Your guide to Pediatric ER care.

It’s one of the scariest questions parents can face: Is this bad enough to go to the ER ?

If you aren’t sure whether you should come to the ER or wait for your doctor’s office to open, you can contact a nurse, 24 hours a day, by phone at (804) 320-3627.

Door-to-Door Directions:

Call (804) 483-0000 for directions, parking, or general information.


ER Symptom Checker — When should you go?


Most children experience abdominal pain at some point. Most times, this pain can be a simple reaction to food and activity or a symptom of stomach flu or food poisoning. But in other cases, stomach pain can indicate a larger issue. It is important for parents to be able to recognize the symptoms that may indicate when a child’s pain is severe enough to require a visit to the ER.

If Your Child Has These Symptoms, Emergency Care May Be Necessary

  • The child is inconsolable
  • Pain is severe and unrelenting
  • The abdomen is tender to the touch or pain radiates to your child’s back
  • Recent injury to the stomach
  • High-risk child such as diabetes, sickle cell disease, recent abdominal surgery
  • Age less than 2 years
  • Fever over 104° F (40° C)
  • They have stomach pain plus any of the following symptoms:
    • Fever
    • Repeated vomiting
    • Significant or bloody diarrhea
    • The child is difficult to rouse and has no interest in eating or drinking
    • Seizures or fainting
    • Distended abdomen

when to call 911

  • Not moving or too weak to stand
  • You think your child has a life-threatening emergency
  • Actively vomiting blood

When an animal or insect bites your child, it can be scary. While many bites are minor and can be treated at home, depending on what type of animal or insect bit your child, and where the bite occurred, emergency treatment may be necessary.

Bites from Dogs, Cats, Pets, Wildlife, and Other Children

Children are bitten by dogs, cats and other pets much more commonly than adults. Young children are also the most at risk of bites from other children. If your child is bitten, you may need to seek emergency care in the following situations:

  • Bites in the hand, face, or joints: If your child is bitten in the face, hands, or joint they may be at risk of underlying damage and infection.
  • Rabies or tetanus risk: If your child is bitten by a wild or feral (a domestic animal that has gone wild) animal, or by livestock, he or she may be at risk of rabies or tetanus. Follow-up shots may be necessary.
  • Viral transmission risk: If a bite from another child breaks the skin, viruses can be transmitted. You should always have a human bite checked by a pediatrician.
  • Cat or dog bites/scratches: A bite or scratch from a cat can easily become infected, particularly if it happens near a joint or on the hand. Your child will typically need to take antibiotics following a cat bite.

Bites from Snakes, Spiders and Insects

In most cases, insect bites and stings are a painful nuisance that will respond to home care. However, some snakes, spiders, and insects can be very poisonous. For that reason, it is important to keep an eye out for these signs that it may be time to seek emergency care for your child.

  • Snake bite: Seek emergency treatment unless you know for sure that the snake is not poisonous. Take note of the snake’s appearance if possible and be prepared to describe it to the emergency staff.
  • Spider bite: If you notice that your child displays any of these signs after a spider bite, seek emergency care:
    • Severe pain at the bite location or anywhere else in the body
    • Redness and warmth surrounding the bite
    • Severe cramping
    • Drainage from the bite
    • Vomiting
  • Bee or wasp stings: If your child develops a large rash or swelling around the sting area, or if pain or swelling lasts a few days, call your pediatrician as these symptoms may indicate an infection. If your child shows these signs of a severe allergic reaction, immediately seek emergency care:
    • Difficulty breathing or tightness in the throat
    • Nausea or vomiting
    • Dizziness or fainting
    • Swelling in the face
    • Hives or swelling all over the body
    • Fever and bite looks infected spreading redness

when to call 911

  • Past life-threatening allergic reaction to same insect bite not just hives and bitten less than 2 hours ago
  • Trouble breathing or wheezing
  • Hoarse voice, cough, or tightness in the throat or chest
  • Trouble swallowing, drooling or slurred speech
  • Hard to wake up
  • Acts or talks confused
  • You think your child has a life-threatening emergency

Abnormal breathing can be troubling for any parent to witness in his or her child. While some changes in breathing are temporary and relatively harmless, other abnormal breathing episodes may indicate a larger problem.

