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The following Healthy Kids column originally appeared in the August 1, 2005, edition of the St. Louis Post-Dispatch.

Summertime is here, and along with it comes every healthy child’s fair share of sunburn, bee stings and scraped knees.

But when does a minor injury or illness become a reason to rush to the emergency room? Most parents have wondered this at some time or another.

In 2004, SSM Cardinal Glennon Children’s Hospital emergency room physicians saw 36,467 patients, and more than 18,400 children have visited the ER so far this year.

The emergency room at Cardinal Glennon, which was the first Level I Pediatric Trauma Center in the state, is equipped to effectively treat even the most serious illnesses and injuries. This is good to know for serious, even life-threatening medical emergencies, but sometimes patients in the ER can be treated by an outpatient visit to the pediatrician, or by treatment and watchful waiting at home.

Dr. John Peter, emergency room physician at SSM Cardinal Glennon Children’s Hospital and Associate Professor of Pediatrics at Saint Louis University School of Medicine, has some advice for parents on what to do in an emergency.

The time to visit the emergency room is when any of your child’s basic life functions are endangered, Peter said. This includes if your child is choking, having seizures, or having trouble breathing. Broken bones and serious lacerations also require emergency care.

 “But in all cases, parents should trust their judgment,” Peter said. “If the injury or ailment doesn’t seem that serious, it is probably something you can talk to your pediatrician about.”

Emergency room physicians are well-equipped with skills to save lives, but simpler problems such as colds, vomiting, diarrhea, coughs and rashes are better cared for – at least initially – by a primary care physician, for a number of reasons.

Your primary care physician’s main advantage over an ER doctor is his or her familiarity with your child, and the ability to follow up and track their treatment.

“With less serious injuries and illnesses, it’s almost always better to have a primary doctor who knows your child, knows their medical history and has established that continuity of care with your family,” Peter said.

Your regular doctor has the ability to follow up and track your child’s progress, so excessive treatment is not prescribed.

For example, if a child comes to the emergency room with a cough, the doctor may order tests, have x-rays done and use other resources in the hospital to evaluate the patient’s symptoms.

Because a follow-up phone call or visit is usually not an option, ER doctors tend to be more aggressive, to make sure they rule out major problems on the first visit. As a result, your child could end up receiving medicine or tests that, while not harmful, may not be necessary, either.

“Nationwide, there is an emergence of antibiotic resistant bacteria, and ERs are seeing more resistant staph infections,” Peter said. “One theory to explain this increase is that we put patients on antibiotics more often now, even when they may not require them.”

Children often come down with a fever, but most can be treated at home by acetaminophen (Tylenol) or ibuprofen.

“If you think your child has a fever, the first, most important thing to do is to check their temperature,” Peter said.

Thirty minutes to an hour after giving the child medicine, check his or her temperature again. If the fever has gone down and the child looks better, an ER visit is probably not necessary. Instead, Peter recommends calling the child’s physician and making an appointment to be seen.

Babies younger than 3 months old, with a fever of 100 degrees Fahrenheit or higher, probably need to be seen in the emergency room, but again, Peter said it is important to call the baby’s physician first.

Most doctors’ offices have exchange numbers available for parents to call after-hours or on weekends. If you are not aware of your doctor’s exchange number, it is important to find out and keep that number in a convenient location.

Though no parent wants their child to experience serious illness or injury, when it is necessary to go to the emergency room, kids here are lucky to have several resources to help them.   

“Often, your community hospital has the resources to treat your child’s health emergencies, but  St. Louis is also fortunate to have two Level I Pediatric Trauma Centers that can effectively treat even the most serious childhood illnesses and injuries.”

 

Dr. Bob Wilmott is Chief of Pediatrics at SSM Cardinal Glennon Children’s Hospital and is a Professor of Pediatric Medicine at St. Louis University School of Medicine. If you have a child health question for Dr. Wilmott, go to the “Ask Dr. Bob” section of the Cardinal Glennon Web site at www.cardinalglennon.com.

 


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