Emergency room: When does my child urgently need help?

When their child is sick but the pediatrician's office is already closed, many parents panic. Out of concern, they drive to the nearest emergency room – but that's often unnecessary. A doctor explains which symptoms really require immediate treatment and who parents can contact for less serious ailments. Sebastian Severa is a specialist in pediatrics and adolescent medicine and works in the emergency room of the children's hospital at Hannover Medical School (MHH). "It's true that parents relatively often come to the emergency room with conditions that could also be treated by a pediatrician," he says.

The most common symptom that brings mothers and fathers to him is acute or chronic abdominal pain. Strictly speaking, chronic pain wouldn't be an emergency. But in regular care, the waiting times are sometimes too long for worried parents: "Some come to us when their child has been experiencing symptoms for some time, but they can't get an appointment with a specialist for another three months," the doctor explains.

Another common reason for a visit is fever. This, too, is often not an emergency: "Many people believe that a fever of 40 degrees Celsius or a fever that won't come down is always dangerous," says Severa. "Parents worry a lot when their child has a high fever, but they don't always understand that it can also be beneficial. It's good for the immune system, but bad for pathogens," the pediatrician explains. It depends on the child's overall condition; children tolerate fever differently: "One child might be lethargic with a fever of 38.5 degrees Celsius, while another might still be jumping around the room with a fever of 40 degrees." So, if a fever is high, it doesn't always need to be reduced. Only if the child is visibly suffering from it.

Severa refers to the new guideline of the German Society for Pediatric and Adolescent Medicine (DGKJ) . This guideline no longer views fever as a "symptom requiring primary treatment," but rather as a "physiological and generally helpful defense mechanism of the body." The DGKJ also states that crucial for assessment are not only temperature readings, but also the patient's general condition and certain warning signs: these include, for example, altered mental status, dehydration, skin hemorrhages, or shortness of breath.

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The situation is different for infants and very young children with fever, Severa emphasizes: "In the first three months of life, you should always see a doctor promptly if a child has a fever. The rule is, the younger the child, the sooner. So, if a ten-day-old child has a fever, they might not necessarily need to be rushed to the hospital by ambulance. But you shouldn't wait another night either."

Even in children aged three to six months, fever should be investigated promptly – at least by calling a doctor. "With children older than six months, you can initially just observe," says Severa. He also cites shortness of breath, lethargy, and skin discoloration such as blue lips as "red flags," warning signs indicating urgency, regardless of age.

Not least, many parents bring their children to the emergency room with cold symptoms such as coughs, runny noses, and earaches. "Often the symptoms appear during the night. And then they come here at seven in the morning because they don't want to wait until the doctor's office opens," says Severa. This is usually unnecessary. For such minor complaints, the rule is: "If the wait for a doctor's appointment is too long, you can give painkillers first. Some parents believe that this distorts the diagnosis, but that's not true. Besides, it's more important that a child doesn't suffer unnecessarily."

In case of serious injuries, you should of course call an ambulance. For minor injuries, it depends: according to Severa, cuts should be treated promptly if they might require stitches. With burns and scalds, blisters are a sign that they should be treated by a doctor, he says: "As immediate first aid, you should cool minor burns with lukewarm water for about ten minutes, but not larger ones, because there is a risk of hypothermia."

It's often difficult for parents to assess how serious their child's symptoms really are. If the pediatrician's office is open, a phone call can provide guidance. The emergency number 112 is for potentially life-threatening and serious cases. It can then be determined whether to go to the emergency room or be taken by ambulance. A medical on-call service for urgent, though not life-threatening, cases can be reached around the clock at 116 117. Parents are usually referred to the pediatric emergency room, says Severa. However, the number can also be used to inquire whether there is a nearby pediatric on-call practice that is open at night or on weekends.

Severa recommends that parents who want to learn more about typical illnesses and possible complications consult the parent information provided by the German Society for Pediatrics and Adolescent Medicine. Articles such as "My child has a cough," "My child has a stomach ache," and "My child has a fever" offer a good overview. For each illness, the information explains when to visit a doctor's office or perhaps even call emergency services.

To separate less urgent cases from genuine emergencies, the emergency room uses a triage system: a classification based on severity from one to five. "One means life-threatening, five is the least urgent; these cases are treated last," explains Severa. The most frequently assigned number is four – meaning not-too-serious complaints.

Thanks to triage, seriously ill children receive timely care even when the ward is overcrowded. However, long waiting times are possible for children with mild symptoms. How does Severa react when he notices that parents have come to him about something trivial? "If I realize they're genuinely worried, I don't really criticize them, but rather hint at it subtly," he says. He only gently suggests that the visit wasn't necessary. After all, he doesn't want parents to be afraid to come next time – when their child might be seriously ill.

The situation is different when parents call an ambulance for harmless or long-standing symptoms and openly admit that they simply didn't want to wait long. "Then I can get a bit snappy," the doctor admits. After all, it could happen that the ambulance arrives late in a real emergency. However, in all cases of doubt, the rule is: "It's better to go to the emergency room too often than not often enough."