I recently had a chat with a good friend of mine who is an emergency room physician in Southern California. Since becoming a mom, I have texted him numerous questions about fevers, croup, bumps, and what I like to call “throat selfies” in an effort to avoid needless trips to the doctor or pediatrician. It occurred to me that he must see a lot of needless trips to the emergency room by worried and well-meaning parents of young children so I asked him a few questions.
I asked him to share one thing that he wished every parent of young children knew. He said he wished parents knew that not every child with a cold needs to see a doctor and fevers are not usually anything to be concerned about. He thinks that a fever at or above 104 degrees Fahrenheit (40 degrees Celsius) is one that should be seen immediately (but even lesser fevers warrant a visit to a doctor as does any fever in a newborn).
As fevers are a topic near and dear to my own heart, I sought further information. He said ordinary fevers (not overly high fevers as previously mentioned) are treated for the comfort of the child, not because it’s dangerous to have a fever. Many parents bring their children to the emergency room with fevers and there’s no need because acetaminophen and ibuprofen are usually effective and can be safely administered at home.
I then asked him what other resources we have at home that often go unused. He said he works the night shift and often parents will come in and say their child was wheezing and coughing but are much improved once in the hospital. He said that’s because the cool night air helped settle their cough. Moist, cool air is sometimes all a child needs to breathe easier. A cool air humidifier, holding the child in front of an open freezer or just stepping outside can get a child through the night to see the pediatrician in the morning.
Breathing is something that should be watched closely though. There were 4 things I was told to watch for in terms of potential respiratory distress, which can in some cases be signs a child is infected with COVID-19 or other serious illnesses. If I see any of the following in my young children, I should take them to be seen by a doctor immediately:
- Nasal flaring
- Retracting of the skin above the collar bone
- Breathing too fast
- Belly breathing, shown in the video below
Then I asked about falls. I shared that I was the mom who needlessly took their child to the emergency room for a fall and we all contracted the stomach flu in return. He said there’s an algorithm doctors use called PECARN (which can be found here) to determine if there is traumatic brain injury. A major takeaway for me is that if a child under the age of 2 falls from a distance of more than 3 feet (1 meter), they should be seen at the hospital. Other things to look for are abnormal behavior or vomiting which would indicate the child should be seen immediately.
I was told photos or videos can be very helpful to the doctor. This is a tip from my doctor friend that has been reinforced by my own personal experience. Not until I took a video of my daughter in one of her many episodes with croup was I taken seriously and sent to a specialist. Pictures of concerning diaper contents, the distance from which the child fell, or a video of a coughing attack can sometimes make it easier for the doctor to fully understand what is happening with our children.
Another way we as parents can help emergency room doctors, and doctors in general, is to help restrain the child if he is fighting his exam. For first time parents, this can be emotionally difficult, but ultimately a proper exam is what’s best for our children and we may have to fight them to achieve it.
Finally, I asked about the best (meaning least crowded) time of day to visit the emergency room (assuming we have a choice). He said mornings (between 6 am and 10 am) are generally pretty slow. He also said if you find yourself waiting for a long period of time, it could indicate that you don’t need to be in the emergency room as the order patients are seen is based on their condition.
As a mom, I have taken my children to the doctor on several occasions when we could have stayed home. I think many of us let our imaginations run wild fueled in part by viral social media anecdotes about sippy cup mold and tapeworms. Now that my children are getting a bit older, I found what my doctor friend told me to be true; when contemplating a trip to the emergency room, I need to observe my child. If they have a fever, but are otherwise acting like themselves, I stay at home and wait it out.
If they don’t have a fever but they’re lethargic, moody, and unwilling to play, I will take them to be seen. With kids, their behavior can be the biggest indicator of how they’re actually doing. When in doubt, call your pediatrician. Most have after hours answering services to help guide us through a particularly rough night. Good luck!