A variety of pediatric respiratory conditions can affect your child's breathing. If you notice chronic breathing concerns, visit a pediatric pulmonologist to determine if it may be due to chronic childhood allergies or pediatric asthma.

Irregular Breathing in Newborns

Newborns will often begin breathing faster for a few seconds and then slow down their breathing, especially when sleeping. This type of irregular breathing is normal and does not require treatment. If irregular breathing persists past the age of 6 months, talk to your pediatrician to ensure your child’s breathing is healthy.

If Your Child Stops Breathing

If your child has stopped breathing and is not responsive, immediately begin CPR and call 911.

If your child ceases breathing for 15 seconds or more, and then resumes breathing, visit the ER. Even if your child seems fine, it is important to make sure the underlying reason for the episode has been resolved.

Many children between the age of 6 months and 6 years experience breath-holding spells, involuntary breath holding that usually occurs when the child is crying or upset. Children who experience these spells do not need to seek emergency care unless the incident results in unconsciousness or a seizure. In these cases, it is best to visit the pediatric ER to make sure there are no other reasons for the seizure or unconsciousness.

Changes in Breathing

If your child seems to be having a hard time breathing, or you notice abnormal behaviors or actions, it may be time to seek emergency care. Visit the ER if you notice these symptoms:

  • Breathing that is faster than normal
  • Breathing harder than usual without exertion
  • Chest and abdomen look like a see-saw (one goes up while the other goes down)
  • Bluish hue to the lips or skin
  • Persistent barking cough or wheezing
  • High-pitched squeaky sound in the upper airway

If your child is recovering from a choking episode in which he or she turned blue but returned to normal, it is still a good idea to visit the ER to ensure there are no longer-term consequences.

Pneumonia in Children

Pneumonia is a common lung infection that can be life-threatening. Children with asthma, have recently been hospitalized, use antibiotics frequently, or have another chronic condition are at a higher risk for developing pneumonia. If your child has had an upper respiratory condition for more than five days and is not getting better, visit your pediatrician - even if they just seem congested. If you are concerned that your child is not eating or drinking enough, or going to the bathroom regularly, seek medical attention. Visit the ER immediately if your child:

  • flares the nostrils when breathing
  • has retractions: working too hard to breathe, shown in the areas below the ribs, between the ribs, and in the neck sinking in with each attempt to inhale

When to Go to the ER if Your Child Has

If your child is diagnosed with asthma you should work with your child's pediatrician or a pediatric pulmonologist to create a list of symptoms that trigger a call to your doctor or a trip to the ER. These should be early warning signs of a flare up and may include:

  • wheezing
  • tightness in chest
  • inability to stand or sit still
  • restless sleep
  • throat clearing
  • rapid or irregular breathing
  • coughing not due to cold or persistent cough
  • unusual fatigue

Visit the ER immediately if your asthmatic child experiences:

  • constant wheezing
  • repeated severe flare-up symptoms that are not relieved with rescue or fast-acting medicine
  • blue or gray lips and fingernails
  • difficulty talking
  • retractions: working too hard to breathe, shown in the areas below the ribs, between the ribs, and in the neck sinking in with each attempt to inhale
  • a peak flow reading below 50% and doesn't improve after using medicine
  • if your child's peak flow reading falls below 50% (which is in the red zone of the peak flow) and doesn't improve after using medicine

Coughs and sore throats often seem like par for the course—especially during allergy season or in the wintertime. In most cases, your child will recover from a cough or sore throat with home care or a visit to the pediatrician. However, if your child’s cough or sore throat is accompanied by any of the symptoms below, or if their immune system is compromised due to an existing condition, you may need to seek emergency treatment.

Take your child to the pediatric ER if the cough or sore throat is accompanied by:

  • Difficulty breathing
  • Shortness of breath
  • High fever
    • Higher than 100.4 degrees for children younger than 3 months old
    • Higher than 102.2 degrees for children older than 3 months old
  • Coughing up blood
  • Inability to swallow
  • Muffled voice
  • Inability to open his or her mouth all the way
  • Significant swelling on one side of the throat, which may indicate an abscess of the tonsil

Scrapes and bruises are a daily occurrence for children. So how do you know if your child’s latest cut from the playground needs medical attention or not? Consider the following advice to determine if immediate medical attention is warranted.

