Parents should know when a sick or injured child needs immediate care. This list of ER -worthy situations can help.

There’s nothing more frightening for parents than a child who appears to be severely ill or injured. And in those first moments of concern, it’s hard to know whether the youngster needs to be rushed to a hospital emergency room or whether an urgent care facility or the child’s pediatrician’s office may be the wiser choice. Who better to help parents tell the difference than the clinical director of a major hospital’s Pediatric Emergency Department?

“Sometimes it can be difficult to know how sick your child is and whether you should go to the ER,” acknowledges Robert Deutsch, M.D., who holds that position at Saint Barnabas Medical Center. “Fortunately, there are signs and symptoms you can look for that will help you decide.”

Below, in seven categories, Dr. Deutsch offers examples of conditions that should be promptly treated in the Pediatric ER. (When you’re in doubt about how to transport your child, or if your child appears to be in significant distress, it’s always better to call 9-1-1 for an ambulance.) You may wish to keep this list handy.

1. Breathing problems 
There are many causes of labored breathing in children, Dr. Deutsch says, including asthma, allergies and illnesses like croup and pneumonia. An ER visit is recommended if you notice any of these symptoms (and, in the case of asthma, if rescue medications do not bring improvement):
• Your child’s breathing seems faster than normal.
• You can see your child’s ribs or collarbone outlined by skin during inhalation.
• The belly moves outward with every inward breath.
• The nostrils flare outward on inhaling.
• The tongue or lips are blue.
• There’s a high-pitched or squeaking noise when the child inhales.

2. Fever “
The vast majority of children who have a fever are not in danger,” says the doctor. “However, fever may be a marker of a more serious condition, such as meningitis, pneumonia or a severe urinary tract infection.” You should bring your feverish child to the ER if he or she:
• Is three months old or younger and has a rectal temperature of 100.4 degrees F or higher.
• Has a fever-related stiff neck.
• Is dehydrated (signs include dry mouth, no wet diapers in 8–12 hours, sunken eyes and sunken soft spot, or fontanelle, in newborns).
• Is having difficulty breathing.
• Is receiving chemotherapy or daily oral steroids, has an intravenous central line or has a condition that increases susceptibility to infections, such as sicklecell anemia.

3. Vomiting
Vomiting is usually caused by gastroenteritis, a virus infecting the gastrointestinal tract, Dr. Deutsch says. This “stomach flu” also can cause nausea and diarrhea. “These infections usually don’t last long and are more disruptive than dangerous,” he says. But come to the ER right away if:
• You observe projectile or forceful vomiting in an infant, particularly a baby who’s less than three months old.
• Your infant is under two months old and is vomiting (not just spitting up).
• Your child vomits after taking an oral electrolyte solution for close to 24 hours.
• Vomiting that has eased starts again as soon as you try to resume your child’s normal diet.
• Vomiting begins after a head injury.
• Vomiting is accompanied by fever.
• Your child vomits bright green or yellow-green fluid, blood or material resembling coffee grounds.
• Your child’s belly feels hard or bloated, and/or is painful between vomiting episodes.
• Vomiting is accompanied by severe stomach pain.
• Your child is lethargic.
• Your son’s vomiting is accompanied by swelling, redness or pain in the scrotum.

4. Poisonings and ingestions
If your child has ingested or come in contact with a potentially toxic chemical or a medication that was not prescribed or that was taken in an excessive amount, call the Poison Control Hotline at 1.800.222.1222. And bring your child to the ER immediately if he or she:
• Is having difficulty breathing.
• Is difficult to arouse or becomes unconscious.
• Has a seizure.

5. Head injuries
A head injury justifies a prompt ER visit if your child is an infant, has lost consciousness (even momentarily) or if he or she:
• Won’t stop crying.
• Complains of head and neck pain.
• Vomits repeatedly.
• Is difficult to awaken.
• Becomes difficult to console.
• Isn’t walking normally.
• Is breathing abnormally.
• Is bleeding—or leaking clear fluid— from the nose, ear or mouth.
• Shows a disturbance of speech or vision.
• Has pupils of unequal size.
• Shows weakness or paralysis.
• Is unconscious.

6. Broken bones
A child with a suspected fracture should be brought to the ER if:
• The injured bone is obviously deformed or out of place (dislocated).
• There is an open wound in the area where the bone is thought to be broken.
• He or she reports numbness, tingling or weakness in a body part beyond the injured bone.
• Body parts beyond the injured bone are cold or pale.

7. Lacerations
When a child has a large cut or a laceration, come to the ER if:
• You’re unable to stop the bleeding after five minutes of firm pressure, or if the wound begins bleeding again.
• You’re unable to clean out dirt and debris thoroughly, or there’s something else stuck in the wound.
• The wound is on the child’s face or neck.
• The injury was caused by an animal or human bite, a burn, an electrical injury or a puncture wound.
• The cut is more than half an inch long or appears to be deep, as large or deep wounds can result in nerve or tendon damage.

Be ready for an ER visit
Follow all the precepts of household safety and healthy living, and you still can’t be sure your child will never see the inside of a hospital emergency room. But you can act today to be prepared to facilitate the best possible care for him or her—just in case. Keep the following documents in a handy place where you can grab them quickly if you need to visit the ER, suggests Robert Deutsch, M.D., clinical director of the Pediatric Emergency Department at Saint Barnabas Medical Center:
•Your child’s insurance card and a photo ID for yourself.
•Names and phone numbers of all of your child’s doctors.
•Lists of your child’s known allergies and medications.
•A summary of your child’s significant medical history, including hospitalizations, surgeries and any chronic medical conditions.
•If someone other than a parent or legal guardian is bringing your child to the ER, he or she should bring an original notarized letter from the parent or guardian stating who may give consent for medical care. The letter must contain full names of you and your child, along with full names and relationships of the individuals who may give such consent.

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