Focus on Pediatrics: When in doubt, parents should visit the ED
Provide information about who to call, when to go
It is difficult to define for a parent what a medical emergency is, says Karen Mathias, MSN, RN, clinical nurse specialist for emergency services at Children’s Hospitals and Clinics Minneapolis/St. Paul. "I think a medical emergency is what the parent perceives it to be," she adds.
If the parent believes there is a severe illness or injury that is threatening his or her child’s health or may cause permanent harm, then the emergency department (ED) is an option, says Kathy Shaw, MD, ED director at Children’s Hospital of Philadelphia and chief of the division of emergency medicine.
"It is difficult for a layperson to know exactly what the end diagnosis is going to be, so they have to focus on looking at their child and if they feel their child needs immediate help, then they should be calling 911 or coming to the emergency department," she says.
However, there is some information that can help parents make appropriate decisions about the ED. Make sure that parents have the number of the nurse triage telephone hotline, whether public access or through their primary care physician, says Mathias. They could report the symptoms to the nurse and receive advice on whether to go to the ED. The advice they get from a nurse should be based on computer database protocols, she adds.
Parents who are not certain whether to take their child to the ED should call their physician first, Shaw advises. Yet they shouldn’t wait too long for a return phone call. Parents need to know that they must be particularly careful with babies. A 3-month-old baby who is crying and has a low-grade fever could have a significant problem such as meningitis or a nonlife-threatening problem as an ear infection.
Parents should know to first undress the baby to see if anything is hurting him or her, and then call their physician. However, it is always best to be cautious, says Shaw.
There are certain signs and symptoms that parents should to be aware of that require immediate medical attention. When these are present, parents should not call their physician or a nurse-advice telephone service before taking their child to the ED, says Shaw. They include:
- trouble breathing or swallowing; lips look blue or gray;
- unconscious, severely lethargic, not responding appropriately or having convulsions or seizures;
- severe, persistent pain that is not relieved by Tylenol or ice;
- a cut or burn that is deep or large or involves the head, chest or abdomen;
- any bleeding that doesn’t stop after applying pressure for five minutes;
- a head injury with loss of consciousness, confusion, vomiting, or a severe headache that is not relieved by Tylenol;
- a fever and a new rash or a fever and altered consciousness or lethargy;
- ingestion of a poison (parents should first call the poison control center).
When parents report to the ED with their child, if possible, they should bring the child’s immunization record, any medications he or she is taking, and if there was ingestion, the substance that was ingested, says Shaw. "Parents should be prepared to tell the nurse or physician exactly what is worrying them about their child. Parents are the best historians; they can tell you what is different about the child," she says.
Parents should be aware that multiple people at the ED will try to gain information about their child’s history, length of illness, and things they see in their child that is concerning them, says Mathias. "Parents need to be taught that they need to be a continual advocate for their child, even in a health care setting." If an hour or two goes by while they are waiting to see the physician and they feel as something has changed about their child’s condition, they need to speak up. n
Focus on Pediatrics: Prevention is the key to fewer ED visits
Teach parents to prevent death-causing injuries
While it is good for parents to know when to visit the emergency department, many of these frantic trips would be unnecessary if injuries were prevented, says Kathy Shaw, MD, director of the emergency department at Children’s Hospital of Philadelphia and chief of the division of emergency medicine. The No. 1 one cause of death for children older than the age of 1 is injury.
Most children die in automobile accidents; therefore, it is important to teach parents how to appropriately restrain their children while riding in cars. This information includes having the child ride in the proper car seat, whether infant or toddler, and to graduate children to seatbelts only when they are big enough.
Another major cause of death, especially in cities, is children being hit by cars while playing in the street, says Shaw. Parents need to make sure that children are not crossing streets on their own and that they are playing in a playground.
Near drowning is another major problem, especially in warm-weather states such as California, Arizona, and New Mexico. Pool owners should fence their pools and adults should learn CPR. "When children are around water, one adult should be assigned to watch them even when a lifeguard is present," says Shaw.
Burns are another common injury for children. All houses need a working smoke detector, and families should have an evacuation plan, says Shaw. Other areas for injury prevention include wearing protective equipment while playing sports and staying away from toys and other objects such as walkers and trampolines that have been reported to be dangerous, says Shaw.
(Editor’s note: Patient Education Management has addressed many of these injury prevention issues. To learn more about drowning prevention education, see PEM, May 2001; for burn prevention, see PEM November 2001; for sports injury prevention see January 2002; and for safety seats, see PEM May 2002.)
Focus on Pediatrics: Tips on reacting to medical emergencies
Parents should remain focused and nurturing
When an incident occurs that may require emergency medical attention, parents need to remain calm. Children, no matter their age, look to see if their parent is stressed, upset, or anxious. "The child feels their parent’s stress, which in turn can make him or her scared," says Katie McFaull, CCLS, a certified child life specialist at the emergency department (ED) of Children’s Healthcare of Atlanta. There are several other things that parents can do, says McFaull. She recommends:
- Acknowledge the facts of the situation, and reassure the child that help is on its way.
- Know that your child is resilient and you are their comforting presence. Let your child know when and where you will be with him or her if they ride in an ambulance or life-flight helicopter.
- Let your child know that his or her body is smart. It makes new blood all the time; blood cleans and helps makes scabs; pain is the body’s way of letting people know they are hurt and need help; the child’s body is already starting to heal itself but the doctor will help his or her body heal faster.
- Small children view their bodies as containers and think that Band-Aids, gauze, or a towel not only help control bleeding but keep everything from falling out. Reassure the child that this won’t happen.
- Talk to your child in a soothing voice, even if he or she is unconscious. If the child is conscious, talk to him or her about relaxing in a soothing voice. Suggest that the child become limp like a spaghetti noodle and take breaths in through the nose and out through the mouth.
(Editor’s note: In the August issue of Patient Education Management, we will cover what parents should to do on the way to the ED, while waiting to see the physician, and during treatment.)
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