediatrics, member of Northwell Health Physician Partners

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About the Author: ML Ball