When should you take your kids to the emergency room and not the doctor's office or home

Local experts say when you need to head to the ER

TAMPA, Fla. - 6-year-old André suffers from respiratory distress, so trips to the emergency room aren't unusual. "If he's under slight distress and we think he needs medical attention, we'll call the doctor. If it seems to be mild or severe we don't wait. We immediately go to the emergency room," said his father, Robert Mizel.

But for many parents, their child's symptoms might not be as obvious. ABC Action News went to the brand new ER at St. Joseph's Children's Hospital to ask the experts what the symptoms are that warrant a trip to the emergency room. Dr. Manuel Carmona, a pediatric emergency physician, said, "The first one is fever, particularly a fever in a baby less than three or four months of age." Fevers in kids over four months of age don't always need urgent care. "If that child is running around and there's a temp of 102 with a runny nose a cold and congestion and the child is being their normal self," said Dr. Carmona, then that child can be seen in the pediatric office the following day.  "If a fever starts and the child is ill and ill appearing with any kind of rash that the parents don't recognize, then that child needs to come to the emergency room," said Carmona.

The second symptom is a bad headache. But how can you tell if a headache is dangerous? The doctor says if it follows a fall or trauma and the child is vomiting, go to the ER.  Also go if it involves a stiff neck. "The whole stiff neck goes with the probability of meningitis," he said.

Next, a widespread rash. "Don't be too concerned about a rash on your child's arms or feet, but if the rash is all over the child's body or includes small red or purple non blanching dots, it's best to see emergency care at once," said Dr. Carmona.

And finally, don't ignore stomach bugs. "That is one of the most common reasons they come to the ER," Dr. Carmona said.

Vomiting and diarrhea can lead to dehydration. The younger the child, the greater the risk. You can always call your pediatrician first. They can help determine the severity of the symptoms, but Dr. Carmona says parental intuition is usually right on. If you know your child isn't looking or acting right, trust your gut and go to the ER.

Here are some more tips from the experts at St. Joseph's Children's Hospital:

Broken Bones

•             Broken bones are among the most common injuries seen in children, resulting from any type of fall or sporting injury. Whether an injury takes place on the playing field or in your backyard, it's not always easy to tell if a bone is broken or how to provide aid. Here's general advice:

o             For deformity, severe pain or swelling, get medical care at once. This also goes for a telltale snap or grinding noise. If a bone has broken through the flesh (a compound fracture), don't move the limb or the child. Apply mild pressure, but do not push a bone back in. Keep the child lying still until help arrives.

o             For a less serious break, stabilize and splint. Use a board or other stiff object placed along the broken limb so it extends above and below the nearest joint. Use a cold pack on the injury and elevate the limb. Then get medical care.

o             For milder pain and swelling, give it a day. A broken bone is not always easy to detect in kids; their softer bones can lead to a buckle fracture: the bone bends, raising a slight buckle. In a greenstick fracture, the bone breaks on one side and bends on the other. Let pain and swelling be your guide; if pain and swelling persist after icing the injury and a good night's sleep, see the doctor. An X-ray can confirm a break.


•             The exact temperature that should trigger a call to the doctor depends on the age of the child, the illness, and whether there are other symptoms with the fever. Watching how your child behaves will also give you a pretty good idea of whether a minor illness is the cause or if your child should be seen by a doctor.

•             Call your doctor if you have an:

o             infant younger than 3 months old with a rectal temperature of 100.4ºF (38ºC) or higher

o             older child with a temperature of higher than 102.2ºF (39ºC)

o             Call the doctor if an older child has a fever of less than 102.2ºF (39ºC) but also:

o             refuses fluids or seems too ill to drink adequately

o             has persistent diarrhea or repeated vomiting

o             has any signs of dehydration (urinating less than usual, not having tears when crying, less alert and less active than usual)

o             has a specific complaint (e.g., sore throat or earache)

o             still has a fever after 24 hours (in kids younger than 2 years) or 72 hours (in kids 2 years or older)

