image credit: Tim Bish via Unsplash
While I am an RN, the information in this article is not a substitute for the care of a physician. As always, if you have further concerns or are unsure about the severity of your child’s illness/injury, please contact your family doctor or head to the ER or urgent care.
Ok, so the ER isn’t always disgusting, but most of the time the ER is not only disgusting, but also expensive, covered in disease, and slow as molasses. My son broke his pinky finger three years ago, which landed us in the ER on a Sunday. We waited for two hours; when we were finally seen, he got some Advil and a splint.
I got a bill for $578.
A broken bone isn’t exactly a fever, but let’s be honest, a kid with a high fever or a cough that won’t quit is sometimes more terrifying than a crooked pinky. For the first five years I was a mother, I had my pediatrician on speed dial #1. Every illness, no matter how minor, sent me into a panic spiral of “my kid probably definitely has leukemia.”
None of them ever actually had leukemia. All that really happened was I spent the equivalent of a semester of college tuition on co-pays.
The million dollar (or $578, as it were) question: To ER or not to ER?
Bookmark this article, it’s going to save you so much money.
Also isn't it a mother-effing bummer that you need to bookmark this article? Healthcare is a human right, but in America it's a human right that costs $578. Not exactly the same thing.
To ER or not to ER? Vast majority of the time, not to ER. To ER if you can’t reduce it with any intervention.
First item of business: Anything under 100.4º F isn’t technically a fever. Don’t bother going to the ER. In fact, don’t do anything.
The highest, and scariest, fevers are often viral. For some reason, viruses cause high fevers (so does pneumonia though, so beware). That’s the bad news. The good news is, viruses can’t be treated with antibiotics, so you just have to wait them out. Which means no ER!
There are a lot of ways to treat fevers*.
*Note: A low-grade fever is best left to do its work. If your child is acting relatively normal (or even a bit lethargic], let the fever do its thing.
Lukewarm bath. Not cold, shivering is not your friend (shivering is the body’s way of warming you up).
Cool rags to the back of neck, top of head, armpits, and groin. These are your hotspots for fever reduction.
Ibuprofen. Give according to your child’s weight every six hours, like clockwork. When you let it lapse, the body has to work double time to get the fever back down.
If the ibuprofen isn’t getting it done, alternate with acetaminophen (Tylenol*). Do it like this: Ibuprofen at 12, 6, 12, 6. Give Tylenol for breakthrough fever as often as every four hours. 4 pm, 8 and so on.
*Word to the wise: Tylenol has a really high potential to be liver toxic, so be careful with the dosing.
Children are not like adults, they can tolerate a fever that would kill us (or at least make us think we are dying.) Even up to 105º F isn’t unheard of. Fevers can last a WEEK. Honestly. I don’t get worried until day 7 (unless there's a hacking cough. See: pneumonia.)
Also, do not trust every thermometer. The tympanic (ear) variety can be unpredictable (usually higher than actual).
The armpit is a good spot (and pretty easy choice for a squirmy kid), just add one degree to whatever reading you get there (and don’t take a temp if there’s been an ice pack or water near the site.) A plain ol digital thermometer works just fine.
A word on febrile seizures: They happen. They are scary but usually just a fluke. If this happens to your child, head to the ER or call your doctor right away. But try not to panic. It’s all going to be totally fine in a few days.
2. Gashes and gouges
To ER or not to ER? Usually only if it needs stitches.
Anytime a child hits his face or head, it’s going to bleed a LOT. There are a lot of vessels in your head (because there is also a brain there) which means at any given time there is a lot of blood circulating. Which means, when they fall face first on the sidewalk, it’s probably going to look like that scene from The Shining.
Forehead/scalp and eyebrow gashes (like from running into a table) often do need stitches because things over bone tend to split open, lips and tongues often do not.
Not surprisingly though, there is a lot of blood in the mouth, which means that a bit tongue can look like a severed tongue. A tongue cut is usually fine left alone and heals quickly. A large one might need further care, usually antibiotics because mouths are a disgusting bacterial breeding ground.
Remember: Blood is normal and expected here.
3. Bumps and bruises
To ER or not to ER? Not to ER.
Your child is going to fall 7000 times (6000 of those are going to happen between one and two years of age.)
Your child is going to have so many bruises, people might consider calling CPS. Bruises are a normal part of the healing process. If you want to help your kid out, in a sort of non-medicinal hippie way, hit up the local health food store (or Whole Foods/Paycheck) and grab some arnica cream. Definitely helps, definitely cheaper than the ER.
At some point during your child’s toddler years, you might be convinced that she has an equilibrium problem because of how frequently she falls. This is highly unlikely. Walking is just kind of hard.
You might also like: 9 Parenting Mistakes Most (ALL) Of Us Make
4. Bangs and bonks
To ER or not to ER? Definitely ER if there’s a dent, otherwise nah.
If your child hits their head on something, and they will, you might think they are going to die. The head is where the brains are, so this is a logical fear.
