When Do I Take My Child to the Emergency Room?

Oct. 10, 2009— -- In the ongoing health care reform debate, one of the most pressing and difficult issues is emergency room visits.

Emergency rooms don't deny anyone -- anyone with minor ailments can show up.

So if it's your child and all you see and hear is blood, bruises, and screaming, you have an ER situation on your hands -- right? Perhaps not.

Dr. Marie Savard, "GMA" medical contributor and author of a new book, "Ask Dr. Marie -- Straight Talk and Answers to Your Most Private Questions -- Sex, Reproductive Health, Fertility, Menopause, Hormones," answers some questions about emergency rooms and your kids.

Q: Let's start with something we fear most in the current swine flu climate. What if a another kid (or a dog) bites your child and the skin is broken. Do you head to the ER?

Dr. Savard: Yes, if it's a human bite. Now, people fear that a child's mouth is more germy than a dog. But you don't get swine flu from a human bite. A bite won't pass on swine flu, but a sneeze could. What you should fear is the bacteria from the bite that can cause a severe infection.

Using the hospital's emergency department for a human bite is often the right thing to do. Emergency doctors generally have a lot of experience with bites and other wounds.

People who do not have a doctor or who cannot get in touch with their doctor may have to use the emergency department even for minor bites in order to get a tetanus shot, and a doctor's opinion of the need for other treatment, such as antibiotics.

Tips

You should still call your pediatrician right away. He or she may decide to send you [to the emergency room] depending on the location of the bite and how it looks.

Large tears/bites are not closed with stitches, as this will lock in infections instead of letting [the wound] drain.

You should also wash the wound immediately and thoroughly with soap and warm water, then apply an antibiotic ointment and bandage.

Q: Your child does a face-plant off the playground slide and knocks her tooth loose or knocks out her tooth. Head to the ER?

Dr. Savard: No. Call the dentist instead.

Assuming it's a baby tooth that's affected, the dentist is likely to pull it if it's dangling. You don't want your child to inhale a tooth that's been knocked loose, but other than that, it's usually more of a cosmetic issue. Another reason to call your dentist: If the tooth gets shoved into the gum, it might damage the developing adult tooth, and the dentist will need to treat that, too.

If a baby tooth is whacked completely clear of the mouth, there's no need to save it. Put it under the pillow for the tooth fairy.

But if a bigger kid knocks out a permanent tooth, put it in a cup of milk [or salt water or even saliva]. Put it back in the socket as soon as possible -- [the] first 30 minutes is best -- and/or bring it and your child to the dentist immediately. He may be able to re-implant it.

Q: Your child gets hit in the eye with a "missile"-like toy from a naughty or jealous child in school or at the playground. Head to the ER?

Dr. Savard: Yes. Go to the ER.

Or call the eye doctor and see only if they can do an exam quickly. It's unlikely that you get to see an ophthalmologist without going to the ER.

When an eye injury does occur, it is always best to have an ophthalmologist [and that usually means a trip to the ER for referral/evaluation by an opthalmologist] to ER-examine the eye as soon as possible.

As a parent, you can look for bleeding, marked redness, impaired vision, or an inability to move or open his eye. If the area around the eye [the brow bone or the lid] looks like it might need stitches, apply direct pressure to stop any bleeding and then call your pediatrician, who will likely advise you to go to the ER. [If it's determined that your child does need stitches, you may want to ask if a plastic surgeon is available.]

Q: Your 2-year-old topples out of the shopping cart and hits his or her head. He or she has a huge goose egg and is hysterical. Head to the ER?

Dr. Savard: No ER. Screaming is a perfectly healthy reaction.

Recent guidelines released this summer on when to do CT scans suggest that it's OK to not do it as long as a child is acting normally and you don't see bruises other than on [the] forehead/frontal.

The vast majority of kids with head injuries -- on the forehead -- are fine. The size of the bump rarely has anything to do with the extent of the injury. There are loads of blood vessels in the head and face, so the swelling can be dramatic.

The exception: Any child under a year of age who experiences head trauma should always be checked out by a physician, because signs of injury are harder to detect in a young infant.

If your child is crying but can get up on his own and is moving about, he's probably just fine. Just keep an eye on him for the next few hours to make sure he doesn't limp or favor one arm, or become sleepy or irritable. If you see any of those signs, call your doctor.

And of course, if your child is motionless or unconscious, or refuses to move after his fall, you should call an ambulance right away.

For more tips on how to deal with children's common health emergencies, visit www.parenting.com.