Most parents have had this situation happen: Your child wakes up in the middle of the night wailing, and they feel hot to the touch, or have a stomachache, or a terrible sore throat. And then you do the mental exercise: Should I take them to the ER or treat the symptom and see what happens in the morning?
Certain things, such as difficulty breathing, an allergic reaction or a possible broken bone, are no-brainers that you need to get them to the emergency room as quickly as possible. But some signs of serious illness are more ambiguous and can be harder to spot. Some symptoms are always a reason to get medical attention, says Dr. Kelly Levasseur, DO, a pediatric emergency physician at Beaumont Children’s Hospital, which has specialized units for children’s emergencies in Royal Oak and Troy.
Fever: This tends to be one of the most worrisome symptoms for parents, but fevers, even high ones, by themselves are not typically cause for concern, Dr. Levasseur says. The exceptions are any fever in a baby under 3 months old, or fevers that occur with another concern, like dehydration or another worrisome symptom. If a fever lasts for more than five days that’s another fairly urgent concern. However, if medicine only drops the fever a few degrees, that’s OK, Dr. Levasseur says. Giving the right dose is critical. “Parents should check with their child’s pediatrician on dosing based on weight,” she says. “That’s the best way to dose it, and they can even ask at the next well-child visit and keep that information on hand.”
Sore Throat: A sore throat can be nothing, or a harbinger of something serious. “Signs that you want to look for if something more is going on would be if they have had a sore throat with fever and get ‘hot potato voice’ – they sound like they have something hot in their mouth and don’t speak clearly,” says Dr. Levasseur. “Any change in their voice could be an indication they could have an abscess in their tonsil.” If they are drooling along with the sore throat, or won’t drink anything, that could mean the pain is bad enough they don’t want to swallow and could get dehydrated. “If they are laying around and haven’t peed in the last 10-12 hours, it’s time to get them in for an evaluation,” says Dr. Levasseur.
Watch for neck stiffness as well (ask them to look at the ceiling and down at their chest); that can be a sign of meningitis or of an abscess in the throat. Much like fever, a sore throat that lasts five days or more also needs attention.
Stomachache/vomiting: “Stomachache is actually one of the most common reasons for an emergency room visit,” Dr Levasseur says. Severe abdominal pain, especially if it comes on suddenly and doesn’t go away quickly, should be checked out, she says. Abdominal pain on the right side, especially if it makes walking difficult or if a child doesn’t want to move at all, is also an emergency situation because it could be a symptom of appendicitis.
A testicle that twists, which typically shows up in boys older than 10, is another concern that can show up as abdominal pain. “That’s something important for a parent to ask,” Levasseur says. “Teen boys don’t typically offer that piece of information.”
Skin conditions: Rashes generally seem innocent, but a few things need to be seen right away, says Dr. Levasseur. Purple or purplish rashes in which the color doesn’t go away if you rub the skin are an emergency, she says. Hives are also a concern, if a child is showing other signs of allergic reaction like eyelids swelling or a tickle in the throat. Hives tend to come on quickly, while simple dermatitis or eczema rashes spread more slowly.
Bug bites are also not typically emergencies, but bites that come with a fever or painful swelling need to be seen right away. Sometimes what looks like a bug bite may be a staph infection; if what looked like a fairly innocent bug bite develops pus or warm, red swelling around it, that requires rapid attention.
General pain: Sometimes kids complain of pain that seems to have no real origin – no injury, sickness or anything else. If a child won’t put pressure on a limb, or if there is redness, warmth or swelling over a joint, that needs to be seen right away, Dr. Levasseur says.
Finally, be confident that you know your child best and if you sense that something is wrong, follow your instinct. Sometimes parents don’t come to the ER because they are afraid if it’s nothing they’ll be embarrassed. That should not be a concern, Dr. Levasseur says – doctors would much rather send a child with a non life-threatening condition home that night than have a child need to be admitted with something that has progressed to dangerous levels. “If something is not right with their child and they think they need to see the doctor, that is why we are there,” Dr. Levasseur says. “You never really know how serious it could be. Especially when a condition unexpectedly requires admission to the hospital, parents tell us they’re happy to have all the support they need under one roof.”