But here’s a quick thing to remember! They almost never die from hitting their head.
bumps = good (I mean not good, but better than a dent)
dents = bad
If they have a HUGE goose egg, that’s actually better than the alternative. It usually means their skull is in one piece. Due to the aforementioned amount of blood in the general head region, it will accumulate under even a small wound, leaving, yep, a bump.
Check pupils to make sure they look the same size and open and close in the light. If they start vomiting (other than the kind of vomiting that happens when a child cries hysterically), go to the ER.
Otherwise: Ice it. Ibuprofen every 6 hours for the headache they will have. Wine and/or meditation every one hour for the headache you will have.
5. Pukes and poops
To ER or not to ER? Almost always NOT to ER.
Most kids have the reserves to vomit and/or have diarrhea for 24 hours before it’s a crisis. If you are breastfeeding, nurse your baby as often as they want. Even if they vomit. That’s fine.
Watch for dry mouths and/or eyes. If your baby has a wet mouth and tears, you’re ok.
The trick about reintroducing fluid is to go low and slow. A couple of teaspoons every 15 minutes or so as long as they can keep it down. Don’t even think about food for 8 hours.
There is such thing as what I call a “fluke puke.” This is like “I ate too much candy” or “I ran around too much and then chugged a bunch of water.” The fluke puke is not the same as the viral puke. If your child fluke pukes just let them decide when they feel like drinking again.
Vomit is scary. It is so scary that there is an actual FEAR of vomit disorder (emetophobia). It’s scary for kids and also for parents trying to catch puke in whatever the nearest receptacle is. Stay calm (for them, you can freak out later if necessary). Most of the stomach viruses last a day or so (until they pass on to the next kid, and the next, and so on).
SAVE THE COMMUNITY, keep the vomit at home (do not take your child to the ER).
*A note: If your child projectile vomits after every breast or feeding, this could be the sign of a more serious issue called pyloric stenosis. Head to the doc.
6. Terrifying coughing
To ER or not to ER? To ER when they can’t breathe. Otherwise, treat it at home or wait for office hours.
There are lots of coughs your kids will have. There is the dry hacking cough. There is the phlegmy wet upper respiratory cough.
And then there is the SEAL COUGH.
It is not unlike that, only it’s coming from your child and it definitely sounds like they are going to die.
ALSO, it always happens at like 2 am. Because isn’t that just how life goes? (There's actually a scientific reason for this.)
I mean, you’re probably going to panic a little but just remember these two options:
If it’s cold, go outside. Bundle your child’s body, leave their head out. Sit. Wait.
If it’s not cold (or if it’s arctic Canada freezing) sit in a steamy bathroom or shower. Sit. Wait.
One of these two things will stop or at least slow the cough, almost always.
While it might sound like your child can’t breathe, they probably can. They are probably mostly terrified of the animal sound coming from their body. If they start turning blue or can’t get a breath, or if you see their chest retracting (video of that here), off to the ER with you.
Other things you can do: Raise the head of their mattress by placing a pillow under it, put vapor rub on the chest and feet and/or some eucalyptus on a rag or towel near their head, sit in a chair and weep.
6. Rashes and other weird skin things
To ER or not to ER? Nope. Only if you know it’s a black widow or brown recluse spider bite OR a spider bite you can’t identify that is very painful or ulcerated.
Kids have weird skin. Combine that with all the weird things of the world and you’ve got a recipe from some gnarly skin stuff.
This gnarly skin stuff can range from a prickly heat rash to blisters, and all incarnations in between. Most skin stuff will resolve with some hydrocortisone and/or Benadryl.
Process of elimination:
Have they had new foods (or were they exposed to one they are allergic to)?
Any change in soap/detergent/fabric softener?
Any contact with grass or other plants?
Any contact with bugs?
A large bump or insect bite can be easily monitored. When you first notice it, draw around the edge with a permanent marker. Keep an eye on if and/or how quickly it spreads.
If you know your child has been bitten by a spider, but you don’t know what kind, keep a close eye. Most spider bites are not a big deal. They will be itchy and/or red like any other insect bite (only larger). If they turn dark red or are very painful or ulcerated (like an open wound), head to the ER. Don’t waste time with that one.
If your child has a rash which follows a high fever, it might be roseola, which is annoying but viral and not a big deal. No ER. Meds for the fever and wait it out.
If your child has a rash on their hands, feet, and in their mouth, it might be the aptly named virus, hand, foot, and mouth, which is ALSO annoying. Wait it out. It goes away.
If your child has a blistery rash around their nose or mouth and/or the same blistery rash on their arms, it’s probably impetigo. Impetigo is highly contagious and also highly disgusting. It’s caused by strep or staph and requires antibiotics. Why the arms? Because kids rub their noses ON THEIR ARMS BECAUSE THEY ARE GROSS. RUN TO THE DOCTOR (you can skip the ER).
Even after 22 years of parenting (and being an RN), some illnesses still catch me off guard. But for the most part, we’ve handled things at home.
When do I always go to the ER?
If I think (or am sure) they have broken a bone.
If they have sliced something open and/or off (a finger for example).
Most of the rest of it, I treat at home: Ice/ibuprofen/acetaminophen/TV for them, wine/Xanax for me.