Jun. 30--Knowing when to take your child to the emergency room isn't rocket science. It's more about common sense and knowing what to watch for when an accident happens or illness strikes.

"The obvious things would be respiratory distress (trouble breathing), uncontrolled pain and uncontrolled bleeding," says Dr. David Tolo, emergency department physician and clinical service chief of Pediatric Emergency Medicine at Children's Hospital & Medical Center in Omaha.

While Tolo doesn't discourage parents from bringing their child to the emergency room, he encourages parents to first pursue other avenues, such as calling their doctor. If it's after office hours, call the doctor's triage line or a hospital nurse line. Some parents will consult health-care professionals in the neighborhood. If a child has ingested something poisonous, call the poison control center.

"If parents think it's a true emergency, then by all means they should just head in," Tolo says. "Obviously, they should call 911 if they think they're in dire straits."

But what constitutes an emergency? The following signs, symptoms and injuries warrant immediate attention and care:

1. Obvious bone or joint deformity or possible neck injury.

2. Seizures

3. Swallowed a small object or questionable substance and are vomiting or experiencing body pain.

4. Blood in the urine or stool.

5. Any eye trauma that affects vision.

6. Any testicular pain without any history of minor trauma.

7. Head injury followed by persistent vomiting (more than once or twice) and a severe headache.

Parents should look for partial loss of limb function and mobility on one side of body and facial drooping. Prolonged crying, irritability and one pupil larger than the other also are signs the child should be seen by a doctor.

8. Loss of consciousness for more than a few seconds.

"If it's more than a minute or two, the child should be assessed even if he seems fine within three or four minutes," Tolo says. If the child can't be roused, take him to the emergency room.

9. Stomach pain that can't be controlled with over-the-counter medication.

If the pain localizes to the lower right above the hip, it could be an appendicitis attack.

10. Neck stiffness and pain along with fever and headache

These are often signs associated with meningitis, which affects the brain and spinal cord.

"It's not just neck stiffness. Children don't want to walk. They don't want to move," Tolo says. With meningitis, a headache is usually more common than just a stiff neck. And a headache that cannot be controlled by medication should always be examined by a doctor, he says.

11. Severe burns

Take your child to the emergency room if a burn is larger than his palm, appears waxy in texture and white in color (a third-degree burn) and doesn't hurt, Tolo says. Burns to the face, hands, feet and genitalia should be seen by a doctor. If burn pain cannot be controlled with ibuprofen or acetaminophen, seek medical help.

12. Trouble breathing

If a child's skin tone is bluish or markedly pale, take him to the doctor. If an older child cannot talk in sentences and needs to catch his breath between words, take him to the doctor. "Sometimes in that situation, they could go to an urgent care center," Tolo says.

13. Fever in newborns

An infant less than 4 weeks old (28 days) with a temperature higher than 100.4 degrees needs to be seen by a doctor, Tolo says.

With older children and fevers, it's more how a child acts than the temperature itself. For example, a child needs medical attention if he has a 101-degree temperature and is very irritable and can't be consoled, or is so listless that he won't eat, drink or respond when prodded.

Contact the writer:

444-1006, teresa.forbes@owh.com

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