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Kids’ Emergencies

Top reasons for taking your little one to the Emergency Room.

The clock says 4 a.m. Your five-year-old is crying and has kept you up most of the night. You’re worried. He has a slight fever, seems congested, and is breathing too rapidly. He looks so weak and little. You feel helpless.

Should you go to the emergency room or wait a few hours and call your pediatrician’s office?

Parents always want to do what’s best for their child. This means learning the warning signs beforehand of what makes for an urgent situation. “In general, one should err on the side of ‘going’ when deciding whether to go to the ER,” said Kelly Ross, MD, a pediatrician at St. Louis Children’s Hospital and director of pediatric hospitalist medicine at Missouri Baptist. “At the same time, if you don’t need to be at the ER, and if your child is able to wait to see your pediatrician, you can save time and money.

“When in doubt, the best approach is to call your pediatrician. A large part of your pediatrician’s role is to guide you in your decisions.”

How A Parent Can Help.

If you decide your child needs emergency care, Dr. Ross has four suggestions to make the visit a little easier.

“First, know your child’s medical history, immunizations, medications and allergies.
Second, bring a favorite stuffed animal, blanket or book, to help comfort your child.”
Third, Dr. Ross suggests, if possible, have another adult stay home with siblings.
“And fourth, do not allow the child to eat or drink anything on the way to the ER,” said Dr. Ross. “Treatment may require sedation, which necessitates an empty stomach for four hours. If your child eats en route, the clock starts from the last bite or drink.”

When To Go To ER.

These are some of the warning signs that tell us it’s time to head straight to the ER:

  • Head or neck injuries, especially with loss of consciousness or vomiting.
  • Severe cuts; profuse bleeding.
  • Fever: if under one-year-old and above 100 degrees. If older than one year, a fever alone is rarely a reason to go to the ER.
  • Breathing issues: if your child is working too hard to breathe, wheezing, choking, or turning blue around the lips. A child who is short of breath uses the stomach and neck muscles to get a deeper breath.
  • Dehydration: if your child has been vomiting, or is too ill to drink fluids. (Tip: try to rehydrate the child at home with slow sips of liquid rather than a full glass, which could trigger vomiting).
  • Behavior Changes: if you notice significant changes, or if your child is lethargic and less alert. Crying babies who seem more uncomfortable when being held, or who cannot be consoled for greater than an hour, warrant an emergency visit.
  • Severe burns (chemical or electrical).
  • Possible poisoning: ingestion of medicines, dangerous chemicals, or hazardous substances (Note: immediately call Poison Control 314-772-5200).
  • Severe animal or insect bites: especially if the skin is broken or the child is having an allergic reaction.
  • Convulsions.
  • Signs of shock, including cold, clammy, pale skin and a weak or rapid pulse.
  • Extreme headache with vomiting or stiff neck.
  • Instinct! If you just know something is wrong and you are afraid to wait to see your pediatrician, then the ER may be the right choice. If you need help in getting your child there, or if your child needs immediate medical attention, call 911.

Choosing A Pediatric ER.

An emergency room that specializes in children is best. St. Louis Children’s Hospital recently opened a pediatric ER at Missouri Baptist, staffed by Washington University pediatricians, and pediatric nurses. “Pediatric emergency rooms understand the disease processes of children and the differences in treatment,” said Dr. Ross, “so when possible, it’s best to take a child to a pediatric ER.” “In addition, pediatric emergency rooms focus on making the experience less traumatic. One way to accomplish this is decreasing painful procedures. Nitrous oxide, commonly known as ‘laughing gas,’ is available at our pediatric ER as a sedation, which means no-pain sedation for children who need it,” added Dr. Ross.

“If your child should need a pediatric specialist, we have the ability to transport them directly to St. Louis Children’s Hospital – one of the best in the nation, “said Dr. Ross

Don't Leave Home Without It

Most schools and camps require a child’s medical information. Be sure to provide as much detail as possible with your contact information and preferred hospital.

If you’re leaving your child with a babysitter, or your child is going out of- town without you, provide the temporary caregivers with two items:

  1. A notarized “permission to treat” form.
  2. A written medical history of immunizations, medications and allergies

“Most parents don’t realize that if their child is hurt when traveling, treatment cannot be initiated until the parents have been contacted, or except in a dire emergency, without a notarized “permission to treat” form,” said Dr. Ross.

“We work hard to take the stress out of your visit to our emergency room. Being prepared is one of the best things a parent can do,” said Dr. Ross.

Dr. Kelly Ross is a board-certified pediatrician and director of pediatric hospitalist medicine at Missouri Baptist Medical Center. She is on staff at Missouri Baptist Medical Center and St. Louis Children’s Hospital. She received her medical degree from the University of Missouri School of Medicine in Columbia, and completed her internship and residency at Duke University Hospital





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