o             has recurrent fevers, even if they only last a few hours each night

o             has a chronic medical problem such as heart disease, cancer, lupus, or sickle cell anemia

o             has a rash

o             has pain with urination


•             Seek emergency care

if your child shows any of these signs:

o             inconsolable crying

o             extreme irritability

o             lethargy and difficulty waking

o             rash or purple spots that look like bruises on the skin (that were not there before the child got sick)

o             blue lips, tongue, or nails

o             infant's soft spot on the head seems to be bulging outward or sunken inwards

o             stiff neck

o             severe headache

o             limpness or refusal to move

o             difficulty breathing that doesn't get better when the nose is cleared

o             leaning forward and drooling

o             seizure

o             severe abdominal pain


•             In children, a variety of conditions can cause vomiting, the most common of which is viral infection of the gastrointestinal tract, or gastroenteritis, also known as "stomach flu," or bacterial infections and parasites in the gastrointestinal tract.

•             Less common causes of vomiting include head trauma or brain injury and brain tumors. Other conditions can lead to vomiting as well, including disorders of the liver, intestines, gallbladder and the pancreas.

•             Because a child loses substantial amount of fluids with vomiting, especially if the vomiting lasts for more than 24 hours and is accompanied by diarrhea, it can lead to dehydration, which untreated can be life threatening.

•             Regardless of the underlying cause, children suffering from vomiting should drink plenty of fluids to replenish water loss from the body.

•             Depending on the cause, vomiting may be accompanied by diarrhea, malaise and fever.

•             Call your pediatrician if your child has vomiting that doesn't go away after 24 hours or it starts again once a child resumes normal diet or if vomiting is accompanied by fever.

•             If your child is vomiting blood, vomiting a substance that looks like coffee grounds or vomiting yellowish or greenish fluid, or if your child vomits after hurting his or her head, seek emergency care. 


•             Lacerations are a commonly treated injury in the Emergency Department. Whether or not your child's laceration warrants a trip to the ED depends on the location and how deep the cut is.

•             If possible, talk to your pediatrician before heading to the ED. Sometimes smaller lacerations can be treated at home or closed with new super skin glues or Steri-Strips right in your doctor's office.

•             Be sure to call your child's physician for lacerations that are:

o             bleeding heavily and does not stop after five to 10 minutes of direct pressure

o             deep or longer than an inch

o             ragged or have separated edges

o             located close to the eye

o             large cuts on the face

o             caused by a puncture wound or dirty or rusty object

o             embedded with debris such as dirt, stones, or gravel

o             caused by an animal or human bite

o             excessively painful

o             showing signs of infection such as increased warmth, redness, swelling or drainage

Hydration/Heat Stroke

•             According to the Centers for Disease Control and Prevention, more than 500 U.S. children died from heat stroke in the past decade after being left inside a car.

•             With an outside temperature of 85 degrees, the air temperature inside a parked vehicle can reach a dangerous 120 degrees within 30 minutes, and nearly 150 degrees after a few hours.

•             When left in a hot vehicle, a child's core body temperature may increase three to five times faster than that of an adult, leading to seizures, multiple organ failure or even death in minutes. And when substituting humid heat for dry heat, as is often the case in Florida, injury or death can occur in half the time.

•             During hot weather, young athletes face the risk of dehydration, which can lead to serious heat-related illness. The cause: failure to drink enough.

o             Drinking is like any other piece of protective equipment used in sports. Child athletes face a higher risk of dehydration because their bodies aren't as efficient as adults' at cooling themselves by sweating, their muscles generate much more heat than adults', and their bodies have a greater surface-area to body-mass ratio than adults. The smaller the children, the faster they absorb the sun's heat.

o             To keep children hydrated, have them drink 12 ounces of fluid 30 minutes before they take the field. Then, for every 20 minutes of activity, they should drink 5 ounces if they weigh 90 pounds or less and 9 ounces if they weigh more. During the first hour after activity, children should drink every 20 minutes.




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