Before You Call 911
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Before You Call 911

When does a child's medical problem require a trip to the ER? LHJ asked top pediatricians.

Knowing When You Need a Doctor

Your child falls off the jungle gym and hits his head. Does he have a concussion or just a bump? It's Sunday afternoon and your baby is running a temperature of 104 degrees F. Should you go to the emergency room or the medicine cabinet? Your teenager's cut is gushing blood. Does it need a bandage or stitches? Here are some common children's medical problems and when you need to seek help:

1. Burns

The problem: Fires and burns are the third-leading cause of unintentional death in children, according to the National Safety Council. First-degree burns cause redness and swelling. Second-degree burns produce blisters. Third-degree burns appear white or charred and cause damage to underlying tissue.

When to get help: Treat first-degree burns at home with cool compresses, antibacterial ointments and pediatric pain relievers. Use those measures for second-degree burns, but if the burn involves the face, hands, genitalia or feet, take your child to the doctor because it's important the burns heal without scarring. But head for the ER if any burn is larger than your child's hand or the skin appears white or charred. Your child needs professional care and may need pain relief and infection-fighting medication. Also get immediate help for electrical and chemical burns, and for severe burns around the mouth, because your child's airways may have been affected.

2. Fever

The problem: Fever can be caused by everything from benign viral illnesses, like colds, to a serious bacterial infection, like meningitis.

When to get help: A rise in temperature can actually be a good thing because it kicks the body's disease-fighting mechanisms -- like white blood cells -- into gear.

A lot will depend not so much on the thermometer, but on how your child is acting. If your child seems comfortable, is eating, sleeping and even sometimes playing, then you might wait to see if the fever comes down on its own or with a fever-reducer, such as acetaminophen. Call your pediatrician, however, if your child is vomiting, complaining of an earache, severe neck or head pain, has a rash, suffers a seizure or isn't urinating. "Your child's symptoms take precedence over the fever," says William E. Bruno, Jr., MD, chief of staff at the Joe DiMaggio Children's Hospital, in Hollywood, Florida.

Fevers in very young children can be dangerous because they have immature immune systems and become dehydrated more easily. Call your pediatrician immediately if your child is under 10 weeks old and has a rectal temperature of 100 degrees F. or higher. Also call if your child is under two and has a rectal temperature of 101 degrees F. or higher.

3. Cuts

The problem: Cuts or wounds that puncture the skin, causing bleeding and/or damage to underlying tissue.

When to get help: Applying firm pressure for five minutes can stop most cuts from bleeding. However, if the bleeding won't stop after 10 minutes, if the cut is contaminated with glass or metal or is more than 1/2 inch long and 1/4 inch wide, your child will need stitches. Many cuts on the face require stitches to minimize scarring.

Concussion, Vomiting, Poisoning

4. Concussion

The problem: A hard blow to the head that can result in loss of consciousness.

When to get help: Many blows to the head produce nothing more than a tender bump. Others injure or bruise the brain and require immediate attention. A child who loses consciousness for more than 60 seconds, vomits repeatedly or can't be roused from sleep should be taken to the doctor. The same goes for a child who has a bump that's larger than 3 inches in diameter or who seems overly cranky or lethargic.

5. Vomiting

The problem: Children vomit for a myriad of reasons, most often because of the flu or gastrointestinal illnesses.

When to get help: Vomiting isn't a major medical worry unless it causes dehydration. If your child is vomiting everything you give her, reduce the quantity of fluids but increase the frequency. "Every fifteen or twenty minutes, give a few sips of fluid -- not water, which can be nauseating, but something like Pedialyte, an oral hydration solution," says Bruno. "Do that for three or four hours. If there's no vomiting, then increase the volume. If your child continues to vomit, call the doctor." Also contact your doctor if you notice any signs of dehydration -- the child hasn't urinated in six or more hours, has a dry mouth, sunken eyes or an absence of tears when crying. The soft spot on top of a baby's head will appear sunken if an infant becomes dehydrated.

6. Poisoning

The problem: According to a 1999 report in the American Journal of Emergency Medicine, 53 percent of poisonings involve children under the age of 6. Household chemicals and plants, prescription and over-the-counter drugs, and cosmetic items are high on the list of toxins.

