HOUSE CALL: Is it an emergency, or can it wait?


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When should you take your child to the emergency room, versus waiting to see your pediatrician during office hours? In general, one should err on the side of going to the ER.

To help you decide, below is a list of reasons to head to the ER. If you're still unsure if your child warrants an ER visit, call your pediatrician or his or her after-hours number.

Go to the ER if your child experiences:

• Head or neck injuries, especially with loss of consciousness or vomiting.

• Severe cuts; profuse bleeding.

• Fever — for babies under 1 year old, seek attention if the fever is above 100 degrees. If older than 1, a fever alone is rarely a reason to go.

• Breathing issues — if your child is working too hard to breathe, wheezing, choking, turning blue around the lips; short of breath.

• Dehydration — profuse vomiting, diarrhea or if your child is too ill to drink fluids. Try to rehydrate with slow sips of liquid.

• Behavior changes — lethargic and less alert; crying babies who seem more uncomfortable when being held or who cannot be consoled for an hour or more.

• Severe burns (chemical or electrical).

• Possible poisoning: ingestion of medicines, chemicals or hazardous substances. Call Poison Control at 314-772-5200 immediately and follow their instructions prior to going to the ER.

• Severe animal or insect bites — especially when skin is broken or there's an allergic reaction.

• Convulsions.

• Signs of shock — cold, clammy, pale skin and a weak or rapid pulse.

• Extreme headache with vomiting or a stiff neck. 

Or, if your instincts tell you something is wrong and you're afraid to wait to see your pediatrician, go to the ER. If your child needs immediate attention, call 911.

Choosing an ER

Children can react differently to treatment than adults. You may want to consider an ER that specializes in pediatric care. Pediatric ERs understand the disease processes of children and the differences in treatment, and they focus on making the experience less traumatic. If your child should need a pediatric specialist, he or she can be taken directly to a children's hospital.

If you decide your child needs to go to the ER:

• Know his or her medical history, immunizations and allergies, and bring medication bottles.

• Bring a favorite stuffed animal, blanket or book to help comfort your child.

• If possible, have another adult stay home with siblings.

• Do not allow the child to eat or drink anything on the way to the ER. Treatment may require sedation, which necessitates an empty stomach for four hours.

If you're leaving town Most parents don't realize that if their child is hurt while they're traveling, treatment cannot be initiated until parents have been contacted, except in a dire emergency, without a notarized "permission to treat" form.

Provide temporary caregivers with the notarized form and a written medical history of immunizations, medications and allergies.

Being prepared is one of the best things a parent can do.

Dr. Kelly Ross is director of Pediatric Hospitalist Medicine at Missouri Baptist Medical Center.

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