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Duke Medicine: When to take your child to the emergency department

Posted October 25, 2010 9:00 p.m. EDT
Updated October 25, 2010 9:07 p.m. EDT

When should you take your child to the emergency department? Dr. James Fox, a Duke pediatric emergency department physician, has some answers:

Many children cared for in Duke Emergency Department's Pediatric Center do not have life-threatening conditions, and many of the children’s conditions may be cared for by the child’s primary care physician.

However, there are many illness which are best cared for in the pediatric ED. The following are a few examples of conditions that should be treated in the pediatric ED. (This list is not meant to be all-inclusive.)

Difficulty Breathing

If at any time you are concerned about your child’s breathing, he should be evaluated quickly by a physician. Signs of difficulty breathing include:

  • Breathing rate faster than normal
  • You can see your child’s ribs or collarbone outlined by skin when he breathes in
  • Your child’s belly moves outward with every breath in
  • Your child’s nostrils move outward when he breathes in
  • Your child’s lips or tongue are blue


While the vast majority of children who have a fever do not have a dangerous illness, fever may be a marker of a serious infection  such as meningitis, pneumonia or urinary tract infection. Children with fever are often tired, much less active, and less interested in eating and drinking.

Giving your child weight-appropriate doses of acetaminophen (Tylenol) or ibuprofen (Motrin; do not use if your child is less than six months old) may make your child feel better and more interested in eating and drinking.

You should bring your child to the ED for evaluation if your child:

  • Is three months old or younger and has a rectal temperature of 100.4 F (38 C) or higher
  • Has a stiff neck
  • Is dehydrated (mouth is dry, no wet diapers in 18 hours, eyes sunken, soft spot sunken)
  • Has a condition which makes him more susceptible to infections (for example, receiving chemotherapy, sickle cell anemia, on daily oral steroids, or has a central line in place)

Call 911 immediately if your child has a fever and:

  • Is difficult to arouse
  • Has difficulty breathing
  • Has a seizure

Broken Bones

When children injure bones, parents often wonder when it is necessary to bring their child to the ED for evaluation. Here are some guidelines:

  • The injured bone is obviously deformed. The bone may need to be “reset.”
  • A bone is out of place (dislocated).
  • There is an open wound in the area where the bone is thought to be broken. This may be an “open fracture.” Certainly if you can see the bone, bring your child to the ED.
  • Your child reports numbness, tingling, or weakness in a body part beyond the injured bone. Also, if body parts beyond the injured bone are cold or pale, an ED evaluation is warranted.

If you believe your child’s injured bone needs to be evaluated in the ED, you may give your child a dose of Tylenol or Motrin but do not allow your child to have anything to eat or drink until he is evaluated by a physician.

For more tips and advice on when to take your child to the emergency room, including what to do in the case of poisoning and specific considerations if your child is having trouble breathing, read the full article in the Your Child's Health section of