If Your Child Has a Cut, Try These Steps First

  • Clean out the cut with tap water and apply pressure for 10-15 minutes to stop the bleeding. If bleeding does not subside, visit the pediatric ER.
  • Measure the laceration. If a cut that is not on your child’s face, is less than 1 mm deep and less than 1 cm long, urgent care is not necessary.

If the Laceration is Severe, Emergency Care May Be Necessary

  • Visit your pediatrician’s office or the pediatric ER if the cut is greater than 1 mm deep and 1 cm long. Lacerations such as this may require stitches or glue.
  • If the cut does not stop bleeding after you have applied pressure for 10-15 minutes, seek emergency care to make sure the bleeding is not indicative of a larger issue.
  • If the cut is on your child’s face, emergency care may be necessary. In most cases, it is best that a layer of broken skin on the face is glued or sewn.
  • If your child is not up to date on his or her immunizations, call your pediatrician to schedule a tetanus shot.

Dehydration in children occurs when more fluids are lost than taken in by the body. Babies and children are more susceptible to dehydration, which can be caused by not drinking fluids or intense diarrhea, vomiting or fever. When the body doesn’t have enough fluids to function properly, it can cause significant damage to your child.

Types of Dehydration in Children

Each child, as with each case of dehydration, is unique. Dehydration in children can be mild, moderate, or severe.

How to Tell if Your Child is Dehydrated

Signs of dehydration in children often depend on each child’s case. A decrease in weight is found in dehydration, but can be hard to measure day to day. A number of physical findings together with clinical history can help assess the severity of dehydration.

Lethargy

If your baby or toddler starts acting lethargic, might be more than just a case of being tired. Go to the emergency room if your child won’t speak or respond to your voice or touch, if they appear limp, won’t walk or move, or appear to be too sick to cry or fuss.

Lack of Body Fluid

A dehydrated baby or toddler will have a reduction in body fluid, which leads to a dry mouth, decreased urine, sunken eyes, and no tears when crying.

Pale Skin

If your child seems very pale, seek immediate medical attention. Additionally, your child’s skin might appear splotchy and the eyes might look sunken in.

Rapid Heartbeat

If your child’s heart beats more than 110 beats per minute, it could be a sign of significant dehydration. Additional symptoms of rapid heartbeat include shortness of breath, dizziness, weakness, light-headedness, sleepiness, and fainting.

Mild fever is generally easy to treat at home with rest, fluids and over-the-counter medications. However, sometimes fever is an indicator of a more serious infection. Typically, it is best to call your doctor first before heading to the ER. However, if your pediatrician is unavailable, here are some general guidelines for when to go to the ER.

Newborns and Infants Younger than 3 Months Old

If your baby is less than 3 months old, visit the pediatric ER if his or her temperature is above 100.4 degrees. You should also seek emergency care if your baby’s fever is accompanied by these symptoms:

  • Difficulty waking up to be fed
  • Difficulty breathing
  • Rash
  • Vomiting
  • Inconsolable or non-stop crying

Babies and Toddlers 3 Months to 3 Years

For babies and toddlers between the age of 3 months and 3 years, visit the ER if the child’s temperature is above 102.2 degrees, or if the child is displaying these symptoms:

  • Difficulty waking up
  • Not urinating
  • Unable to keep fluids down
  • Inconsolable
  • Not up to date on immunizations
  • Difficulty breathing
  • Rash

Children Age 3 and Older

If your child is 3 or older, visit the ER if the child’s temperature is over 102 degrees for two or more days. You should also seek emergency care if the fever is accompanied by any of these symptoms:

  • Abdominal pain
  • Difficulty breathing or swallowing
  • Unable to keep fluids down
  • Burning during urination or does not urinate
  • Rash
  • Stiff neck
  • Difficulty waking up
  • Not up to date on immunizations

When a child eats or drinks something he or she is not supposed to, it can be very alarming, especially if you are unsure of the substance’s contents. The most important step to take is to first get the item away from your child. Do not try to make your child vomit; this may cause more damage.

If Your Child Shows Minimal Symptoms, Call the Poison Center

If your child is experiencing minimal or no symptoms, call the poison center first at 1-800-222-1222. The poison center will be able to tell you the next steps to take to care for your child.

