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When to take your child to the emergency department

Source: https://www.thestar.com/life/parent/2022/06/01/when-to-take-your-child-to-the-emergency-department.html
By Sarah Moore
Date: Jun 1, 2022

Into every childhood, some aches, pains and illnesses must fall. And parents can find themselves unsure of what afflictions require a trip to the emergency department. According to Dr. Daniel Rosenfield, an emergency physician with The Hospital for Sick Children, a good percentage of the children who arrive at the SickKids emergency department could be treated at a clinic or by their primary health-care provider. However, he says there are warning signs parents should not ignore. Rosenfield identifies cases in which a trip to emerge is necessary.

An allergic reaction
What you look for are signs of anaphylaxis. Those symptoms might include hives, vomiting or diarrhea, a swollen tongue, difficulty breathing or a rash. An anaphylactic reaction usually happens very quickly and involves two different body systems. For example, if your child is stung by a bee, and subsequently develops hives and starts wheezing, that’s actually two systems (skin and lungs). If your child’s tongue swells and they have trouble breathing — that’s two systems. If you suspect your child is having an anaphylactic reaction, call 911 right away. Do not treat it with an antihistamine, such as Benadryl. The treatment is an EpiPen. Some parents who regularly carry EpiPens can be nervous to use them, especially for the first time. But the implications of not giving the medication when it’s needed are much more severe than administering an EpiPen to a child who doesn’t need it.

Trouble breathing
This is a situation where the cause is almost secondary to the immediate issue of laboured breathing. Your child might have influenza, the flu, COVID-19, or even something mild, but if they are struggling to breathe, they need immediate medical attention. To determine severity, look at how your child is breathing. Quick breathing is a troubling sign. With younger children, we recommend you take their shirt off and watch them breathe. Are they “working to breathe”? Meaning that you can see the hollow of their neck is sucking in when they breathe. Their nostrils will flare and the skin between their ribs is sucked in. Young babies will sometimes breathe with their tummies, which we call abdominal breathing. This is when the infant’s belly goes out when they suck in. These are all signs of respiratory distresses and should be assessed immediately.

Fever with other symptoms
Parents often ask how high a fever needs to be before bringing their child to the ED. The number itself doesn’t send a child to emergency, it’s what else is happening — what is causing the fever. In addition to fever, if your child is dehydrated from vomiting, has diarrhea, can’t keep down fluids, or is lethargic and isn’t waking up appropriately, then they should be taken to emerge. For a detailed list of associated symptoms, visit AboutKidsHealth.ca. Also, any child under three months old with a fever over 38 degrees Celsius, needs to go to the ED. Certain other at-risk populations, such as the immunocompromised, also need to go to emerge when running a fever.

Cuts and broken bones
If your child has a bad cut, you want to pay attention to whether the wound can be closed at home using regular bandages. If not, you need to come to emerge. If there is profuse bleeding that’s not stopping, you need to go to a hospital. If your child has a wound with jagged edges, that’s usually a tipoff it’s going to need sutures to close it. If you think the cut is deep enough that it might involve a tendon, artery or vein, bring your child in. Also, cosmetically sensitive areas sometimes need to be seen for stitches — anywhere on the face, eyes, ears or genitals. If your child’s cut was caused by a bite — animal or another child — it may not necessitate a visit to the ED but will likely need to be addressed by a primary caregiver the same day. A broken bone needs urgent attention if the bone looks obviously deformed, badly bent, or bone has pierced through the skin.

Abdominal pain
Abdominal pain is one of the most common complaints we see in the ED, and the vast majority stem from something minor. However, with tummy pain, you want to pay attention to where the pain is located. If the pain is in the lower right quadrant of the stomach, that might be an indication of appendicitis, in which case you want that addressed immediately. You also want to think about whether the pain is associated with other symptoms, such as high fever or significant lethargy. If your child is vomiting blood or bile, or has blood in their stool, they should be seen.

Gastrointestinal issues
The first thing we look at in emerge is hydration. If the child is extremely lethargic and you can’t get any more fluids into them, if their eyes are sunken, the tongue or lips are really dry — those are signs of dehydration. If you think your child might be dehydrated, consider how many times in the past 12 hours they’ve gone pee. With babies, we look at the soft spot on the skull. Is it sunken in? Most importantly, are they putting out urine? How many wet diapers has the baby had in the last few hours? Is it significantly less than normal? Finally, you want to consider the duration. If your child has had non-stop vomiting and diarrhea for multiple days, that needs to be addressed. A more typical pattern would be 24 hours of vomiting, followed by a few more days of diarrhea afterwards.

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