When Should I Go to Emergency?Common Health Concerns & What to Do

Sarah Reid, MD, FRCPCPediatric Emergency Physician

What we’ll cover

• What to expect from your Emergency visit

• Common concerns in the 1st year of life

– Jaundice

– Breathing problems

– Fever

– Dehydration

WAITING

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CHEO Emergency Department

• >65,000 visits/year

• >175 visits/day

• 15% of visits are 0-1 year olds

– Jaundice

– Breathing problems

– Fever

– Dehydration

JAUNDICE

JAUNDICE

• Yellow pigment in skin and eyes

• Common in healthy newborns (60%)

• Can last up to 4-6 weeks in breast-fed infants

• A problem if high levels of yellow pigment

(bilirubin) in blood

JAUNDICE

• Levels are checked within 1st 48 hours after

birth

• May need follow-up levels

Red blood cells

break downThe liver

Eliminated in poo/pee

BILIRUBIN

Yellow pigment released

Why?

• High bilirubin levels are associated with:

– Dehydration/feeding problems

– Mom and baby’s blood group are different

– Infections

– Other more rare problems

• High levels need treatment to prevent

complications

When to come to CHEO

• Feeding less than every 4 hours

• >6 hours since last wet diaper

• Very sleepy or hard to wake

• Irritable, crying more than usual, can’t console

• Fever

• Looks more jaundiced (yellow) to you

Your visit

• Jaundiced babies are placed under treatment lights immediately

• Blood test is drawn to check level of bilirubin

• MD will see you very quickly to take a history and examine your baby

Your visit

• Then what?– Low levels – home with regular care/feeding

– Moderate levels – home with follow-up/repeat levels

– High levels – admitted for treatment

BREATHING PROBLEMS

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Signs of breathing problems in babies

– Faster

– Harder

• Chest moves more than normal

• Skin pulls in over breastbone, windpipe and

between ribs

• Nostrils flare out

– Extra noises

Why?

• Most commonly caused by viral infections

– Colds cause stuffy noses

• Small babies like to breathe with their nose

– Some colds can cause swelling and irritation of

smaller air tubes (bronchioles)

– Bronchiol-itis is the most common reason for

babies to be admitted to hospital in Canada

• Typically December-March

When to come to CHEO

• If you notice your baby is breathing harder or

faster

• If you notice your baby is having pauses in

their breathing

– Longer than 10-20 sec

– Pale, blue, floppy during pauses

• If your baby is not feeding well because of

their congestion or breathing problem

Your visit

• Triage nurse will assign priority based on

level of breathing trouble

– Breaths per minute, oxygen level, looking/listening

• Assessment by MD will follow

• Treatment based on cause

– Extra oxygen if required

– Suctioning out nose

– Treatments with medicine to open airways

FEVER

FEVER

• 0-3 month old babies– > 38 oC (rectal)

• Older babies/children– >38.5 oC (rectal)

– >38 oC (mouth)

– Underarm and ear not accurate

FEVER

• A symptom

• Helps fight infection

• Shows us the immune system is working

• Does not cause brain damage

• Worries parents!

FEBRILE SEIZURES

• Convulsions/seizure with fever

• 6 months – 6 years old

• 4% of kids

• No increased risk of seizure/epilepsy

• Fever medications do not prevent

Why?

• Usually caused by an infection

• 90% VIRAL (not treated with antibiotics)

• 10% BACTERIAL (treated with antibiotics)

– Most commonly bladder infections

– Meningitis and blood infections are rare

**Childhood immunizations give excellent

protection against serious bacterial infections

When to come to CHEO

• Babies 0-3 months with:

– Any fever

• Older babies with:

– Persistent fever (>48 hours)

– Fever with other symptoms – very sleepy/hard to

wake, breathing problems, dehydration

Your visit

• Triage nurse will assign priority based on

assessment

– Vital signs, appearance

– Babies under 3 mos are given priority

• MD assessment based on priority

• Full history and examination looking for cause

of fever

Your visit

• Tests as required:

– Often: urine test

– Sometimes: other tests like blood tests, Xrays

• Fever medication for comfort, fluids

• Good follow up

DEHYDRATION

Input and Output

• Newborn babies– Feed every 2-3 hours

– 6-8 wet diapers/day

– Pooing is variable• black green/brown yellow-seedy

– Weight initially drops in first few days• Back to birth weight by day 10 or so• Should not lose more than 10% of birth weight

Input and Output

• Older babies

– Feed less often – usually every 3-4 hours, may

sleep more at night

– Minimum 4 wet diapers/24 hours

– Stooling variable – multiple/day once a week!

Diapers not very wetNot feeding well

Less than 4 wet diapers/24 hoursDry lips and mouth

No tears

Tired, less active

High heart ratePale, cool hands/feet

Hard to wake up

MILD

MODERATE

SEVERE

Why?

• Usually due to gastroenteritis – “stomach flu”

– Vomiting and diarrhea

– VIRAL infection

• Also can see with other infections/problems

– Babies often don’t feed well when they are sick

• Colds and fever

When to come to CHEO

• Less than 4 wet diapers in 24 hours

• No pee in > 6 hours

• Not drinking well and other symptoms

– Dry lips and mouth

– Very tired/hard to wake up

– Lots of diarrhea and vomiting

Your visit

• Triage nurse will assign priority based on assessment– Vital signs, appearance

– Babies under 3 mos are given priority

• MD assessment based on priority

• Full history and examination

Your visit

• Treatment based on severity

– Fluids by mouth for mild/moderate

– Intravenous fluid for severe

– Occasionally other tests to look for causes or complications

Making a difference in the lives

of children and youth

www.cheo.on.cawww.caringforkids.cps.ca

QUESTIONS?