By Mary Engrav, M.D., an emergency medicine physician at Children’s Emergency Care at Providence St. Vincent Medical Center in Portland.
I’ve worked in emergency departments for more than 15 years, and I’ve taken care of thousands of children. I often think of what a frightening, cold place an emergency room can be from the eyes of a small child.
I hope your child never has to go to the ER but, if she does, here are some suggestions to make the visit easier.
Tell your child what to expect
If your child must visit an ER, it is important for you to tell her what to expect. If she is a toddler or preschooler, explain the reasons in very simple terms. Tell her she will be seeing a doctor, but not her regular doctor.
If the child asks if the doctors or nurses are going to hurt her – which is usually one of a child’s biggest fears – tell her that the doctors and nurses are there to help her and that you’ll talk about what needs to be done when you get there. Sometimes something painful, such as an intravenous procedure or a shot, is needed, and it’s better to be honest with the child.
Some children are very fearful that they will be separated from their parent. Tell your child that you will stay in the room with her. If you’re arriving by ambulance, you should know that paramedics typically let one parent ride with the child. Try to stay where your child can see you; this will calm her.
What to expect (for Mom and Dad)
When you arrive at the ER, the triage nurse will talk to you, get a brief history of your child’s injury or illness, and check her vital signs.
There may be a long wait before a doctor can examine your child. If possible, before you leave home, grab your child’s favorite book, blanket or other small object to help comfort her. Once you are at the hospital, do not give the child any food or water unless a doctor or nurse says it is okay.
Cell phones are not allowed in the ER because they can disrupt hospital monitors. On a more basic level, however, cell phones can distract parents from comforting their children. If you must make a phone call, ask the nurse if you can use an ER phone.
Be sure to let the ER nurse and doctor know if your child has experienced similar problems in the past, what the child’s health and immunization histories are, and whether your child has any allergies. Don’t hesitate to ask about your child’s health care. (See "Are You Prepared for an ER Visit"?)
Even though all parents feel shaken when their children are in the ER, try to stay calm.
Stitches and shots and IVs – oh, my!
If your child must undergo a painful procedure like a shot or IV, the nurse or doctor will explain this to her. Some children want detailed explanation. Others prefer a simple announcement before the procedure is done. Feel free to tell the doctor or nurse what approach you think will work best for your child.
If stitches are needed, a topical numbing medicine can be used in some cases. Ask if it is appropriate for your child. While the doctor works to repair the wound, many parents read or talk to their children to calm them. One of my favorite dads made up an incredible imaginary story for his four-year-old, which was a bedtime ritual for he youngster. I have to say, I enjoyed hearing the story as well.
To repair very small cuts, we may gently restrain a toddler on a padded board or with a sheet. Sometimes I will have the child sit on her mother’s lap or lie on her mom, with the mother gently but firmly wrapping her arms around the child. This works with fairly cooperative, calm toddlers.
For painful procedures, such as setting a bone, we typically perform “conscious sedation”, in which the child is given medication to sedate her without making her unconscious. With conscious sedation, a child doesn’t usually remember the procedure.
For X-rays, I often tell the child that it will be like taking a picture, but of her bones. This seems to make sense to most children over the age of three. If babies or toddlers need X-rays, we may set them in a device that looks like a plastic funnel. Although it resembles something out of a torture chamber, it doesn’t hurt them.
What should you do if you feel that your child is in unnecessary pain? By all means, tell the nurse or doctor. Children act very differently (as do adults) when they are in pain. If your child is very quiet and doesn’t complain, the doctor or nurse may not be aware of how much pain she is having.
I like to have parents stay with their children in the ER. Sometimes, however, parents don’t feel comfortable staying in the room during a procedure. They fear that they may pass out or get too upset. If you need to step out of the room, rest assured that we’ll take excellent care of your child and will treat her as if she were our own.
As you leave
Ask the nurse and doctor about follow-up care for your child. When do the stitches come out? How should you wash the wound? When should the child be re-checked by her pediatrician? What signs should alert you to bring the child back to the ER? You will usually receive the answers to all of these questions in writing before you leave.
When your child is discharged, praise her for being brave and calm and for making it through a difficult situation. Praise yourself, too, for helping your child cope with this new situation. Parents truly are their children’s best advocates in the ER!
This material is revised and reprinted with permission of Metro Parent magazine. If you have questions, call us at 503-216-2361.
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