“Doctor, When do I Need to Take My Child to the Emergency Room?”

“Doctor, When do I Need to Take My Child to the Emergency Room?”

By Mamatha Ananth, M.D., and Arturo Gastañaduy, M.D., A&G Pediatrics

Click aqui para español- >“Doctor, ¿cuándo debo llevar a mi niño a la Sala de Emergencia?”

For all parents, their children are the most precious persons in their lives. Thus, this is an important discussion during a well-child visit. Every year 24 million patients 0-18 years are seen in the Emergency Room. CDC estimates an average of 2 hours for waiting and treatment time. The cost of ER visits is $500-$10,000. One third to one half of all ER visits are non-urgent.

As nobody wants to waste time or money, here are some guidelines for when to bring a child to the Emergency Room:


  1. Trouble Breathing
  • Wheezing
  • Noisy breathing
  • Rapid or shallow breathing              
  • Blue lips
  • Choking/Gasping
  • Not breathing


  1. Seizures/Loss of Consciousness/ “Too sleepy”/ “Unusual behavior”

If a child has a seizure, lay him on his side to prevent choking. Tongue injuries are rare, therefore do not put anything in his mouth. Call 911 and monitor how long the seizure lasts.

  1. Injuries
  • Motor Vehicle, skiing, horse-riding
  • Head trauma
  • Drowning/Water sport injuries
  • Eye injuries
  • Burns: blistering, electrical, smoke exposure
  • Falls greater than three feet
  • Loss/Displaced permanent teeth
  • Stabs, gunshot wounds
  • Suspected fractures/dislocations
  • Cuts > ½ inch, persistent bleeding


  1. Poisonings

Children with ingestion or exposure to chemicals, cleaning agents or medications need to be evaluated. Call POISON CONTROL 1(800)-222-1222, follow their advice and go to the nearest ER.

Do not provoke vomiting; it could worsen the situation. If a chemical got into the eyes, rinse them well with water.

  1. Allergic Reactions

Wheals all over, trouble breathing, and fainting may occur with eating some foods (e.g.: nuts, seafood, pork), medications, insect bites or stings or contact with Poison Ivy/Oak. If your child is known to be allergic and you have an Epi-Pen, please use it and go to the ER.


  1. Sickle Cell Patients with:

Fever, severe pain not improving with usual treatment, distended painful abdomen and increased pallor and tiredness.

  1. Foreign Body Ingestions

Coins and other small objects can obstruct the airway or alimentary tract. Batteries and magnets produce serious injuries by different mechanisms.

  1. Skin

New red or purple spots that do not blanch

Rapidly enlarging red and painful areas

Large boils (> 5cms)

  1. Abdominal Pain

Severe pain localized to one area of the belly in a child who is not eating or playing.

  1. Chest Pain

Chest pain is rare and much less serious in children than in adults. Heart beating too fast or funny, fainting.

  1. Fever

Fever is defined as rectal temperature greater than 100.4 °F or 38.0 °C. Oral, Axillary and other area temperatures are usually lower than the rectal one. Most cases of fever are viral infections that resolve on their own and patients may be seen in the clinic by their doctor. Fever could be dangerous and need ER evaluation in patients with the following:

  • Age less than three months
  • Seizures, lethargy, altered mental status
  • Sickle cell disease
  • Trouble breathing
  • Cancer or chemotherapy
  • Belly pain with bilious vomiting, bloody stools
  • Non blanching red/purple spots
  • Swollen, painful joints or limbs
  1. Gastrointestinal

Bilious vomiting, bloody stools or vomiting and diarrhea with decreased activity and urination.

  1. Genitourinary
  • Bloody urine
  • Severe lumbar pain radiating to genitals
  • Lower abdominal pain in adolescent girls
  • Swollen painful genitals in both sexes
  1. Bites
  • Deep/multiple dog/cat bites (unknown or unvaccinated)
  • Wild animals: bats, raccoons, foxes, snakes
  • Insects bite/sting with difficulty breathing
  1. Psychiatric/Social
  • Suicidal or homicidal thoughts
  • Hearing or seeing things that are not there
  • Violent behavior
  • Physical or sexual abuse

Reasons to bring children to the doctor’s office or urgent care and NOT to the Emergency Room:

  • Colds
  • Earache
  • Pink eye
  • Diaper rash
  • Constipation
  • Colic
  • Vomiting/Diarrhea
  • Checkups, shots
Arturo Gastanaduy MD F.A.A.P

Writer/ Escritor Wellness

A & G Pediatrics


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