by Douglas J. Segan, MD, JD, FACEP
Taking your child to the emergency room can be a daunting and difficult experience–for your child and the entire family. While we all wish pediatric ER visits were rare, there are more than 30 million a year.
Here are a few suggestions unique to pediatric ER patients and their parents. (Advice on surviving an ER visit for patients of all ages can be found here.)
Prepare a Medical History Form and Educate Caretakers
Fill out a medical history form for each member of your family. One example is available here. Attach a copy of your child’s immunization card to this form, and update it regularly.
Be sure that everyone who cares for your child has easy access to the form. Review your child’s medical history, medications, and allergies with your child’s caretakers.
Write your child’s caretakers a permission slip authorizing them to seek medical care for your child; in a true emergency, your child will be cared for by ER staff, but the process will go more smoothly if this step has been taken in advance.
Where Do I Go and How Do I Get There?
If your child is ill or injured, it can be difficult to decide if you should proceed directly to the ER, or instead visit an urgent care clinic or doctor’s office. If your child is stable, it is generally advisable to try to ask your child’s pediatrician for advice. But if the pediatrician is unreachable, an urgent care clinic is a good option for many minor emergencies.
Although some urgent care clinics are open 24/7, many have specific hours. It helps to know the hours of the nearest clinic. It also makes sense to keep the phone number of the clinic posted with the pediatrician’s number. Calling first can save a frustrating trip if you or your child-care person arrives to find the clinic closed.
The ER is the best venue for serious injuries and illnesses such as severe infections, head trauma, intractable pain, airway and breathing difficulties, seizures (unless very brief), significant dehydration, and significant changes in behavior and mentation.
Call 911 or Go by Family Car?
Call 911 if your child is in extremis: poorly responsive, bleeding profusely, or seriously injured. You should also travel by ambulance if there isn’t a calm adult driver available.
Deciding Which ER Is Best for Your Child
If you are fortunate enough to live in a community with a number of ER choices available, do some research to find out which one is most child-friendly. Ask your pediatrician and ask other parents about their experiences in local ERs.
For children with special needs and for some very serious emergencies, going to a children’s hospital or a hospital with a dedicated pediatric ER and ICU may be appropriate.
Bring Items to Calm Your Child, Calm Yourself, and Ease the Wait
If there is time to pack a bag before going to the ER, consider taking some items that will make the experience go more smoothly and the inevitable waiting less stressful. Extra diapers, stuffed animals, a favorite blanket, books, music and video games may be suitable things to bring for your child. If there’s a chance that your child will be admitted overnight, add familiar nighttime items that will help your child feel more comfortable sleeping over at the hospital.
Also bring a favorite snack and beverage, but don’t give your child anything to eat or drink until you get the green light from the ER staff.
En route to the ER–and while there–your child may be filled with fear. Try to be both honest and reassuring at the same time. It will be challenging, but try to alleviate your child’s understandable fears by working to stay optimistic, patient, and calm yourself.
Children with Special Health Care Needs
If your child has special needs or an uncommon disease, work with your child’s doctor so that you and other caretakers have a clear plan in mind if an emergency develops. The American College of Emergency Physicians and the American Academy of Pediatrics websites have an excellent “Emergency Information for Children with Special Needs” form that you should fill out with your child’s doctor.
In addition to the usual spectrum of illnesses and injuries that can occur, adolescents may have sensitive emergency medical problems relating to alcohol and drug use, psychiatric problems, and pregnancy. If you feel that your adolescent may be more forthright with the medical staff if you are not at the bedside, consider stepping out of the exam room for a few minutes.
Understanding Risks and Benefits:
The ER physician may recommend that your child have a CT scan. There is no doubt that a CT scan can be a very valuable test–it can even be life-saving. As a result, there has been a sharp increase in CT scan use: nearly 5 million CT scans are performed on children in the U.S. every year. But as the test has become more common, concerns about the risks of radiation exposure have also increased. The radiation from a CT scan is much greater than from a standard X-ray. And children are more sensitive to radiation than adults.
The risk to an individual child of a CT scan radiation-related cancer is believed to be low. The National Cancer Institute has reported that the highest estimated lifetime risk is less than 1 in 1000. The problem is that we never know how many more CT scans a child will need later in life, and the more CT scans are performed, the greater the risk.
Unnecessary CT scans should be avoided. If your child’s doctor recommends a CT scan, do not refuse if it is truly needed. But try to understand whether the benefits outweigh the risks. Asking the ER doctor what she would suggest for her own child can often prove useful.
Antibiotics can also be essential and life-saving. But they, too, carry certain potential risks: allergic reactions, gastrointestinal side effects, drug interactions, and infection with drug-resistant organisms. Most children with fevers are suffering from viral infections, and antibiotics are not indicated. Likewise, upper respiratory infections–i.e., colds–are usually viral as well, so antibiotics will not be beneficial.
Physicians previously prescribed antibiotics to virtually all children with ear infections (otitis media). Recently, good evidence has emerged indicating that some children with ear infections can be carefully observed (a process known as “watchful waiting”) rather than being immediately started on antibiotics.
If your child’s ER doctor does suggest an antibiotic, discuss the pros and cons with him.
Understand your Child’s Discharge Instructions and Obtain Close Follow-up
Before leaving the ER, make sure you have a clear understanding of which tests were administered to your child, and what the preliminary results were. Also keep a record of any medications your child received, and in what dosages. You should also be told which adverse symptoms to watch out for–including bad reactions to medications or tests–and what signs would indicate that you need to bring your child back to the ER. If you are in any way confused, or have doubts about instructions you’ve received, don’t be afraid to ask questions.
After an ER visit, close follow-up with your child’s pediatrician is imperative. Ideally, the ER chart and final lab and radiology reports will be reviewed with you during this follow-up visit.
Taking your child to the ER can be a challenge. Some advance planning, patience, and good communication with the ER staff will help make it less traumatic for you and your child.
By Douglas J. Segan, MD, JD, FACEP (Emergency Medicine Specialist)