If Your Child Has More Severe Symptoms, Emergency Care May Be Necessary

Dial 911 for immediate medical care if your child’s ingestion is accompanied by any of the following:

  • Your child does not look good
  • Loses consciousness
  • Experiencing seizures or convulsions

Keep Medications and Household Products Out of Reach of Children

To avoid accidental ingestion of medications or household products, always make sure cabinets that contain cleaning solutions and medications are locked and out of your child’s reach. Also, ensure that all visitors keep their medications, including over-the-counter drugs, out of reach.

When your child has a rash or skin irritation, it can sometimes be difficult to determine whether the best course of action is to treat the rash at home, call your pediatrician, or seek emergency care. Common causes of rash may include allergic reactions to shampoos, soaps, or detergents; reactions to viral infections; reactions to heat or cold; and reactions to stress or embarrassment. These non-emergency rash causes will generally respond to home care. However, if your child’s rash persists, call your pediatrician.

With more serious rashes, you may need to seek emergency care. Seek ER treatment if the rash is accompanied by any of the following:

  • Shortness of breath
  • Skin peeling away or blisters in the mouth
  • Swelling or tightness in the throat
  • Areas of tenderness
  • Fever
  • Joint pain
  • Headache
  • Streaks of red
  • Abnormal bleeding or bruises under the rash

Reactions to Medication

If you believe your child has developed a rash as a reaction to a medication, he or she is taking, immediately stop giving your child the medication and call your pediatrician. Do not resume giving your child the medicine until your pediatrician says it is okay.

Call Your Pediatrician if the Rash Does Not Go Away

A recurring or persistent rash may indicate that your child has an ongoing allergic reaction or a skin condition (such as eczema or psoriasis). In this case, you may not need to take your child to the pediatric ER, but you should make an appointment to see your pediatrician.

Soccer. Basketball. Baseball. Football. Cheerleading. Sports injuries can occur at any time during any type of practice, game, match, set or competition. Head and orthopedic injuries can even occur when your child is playing at home. In most cases, your child’s pediatrician can provide initial care for many orthopedics concerns: broken bones, sprains, strains, and ligament tears (such as the common ACL tear). He/she will refer your child to a pediatric orthopedic specialist as needed. However, if your child sustains a more serious injury while on the field, emergency care may be necessary.

Seek ER treatment if your child’s sports injury meets the following parameters:

  • The child is younger than 4 years old and cannot use the arm or bear weight on the leg that was injured.
  • The limb that was injured looks misshapen or bone is protruding from the skin.

Concussions are a significant concern for sports injuries, and special care is required during and after a concussion. If your child’s injury is accompanied by these symptoms, emergency care may be necessary:

  • Loss of consciousness
  • Change in level of consciousness (asks repetitive questions, has memory loss)
  • Vomiting more than once
  • Fever
  • Abdominal pain
  • Neck pain
  • Difficulty breathing

If you have a child or toddler vomiting with a fever or a child or toddler with diarrhea and a fever, you may not know the cause or whether or not to be concerned.

Both vomiting and diarrhea are common symptoms of food poisoning and the stomach flu, among other common ailments. So how do you know if your child’s pain is severe enough to require an emergency department visit?

Fever and Vomiting in Toddlers and Children

In a child or toddler, fever and vomiting in and of itself may not be cause for concern. If they have a low-grade fever and/or vomits once, call a doctor to be seen the next day. However, symptoms such as high fever & vomiting may warrant a trip to the ER. Visit the ER if your child has a fever and is vomiting and any of the following apply:

  • The child is younger than 3 months old
  • Repetitive vomiting
  • Not urinating or wetting diapers
  • Lethargic
  • Inconsolable
  • Vomiting toddler or child with fever higher than:
    • 100.4 degrees for children younger than 3 months old
    • 102.2 degrees for children older than 3 months old
  • Fever and Diarrhea in Toddler or Child

    Similarly, to vomiting, diarrhea and fever in a toddler or child may be an outcome of common ailments. However, when diarrhea and fever is accompanied by these symptoms, you should seek emergency care.

    • Blood in diarrhea
    • Dry mouth
    • Sunken eyes
    • Not urinating or wetting diapers
    • Lethargic
    • Inconsolable
    • High fever
      • Higher than 100.4 degrees for children under 3 months old
      • Higher than 102.2 degrees for children over 3 months old