TO E.R. OR NOT TO E.R.

By Natasha Tsagogeorgas

We’ve all been there. It’s 2am, your baby is awake and has a fever of 39. You gave her Advil 2 hours ago, and she still feels warm. 

You get anxious. You Google. You get more anxious. You ask The Rebels for advice. A couple of them suggest taking your baby to ER because you “just never know”.

What should you do?

I had the privilege of working as part of Ontario’s most elite Emergency and Trauma team at Sunnybrook Hospital for 15 years. I worked alongside the most talented and amazing doctors and nurses. While my role was clerical in nature, I definitely reaped the benefits of being surrounded by so much medical knowledge, and I am here to pass it on to you!

My colleagues definitely taught me a thing or two, which came in super-handy during those sleepless nights of momming with my own under-the-weather spawn.

So here’s a great go-to mental checklist for when you inevitably find yourself in a similar predicament:

  1. Disposition is EVERYTHING. Whether your kid has a fever or just fell and bumped his head. Is he acting “normal”? Is he crying? Talking to you? Generally behaving close to his baseline behaviour – this includes tantrums, unfortunately.  If the answer to these is “yes”, chances are you don’t need the E.R.. Doctors will always ask you about your child’s baseline behaviour; if it’s still the same, 95% of the concerns are crossed off the list. When to worry? If your child is limp, lethargic, or inconsolable despite all your attempts, you should probably have them checked out.
  2. Fevers last 5 days, coughs last 30.  One of my favourite doctors also worked in E.R. at Sick Kids and he made me commit this rule to memory. Children’s immune systems develop when they are little. Unfortunately, as each virus is introduced into their bodies, they fight it with fever. Typically speaking, fevers take 5 days to go away. Also, as the Mom of a kid who ALWAYS had upper respiratory tract infections (URTI), I spent the better part of 2 years watching my little boy battle perpetual coughs. URTIs are notorious for sticking around. Other than soothing measures (tea, honey, etc) there’s not much that you can do for those, either. (FYI, kids who have eczema or sensitivities to food tend to be prone to URTIs.) When to worry? If you have a hard time keeping the fever down (ie: despite medications, fever won’t come down), if the fever is very high (40++), or it persists past 5/6 days you need to get it checked out to rule out anything bacterial. If the infection is bacterial, it needs to be treated with antibiotics.  With coughs, you should see a doctor if your child develops a wheeze or bark, or if breathing sounds very laboured (read: your kid is struggling to breathe). This is cause for immediate medical attention.
    * Note – high fevers in an infant (0-3 mths) are more high risk than that of a toddler, so use your discretion.

  3. Vomit. When is it too much? Babies or children with a bad cough will probably also vomit intermittently because the two impulses are connected by the same nerve. Kids with the flu vomit too; all normal. Symptoms that warrant same-day attention: when bile starts to come up (ie: bright green or bright yellow discharge), or if they’re vomiting blood. If she hasn’t been able to drink in many hours, or hasn’t urinated in the previous eight to 12 hours, see a doctor.
  4. When does an injury warrant an E.R. visit? Has the bleeding stopped and your child can move that body part? Is she responding verbally, can see and hear, you can likely skip the hospital run and treat any pain with ibuprofen. If she’s numb, has a lot of swelling, is in severe pain or the body looks deformed, see someone immediately. Side note: any baby younger than 3 months who hits his head hard enough to get a visible bump should be seen that day. 
  5. Make sure you’re dosing correctly. When my eldest was little, I fell into the common trap of under-dosing him. Kids grow so rapidly, it’s quite easy to mistakenly think that they’re still 21lbs, when they are actually 25.5lbs. Make sure that you’re giving the correct amount of medication for your child. P.S.: it is VERY VERY hard to overdose on over-the-counter drugs. If you happen to go a few milliliters over, your kid will be just fine. 
  6. There are options other than E.R.. This one is a particular sore point for me. I cannot tell you the number of patients we’d get who waited until the weekend (because they “had no time”) to get their child checked out in Emerg, and then complained that the wait was too long, or that their child was not being properly cared for in a waiting room. If you have access to a family doctor, that should always be your first option, for they know your child best. Please don’t wait until the 6th day of a fever and then demand immediate attention in E.R.. If you have concerns, try your family doctor, a walk-in clinic first (there are great ones out there), or Telehealth. 
  7. Keep in mind there are really sick kids in E.R., and if yours isn’t one of them, she might be soon. You’re exposing your little one to a lot of airborne bacteria just by entering the premises. You also risk infecting other children whose immune systems are already weak, such as chemo patients.

I know I know, our Healthcare is the bomb and it can be very easy to jump the gun and head to E.R. unnecessarily, but I urge you to really work through the symptoms first. Your pediatrician is a phone call away, and can help you decide if it’s an emergency situation. Having said that, if you know in the pit of your stomach that something is seriously wrong, GO. At the end of the day, you know your child best.

But if I’ve saved even one frazzled, in-need-of-sleep mama from a midnight visit to the E.R., my work here is done.

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PS: We’re going to stick this little sentence here about not being liable for any medical (or life) advice. Read and react responsibly. When in doubt, just do whatever your doctor tells you to do.

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Featured Image: Grey’s Anatomy

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2 Comments Add yours

  1. Jacqui Holiff says:

    I like your writing and your message, but I strongly feel your credentials and disclaimer about this not being actual medical advice should go at the top. It sounds like you have learned a lot, but this could easily be taken as medical advice – especially by a worried, sleep-deprived mom. Thank you.

    Like

  2. Christine says:

    ER doc here – love this list! I especially love the point about the kid’s behaviour – can’t even count the number of times I’ve said that speil to a parent. One thing I’d say is that any fever (>38°C) in a kid under 3 months of age needs the be seen, ideally in the paediatric ED (most especially babies under 1 month of age). Little babies are susceptible to more concerning illness and may look fine and have no focal symptoms but actually have an illness that requires treatment, like a UTI or, much more rarely, sepsis or meningitis.

    Like

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