When should you take your child to the emergency room?



Estimated Reading Time 4 Minutes

This is a call that isn’t always easy. Does a child need to be unconscious, or is really unwell enough? And what does really unwell look like? Actress Natasha Richardson, who died unexpectedly after a seemingly minor fall on the ski slopes, probably thought “It’s just a bump. I’ll be fine!” I’ve said those things about my kids’ bumps and lumps.

Clearly, not all emergencies are bell ringers. Nor do they need to be, according to Dr. Manish Bhatt, chief of the emergency department in Vernon, B.C. “I tell parents that if they’re concerned,  they should get their kid looked at.” He says that, yes, some conditions may not necessarily need the emergency department, but if you have concerns about an injury, dehydration, an illness, or you’re just not sure what’s going on, it’s a good time to grab the keys and go.

HOW BAD DOES IT HAVE TO BE?
A change in behaviour, a change in input (drinking, eating) a change in output (vomiting, diarrhea) can all be signs that something isn’t quite right.

Go to the ER if your child has a …

  • Fever and is under three months of age, or if the child’s behaviour has changed and isn’t eating or drinking or otherwise looks unwell. The height of the fever isn’t the main concern.
  • Rash, if it isn’t ‘blanchable’ (when you press on it, it doesn’t go white).
  • Cut, if a person did it, an animal did it, if it’s on the face, or if the edges are spread apart.
  • Sprain/broken bone, if there is a persistent limp, swelling, a pain that won’t go away, or if the pain is in a specific spot, it’s likely a break or a sprain.
  • Vomiting, if it occurs without diarrhea, if there is blood in it, or if there are signs of dehydration such as no tears when crying, a dry tongue, no urine output.
  • Respiratory problems, if the child struggles to breathe, breathes too fast, or changes colour (turns blue).
  • Allergic reaction, if the child has eaten something/ stung by a bee and suddenly shows signs such as hives, swelling, or difficulty breathing.

WHEN YOU GET THERE YOU CAN EXPECT…

… TO WAIT:
On TV, skilled, scrubbed, oversexed doctors immediately take charge. Life isn’t like that. We wait. And wait. In part it’s because the ER is a busy place. It’s also because doctors are generally not interested in practising what they refer to as ‘drive through’ medicine. And, while TV doctors diagnose immediately, real doctors know that jumping to quick conclusions isn’t practising very good medicine. If investigations and tests are needed, it all takes time.

… TO BE IN GOOD HANDS:
By the time you take a seat and start flipping through magazines, you or your child have already been assessed by an experienced specialist. “When you walk in, you will be seen by a triage nurse and that nurse is the most experienced nurse in the emergency department,” says Dr. Teresa DeSantis, an emergency physician in Burlington, Ont. More than anyone else, the triage nurse knows – often with little more than a glance – who is really ill, who is about to be really ill, and who is stable. And you remain in their gaze the entire time you are there. So, relax. If something changes, let someone know, but otherwise, you’re covered.

… TO HELP THE DOCTOR:
“The most helpful thing is to tell me exactly why you are here, what happened and what is going on,” says Dr. Graham Thompson, a paediatric emergency specialist at the Alberta Children’s Hospital in Calgary. Brevity is appreciated. Tell the doctor about any medications the child has been taking (with actual names and dosages, not just colour and what it smells like), and if immunizations are up to date. Save the long version for the watercooler.

… TO HELP THE CHILD:
My mother’s tone used to change the instant we got in front of the doctor. At home it was, “Don’t worry about it, you’re fine, it’s nothing.” In front of the doctor it was, “Just look at this!” If I hadn’t freaked out before, I did then. Keep your child comfortable, calm, entertained and hydrated. Keep yourself calm, too.

… TO LEARN SOMETHING:
Research shows that parents remember less than 50 percent of what they’ve been told during an emergency visit. If the ER were school, we’d be staying after class. During the visit, a lot will be said, so take notes and ask the doctor to repeat something you missed. Or bring another person along with you so that, between you, you get all the important stuff.

… TO LEAVE:
Yes. The wait is frustrating and worrisome, it’s hard to keep your child calm and you’ll grumble a bit as you head for the parking lot. In time, however, you’ll snap out of the funk and be glad that you didn’t take any chances. Bottom line, the medical team is overworked, but the emergency department is for us, it’s a lifeline and works best when we make appropriate use of it.



HOW SICK IS SICK?


THE CANADIAN TRIAGE AND ACUITY SCALE (CTAS) IS A GUIDELINE THAT HOSPITALS USE WHEN RANKING PATIENTS IN THE ER.
If you are higher than three on this scale, you’re going to wait.

1. CONDITION: requires resuscitation, life is threatened, requires aggressive intervention

FOR EXAMPLE: stopped breathing, major trauma, shock

YOU CAN EXPECT: bells, whistles, alarms. Just coming through the door you will have really got people’s attention

2. CONDITION: condition threatens life or limb function

FOR EXAMPLE: head injury, chest pain, GI bleeding, abdominal pain, jaundice in babies

YOU CAN EXPECT: to wait about 15 minutes

3. CONDITION: condition could become serious, requiring emergency intervention

FOR EXAMPLE: asthma, moderate trauma, vomiting and/ or diarrhea in children two and under

YOU CAN EXPECT: to wait about 30 minutes

4. CONDITION: condition would benefit from intervention or reassurance within one to two hours

FOR EXAMPLE: urinary pain, mild abdominal pain or earache

YOU CAN EXPECT: to wait about an hour

5. CONDITION: requires non-urgent care and includes conditions in which investigations or interventions could be delayed or referred

FOR EXAMPLE: sore throat, conditions related to chronic problems or psychiatric complaints

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