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Written by Dr. Neil Barclay, with Dr. Urbain Ip and Dr. Kim Veldhuis

Parents’ Guide to Using the ER Wisely

08/02/2017 2:55:22 PM | 0 comments |
When to treat common childhood illnesses at home and when a doctor’s care may be needed. 

"It's 2 a.m. and my little boy has a fever. Should I take him to the hospital?"


That question has been asked by just about every anxious parent at some time or other. The concern stems from not knowing the cause of the fever, not knowing what to do next and worrying that there may be something serious going on.
 
Any temperature above 38 C is considered a fever. A fever is only a symptom – not a disease – and
a by-product of the most common ailments children suffer from – the common cold and accompanying cough, and gastroenteritis or stomach flu. Like their accompanying diseases, most fevers do not require a trip to the ER, or even a visit to your family doctor. But if you’re unsure, call 8-1-1 for advice.
 
Here are some guidelines for parents about how they can help treat these ailments at home and when they should seek help elsewhere:

Common Cold

A cold is an upper respiratory (upper chest/throat/head) illness caused by a virus infection of airway passages. You know your child has a cold if they have a runny/stuffy nose, sneezing, watery eyes, sore throat, cough, aches, sweats, and/or a fever.
 
Colds are contagious during the first three to four days. Antibiotics will not help recovery because antibiotics cannot cure viruses.

 

How can a parent help?

With acetaminophen (Tylenol) or ibuprofen (Advil), plenty of clear fluids (water, fruit juice, tea, clear soups), and rest, a child recovers in a few days or sometimes in up to a week or two.

 

When to seek help?

  • Unusual shortness of breath
  • Not responding to you
  • Child is clearly very unwell – lethargic, listless, not drinking at all, poor interaction, inconsolable
Most cases can be cared for at home or by a family doctor. If you feel your child is very unwell or 8-1-1 recommends it, a visit to the ER may be appropriate.

Gastroenteritis (diarrhea and/or vomiting) aka stomach flu

Most diarrhea and/or vomiting in children is caused by a virus. Children with gastroenteritis, also known as stomach flu, may experience stomach cramping, fever, fatigue and lack of appetite.
 

How can a parent help?

Antibiotics will not help recovery because antibiotics cannot cure viruses.
 
If your child is being breastfed, continue even if the baby is unwell or has diarrhea. Feed them smaller volumes more frequently.
 
Be sure your child drinks to replace lost fluids. You can purchase Pedialyte (or Lytren/Gastrolyte) from a pharmacy. Older children can also have diluted juice and clear soup/broth.
 
After 24 hours of just fluids, the diarrhea and vomiting will likely decrease. If symptoms are improving, slowly return your child to their normal diet of formula or easily digestible solid food (crackers, flour chapati/roti, rice cereal, mashed potatoes, plain meat/eggs, applesauce, bananas).

If the diarrhea is almost gone by day three, return your child to their normal food.

 

When to seek help?

  • No decrease in the diarrhea after 24 hours of just fluids
  • Signs of dehydration (dry mouth, severe thirst, no tears when crying)
  • No urine for six to eight hours in older children or four to six hours for babies and young children
  • Blood-stained mucous or stools
  • Starting to appear more sick
  • Has bad belly pain that lasts for more than a few minutes at a time
  • Is not responding to you
Most cases can be cared for at home or by a family doctor. If you feel your child is very unwell or 8-1-1 recommends it, a visit to the ER may be appropriate.

 

“In the winter, our Emergency Rooms see a lot of coughs, colds and viral gastroenteritis, also known as the stomach flu in children,” says Dr. Neil Barclay. “These are common illnesses and they rarely need a hospital visit. The best thing a parent can do when a child has a fever and shows symptoms of a cold or an upset, crampy stomach is to treat the symptoms at home. If the symptoms are getting worse or not going away after a few days, they can make an appointment with their family doctor or call 8-1-1 for advice.”

Fever

A fever is only a symptom, not a disease. The most common cause is an infection caused by a virus (most common) or a bacteria. A virus-related fever is often the result of a cold, influenza, bronchiolitis, croup or gastroenteritis, commonly known as the stomach flu. A bacteria-related fever may be the result of an ear infection, bladder infection or pneumonia.
 
With a high temperature, a child will feel unwell. They may not want to eat, be a little more fussy than usual and play less, but the fever will typically go away in 3-4 days.
 
A child with specific symptoms such as an earache that lasts for more than two days, breathing problems or bladder symptoms along with the fever, should be assessed by your family doctor. As well, babies less than three months old with fever and no obvious source should be seen by your doctor.  

 

How can a parent help?

The best, and most accurate, way to take a temperature is to use a rectal thermometer.  You can also take a temperature from the armpit, mouth or ear. Remember that the number is not as important as the symptoms. Visit HealthLink BC for more information about how to take a temperature.
 
Along with rest, make sure they drink enough, even if it’s just sips of water or formula or more frequent breastfeeding. Use medications such as acetaminophen (Tylenol) and ibuprofen (Advil and Motrin) from a pharmacy. The right dosage depends on the age and weight of the child.
 
If you’re unsure if your child needs to be seen by a doctor, call HealthLink BC (Dial 8-1-1) to speak to a nurse any time of the day or night.

 

When to seek help?

Parents should recognize symptoms that may represent a more serious underlying cause for the fever and know when to go to their family doctor or to the Emergency department if their doctor is unavailable to see them quickly.  

The degree of temperature is less important than the associated symptoms. Children with a fever that should be assessed by a doctor – your family doctor or an Emergency physician – as soon as possible include:
  • Babies under three months with no other obvious symptoms. They can get very sick quickly and require an aggressive approach to investigate the underlying cause.
  • Children who experience seizures due to a rapid increase in temperatures.
  • Children between three months and three years with a fever for more than three days and who appear ill (not drinking, very clingy).
  • Children with fevers lasting longer than seven days.
  • Children with a known chronic medical condition.
  • Children with a new rash that does not turn white when you touch it.
  • Children who are clearly very unwell – lethargic, listless, rapid breathing, not drinking, poor interaction, inconsolable.
Visit HealthLink BC for more information about fevers. 

How to Use the ER Wisely 

Children are frequently cutting themselves, scraping knees and elbows, sometimes falling and even breaking bones. The guidelines below apply to children and adults alike. Hospital emergency rooms are not the place to go for common illnesses or minor injuries. 
  • For any health concern call your family doctor first. Your family doctor knows you and your medical history. Same-day urgent appointments may be available.
  • If your family doctor is not available check medimap.ca for walk-in clinic wait times and hours.
  • For trusted health advice call 8-1-1, HealthLinkBC, available 24 hours/day, 7 days/week. Speak with a representative who will help you find health information and services, or connect you with a nurse for health advice, a dietitian for nutrition information or a pharmacist for medication advice.
  • For an urgent medication refill speak with your pharmacist. Your pharmacist may be able to provide an emergency refill of your prescription, including medications for chronic conditions. Contact your pharmacist for minor issues that might be managed with over-the-counter medications.
  • For a child/youth mental health crisis, call Fraser Health’s START program at 1-844-782-7811.
  • For a possible poisoning or exposure to a toxic substance, call Poison Control at 1-800-567-8911.
  • For critical or life-threatening conditions, including broken bones, severe breathing problems or severe bleeding call 9-1-1 or go to the nearest emergency room. 

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