When should I take my child to the emergency room?

Suzanne Berman, M.D.

It's 2 am, and 2 year old Cameron just woke up screaming and pulling at her ears. You pick her up and she's really hot - the thermometer reads 103. Sounds like that nasty ear infection is back again. The doctor's office won't be open for several hours yet, but try explaining that to Cameron! You get dressed and bundle her up, preparing to take her to the emergency room of the local hospital.

Hang on a minute there. You're exhausted, and Cameron's sick, but....is this really an emergency?

When should I go to the emergency room?

Problems which are life-threatening in a matter of minutes are best handled in a hospital emergency department. For all other problems, it's really better to call us first, whether our office is open or closed.

Problems that the ER is best equipped to handle include:

Severe cuts or lacerations
A head or neck injury with loss of consciousness or vomiting
An altered mental state: either a decrease in the level of consciousness or excessive sleepiness or having uncontrollable agitated behavior
Severe burns of all types, including chemical and electrical burns, especially on the face
Poisoning, caused by ingesting dangerous chemicals or medications
Convulsions lasting more than 15 minutes or any unexpected convulsions
A serious animal bite which has broken the skin
Difficulty in breathing, uncontrollable choking, or turning blue around the lips
Stopping breathing or the pulse stopping
Signs of shock, including pale, cold clammy skin and a weak and rapid pulse
Severe headache accompanied with vomiting or stiff neck.

For these kinds of problems, go straight to the ER. Call 911 if you need help getting your child there. After your child has been stabilized, the ER staff can call us and let us know what happened.

What about other kinds of illness and injury?

For other problems, please at least call us before going to the emergency room, walk in clinic, or Prompt Care. If we can discuss the problem with you over the phone first, we can help you determine if it needs to be seen immediately or not. If our office is closed, we'll help you decide whether it can wait until office hours the next morning. We understand that when your child becomes ill unexpectedly, sometimes it seems like a crisis. It would be great to be able to walk to an ER 24 hours a day and see a doctor right away to reassure you that everything's ok. But your own pediatrician's office, who knows your child and has access to your child's medical record, is just a phone call away. It's so important to us that your child's record be complete that we've made our ER policy part of our new patient brochure.

Why not just take my child to the emergency room? I hate to bother the doctor with a phone call if it's late at night.

Here are some reasons why we want to keep your child out of the ER unless he or she really needs to go.

The ER can be a scary place for kids. Victims of gunshot wounds, mentally ill patients, drug overdoses, etc. also go to the ER. If those patients are getting cared for in the next room, the sounds and smells can frighten your child.
Unless your child is very sick, it can be very slow. Heart attacks and strokes have to take priority over fevers and earaches. Usually, young children end up waiting around. This is rough for any toddler, especially a fussy one.
The cost is much higher to visit the ER than a doctor's office. Because the ER has to have so much staff and specialized equipment ready to go 24 hours a day, the ER has to charge 3-4 times what an office visit costs. Insurance companies don't like this very much. In fact, your insurance company may charge you as much as $100 if they think your ER visit wasn't appropriate. Even if you don't have an ER copay, you still pay indirectly with more tax dollars and higher insurance premiums.
The ER doesn't have your child's medical history on file. Without access to your medical record, the ER staff may need you to recite your child's entire previous medical history in order to figure out what's going on. They may have to repeat blood tests and studies that would be unnecessary if a doctor familiar with your child was there.
It may not save you time in the long run. Even if you do go to the ER at 2 am and get a prescription for an ear infection, will the pharmacy be open to fill it? Your time might be better spent at home getting the fever down and making your child comfortable in her own bed until our office opens in the morning.
Continuity of care is important to your pediatrician. It's frustrating for us to have patients come in the office who are on "two syrup medicines that the ER started." In order for your child's record to be complete, we'll want to know the name and doses of the medications, vital signs, the results of your child's blood work, etc. Parents may not always remember all those details, but they are important to us. If you can give us adequate notice that your child went to the ER, we can get those ER records and update your child's chart in our office.

Also, don't worry about "bothering" the doctor with a phone call about an urgent problem. You're not a bother -- you're child is our patient! Besides, if it's really an emergency, your child's doctor does need to know about it.

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Last revised 5/27/03

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