When to Bring Your Child in for Urgent Medical Evaluation

I’m a pediatrician and one common question I get from parents  is, “When should I bring my child for urgent medical evaluation?” I do recognize how difficult it can be to bring a child in for an emergency visit. It often requires time from work, childcare for siblings, and transportation to a medical facility. So when should you be concerned enough to take your child in for evaluation? Here is a basic rule of thumb: if you are worried and can’t easily exclude a life threatening illness—take the child in to be evaluated. It is better to be over-worried and well, then under-worried and gravely ill.

Obviously, though, depending on the age of the child, different illnesses have different manifestations. Thus, while a temperature of 100.4 F is not concerning in a well-appearing 10 year old, it could signal rapidly progressive meningitis in a 2 week old. Below are some basic signs and symptoms (broken into age groups) that can show parents or caregivers that a medical evaluation is indicated.

Note: This is NOT an exhaustive list and parents should err on the side of caution rather than “watching and waiting.” However, the list does give some helpful parameters for parents to use to guide their decision making process.

Under 3 months old

  • Rectal temperature greater than 100.4 F
  • Blue around lips, hands, or feet
  • Not feeding well
  • Crying spells more than three hours or more than twice a day
  • Bruising
  • Crying with diaper change
  • Change in mood (e.g. a fussy baby who is now abnormally calm and difficult to awaken, or a calm baby who is now fussy and difficult to console)
  • Unable to arouse
  • Bulging fontanelle
  • Rash
  • Blood in stool
  • Less than 1 wet diaper in 4 hours
  • Any fall
  • Any burn
  • Wheezing
  • Difficulty breathing
  • Grunting
  • Cough

Fully vaccinated* children 3 months – 6 months

  • Fever greater than 102 F
  • Any fever with a rash
  • Vomiting
  • Diarrhea
  • Less than 1 wet diaper every 6 hours
  • Wheezing
  • Grunting
  • Difficulty breathing
  • Cough
  • Bruises of any kind

Fully vaccinated children 6 months-2 years

  • Fever greater than 102
  • Vomiting and unable to keep any liquid down
  • Bloody vomiting
  • Diarrhea
  • Bloody diarrhea
  • Abdominal pain and fever
  • Severe abdominal pain (unable to walk or pulls legs up in pain)
  • Cough lasting more than 5 days or significantly worsening or causing difficulty breathing or vomiting
  • Wheezing
  • Unexplained bruising
  • Difficulty breathing
  • Grunting

Fully vaccinated children older than 2 years

  • Fever greater than 104
  • Vomiting and unable to keep any liquid down
  • Bloody vomiting
  • Diarrhea with fever or decreased urination
  • Bloody diarrhea
  • Abdominal pain and fever
  • Severe abdominal pain
  • Worst headache of life
  • Wheezing
  • Cough lasting more than 5 days, progressively worsening, causing difficulty breathing or associated with vomiting
  • Difficulty breathing
  • Grunting

A child of any age should be evaluated with:

  • Laceration
  • Possible fracture
  • Loss of consciousness
  • Fall onto head
  • Seizure
  • Sleepy, confused, difficult to wake up
  • Suddenly unable to see, walk, move, or speak
  • Heavy bleeding
  • Deep wound
  • Serious burn
  • Fast heartbeat
  • Impending sense of doom
  • Body part that is numb, tingling, weak, cold, or pale

There are times you shouldn’t wait to drive to an emergency department but rather immediately call 911:

  • Any symptom you worry may be progressive and possibly life threatening
  • Choking
  • Head injury and child is unconscious
  • Any neck injury
  • Severe burn
  • Seizure
  • Bleeding that can’t be stopped
  • Difficulty breathing
  • Allergic reaction

Finally, it’s important to research the emergency health care options in your cities. This is a detail many people don’t think about until an emergency occurs. Most pediatricians have sick visit slots during normal business hours. After hours, they often have a call-in line where a physician or nurse practitioner can triage your need. Some cities have pediatric emergency departments. Other cities have pediatric specific urgent cares. Ask your pediatrician what are the best options in your area.

Keep your pediatrician’s number, the emergency department’s number, and any local urgent care numbers on your cell phone’s speed dial. Discuss with your group of friends about emergency child care options (and be willing to watch their kids as well). When traveling, make sure you always carry your child’s identification and insurance card (if applicable). Check out the nearest hospitals around vacation destinations. Hopefully, with a little forethought and planning, you can make even an emergency situation flow smoothly and keep your loved ones safe.

 

* Unvaccinated children are at significant risk for invasive S. pneumonia and H. influenza. In addition they are at risk for pertussis, measles, mumps, varicella, and rubella. As such, they should be evaluated sooner and more frequently than a vaccinated child.

 

Rachel Nelson MD
Rachel Nelson MD

graduated from Loma Linda University and completed a pediatric residency at UC Davis. She has a passion for helping children reach their full potential. She is married to a colorectal surgeon and together they have two children: Amy and Michael. Dr. Nelson enjoys playing outside with her kids, gardening, and music.

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