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When Do You Need to Take Your Child to the Emergency Center?

Posted on Sep 30, 2019

On this week’s On Call for All Kids, Joe Perno, M.D., vice president of medical affairs at Johns Hopkins All Children’s Hospital, shares information for parents about when an injury can be treated at home or when you should seek help from your pediatrician or a hospital.

Kids seem to hit their heads all the time, how do you know when an Emergency Center visit is necessary?

Head injuries are one of the more common injuries we see in the Emergency Center (EC). Several things factor into whether or not an EC visit is required. The first would be the circumstances. For example, bumping their head on a table is different from falling from Dad’s shoulders. The greater the impact the more likely they should be seen.

Some key things parents can easily assess:

  • Was the child knocked out?
  • Is the child excessively sleepy or lethargic?
  • Did the child vomit more than once?
  • Is there significant swelling on the face or head?
  • Is the child crying and cannot be consoled?
  • Is the child’s behavior abnormal?

Essentially if any of these are yes, the child likely should be seen in the EC so that we can evaluate if a CT scan is necessary or not.

Lastly, one of the best ways to prevent head injuries is wearing helmets when appropriate, such as bicycling, skateboarding, rollerblading, etc. If it has wheels, you should wear a helmet.

At some point, all kids seem to need stitches. How do you know if a cut can be managed at home or does it need stitches?

You are correct, lacerations are a very common cause of EC visits. There are some specific first aid maneuvers families can do at home to help determine if a cut will require stitches. The first thing to do is hold pressure on the wound to see if bleeding can be controlled. If you cannot get the bleeding to stop, you will need to head to the EC.

Once the bleeding is stopped, you can evaluate the cut. Many parents are surprised to see how much blood can come from a very small cut, especially on the face and head.  As you evaluate the cut, you need to see if it is gaping open, fat is coming out or if it is deep. All of these things may indicate stiches are required. Lastly, I recommend gently pushing from both sides of the cut. If the edges push together and the cut looks smaller, it likely needs stitches. If pushing on the edges does not move the tissue, you likely can avoid that EC visit.
If an EC visit is not needed, it is very important to cleanse the wound, apply a topical antibiotic and some form of dressing.

What is another common injury you see in the EC?

Broken bones are a very common injury. One of the most common questions I get from friends after an injury is whether or not they need an X-ray. Although this can be challenging, there are some simple things parents can look for at home:

  • Is the bone deformed or bent in any way?
  • Is there localized tenderness over one spot of the bone?
  • Is the child unable to use the extremity?
  • Is the pain unable to be controlled with simple pain relievers at home?

If the answer is yes to any of these you likely need an X-ray. If you decide to wait it out, if the child is still having persistent or worsening pain, you may need an X-ray. As a general rule, the younger the child the less likely they are to have a sprain and more likely to have a fracture.

Anything that you see in the EC that is unique to Florida?

The Gulf and Tampa Bay provide some unique injuries. For example, anyone cut in water by coral, shells or other objects can potentially be infected by bacteria. Any significant cut should be seen in the EC, washed out and likely started on antibiotics. Also, sting-ray bites often require both pain medication and an X-ray to rule out a barb in the wound.

On Call for All Kids is a weekly series featuring Johns Hopkins All Children’s Hospital medical experts. Visit HopkinsAllChildrens.org/Stories each Monday for the latest report.


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