When to get help: Play it safe and call the American Association of Poison Control Centers (800-222-1222) whenever your child has swallowed something not meant to be ingested. If you find your child near an open cabinet full of cleaning supplies but you're not sure what -- if anything -- he swallowed, smell the child's mouth, face and clothes. If you detect anything suspicious -- or you're simply not sure -- call poison control. Get immediate help if you notice signs of poisoning -- a staggering walk, vomiting and excessive sleeping. Never induce vomiting without the advice of poison control. Some substances, like bleach and drain cleaners, burn the esophagus on the way down -- which means they will also burn it on the way up.

Accidents, Choking

7. Motor-vehicle accidents

The problem: Car accidents are the leading cause of death among children, killing approximately 12,000 each year, according to national safety statistics.

When to get help: "Kids who are properly restrained have a low risk of injury," says Jane Knapp, MD, chair of the Committee on Pediatric Emergency Medicine of the American Academy of Pediatrics. Still, you may want to have them checked for internal injuries or head trauma. Babies should always be seen by a doctor. Ditto any child who took a blow to the head or complains of pain within a few hours after the crash. Contact your doctor if your child is crying persistently, vomiting or not moving an arm or leg.

8. Choking

The problem: Choking-related injuries send 73,000 children to the ER every year, according to the U.S. Centers for Disease Control and Prevention.

When to get help: "If your child can breathe, even if she's coughing, it's best to let her try to clear her airways," says Knapp. Coughing is the body's way of expelling a foreign object. If you interfere with it or do a finger sweep of her mouth, you could actually make the situation worse. "If, on the other hand, your child can't speak or cough, it probably means her airways are completely obstructed and you should start first aid," she says. To help a child who's choking, use the techniques described below:

Heimlich maneuver On a child over age one: Stand behind the child with your arms around his waist. Form a fist with one hand and place it, thumb side in, between his ribs and waist. Grab your fist with your other hand and give four quick inward and upward thrusts.

On an infant: Place the baby face down on your forearm, supporting her head with your hand. (You may need to rest your forearm on your leg.) With the heel of your hand, give four blows to the back between the shoulder blades.


Labored Breathing, Dog Bites

9. Labored breathing

The problem: Nearly a million children per year visit emergency rooms around the country for breathing difficulties, reports the National Center for Health Statistics. Symptoms include wheezing, shortness of breath, fast or hard breathing, and a whistling sound during exhalation. The symptoms are caused by a variety of illnesses, including asthma, croup, pneumonia and severe colds and allergies.

When to get help: If your child is experiencing any of the above symptoms, contact your doctor. "This is a situation where you should at least seek telephone help," says William Bruno. "And I'd err on the side of having the child seen so your doctor can listen to his chest." Call the paramedics immediately if your child is blue, has poor coloring or difficulty speaking -- all are signs that he isn't getting enough oxygen.

10. Bites

The problem: An estimated 2.2 million children under 12 are bitten by dogs each year, according to a report in the Journal of the American Veterinarian Medical Association.

When to get help: Your first step is to clean the wound. "Wash it with regular hand soap and then place the wound under running water for five minutes," says Knapp. "You're trying to knock the bacteria off the skin that can lead to infection." If the skin is broken, try to locate the animal or its owner to determine if the animal is infected with rabies. Next, see your doctor -- he or she will probably do a more thorough washing and begin rabies treatment if the animal has not been vaccinated.

What to do for a human bite depends on the extent of the puncture. If your 2-year-old has been bitten by another toddler and the skin is still intact, "Wash it and watch it at home," says Knapp. "Look for signs of infection, like redness or swelling." If the skin has been broken, contact your doctor. Because our mouths are loaded with bacteria, a human bite has a good chance of becoming infected.

Beyond a Bandage

When an emergency strikes, you need to act fast. Here, how to be prepared:

  • Children over 3 should be taught how to dial 911 and to recite their names and addresses.
  • Keep up-to-date medical information -- listing current medications, diagnoses and allergies -- on each child. Keep copies near the phone at home and in your car and wallet.
  • Take an emergency first-aid or CPR course. If you have a baby, be sure to learn basic first-aid measures for an infant as well as an older child.
  • Keep a well-stocked first-aid kit in your home and car. Include bandages, antiseptic wash, an antibacterial ointment, pain relievers, thermometer, disposable ice bag, scissors and tape.
  • Post the numbers of your pediatrician, the poison control center and emergency medical services near every phone in your house. --Donna Christiano