Seven Reasons to Take Your Child to the ER

Jendi Haug, M.D., Emergency Services Physician

Sometimes it is easy to know when to go to the ER – a broken bone or a cut that needs stitches. But often parents struggle with the decision of whether to take their child to the ER for other reasons.

The Children’s Hospital of San Antonio now has three emergency centers just for children. They are open 24 hours a day, seven days a week, all weekends and all holidays.

Pediatric ERs are special emergency rooms that treat children from birth until age 17. The nursing staff, advanced practice providers such as nurse practitioners and physician associates, and physicians understand that children are not just little adults. Children have their own unique physiology that is different from adults.  Their illnesses and injuries are oftentimes not treated in the same manner as an adult with similar symptoms.  In a medical emergency, your child needs to see a doctor who only specializes in treating children.

At The Children’s Hospital of San Antonio, we know children are not little adults. They require the expert care of doctors and nurses specially trained in emergency pediatric medicine. Taking a wagon ride to get an X-ray is just one way we ease a child’s fears!

Here are some examples of major and minor instances when you should go directly to your nearest pediatric emergency room:

1. Newborn with a fever: Any infant 30 days old or younger with a temperature of 100.4 degrees or higher needs medical attention. No matter how you take the baby’s temperature (armpit, forehead, frontal sensors, or rectally), a temperature of 100.4 warrants an assessment by a physician or APP.  Infants born premature or with underlying medical conditions are at an even higher risk of serious infection and should continue to come in even at older ages.
2. Difficulty breathing:  Abnormal breath sounds like wheezing or stridor can be associated with bronchiolitis or croup or pneumonia. They can be scary and cause kids to breathe fast. Kids may start working to breath- belly breathing, sucking in the skin between their ribs or refusing to lie down. These are worrisome symptoms and need to be immediately evaluated.
3. Extremity or bony deformity:  When there is an obvious deformity along with swelling or pain, they should be seen that same day for assessment of any possible fracture or dislocation.
4. Abnormal/unusual behavior or altered mental status: You know your child and are the best gauge of your child’s behavior and their typical baseline. If something is not quite right, they need to see a medical provider for a complete evaluation.
5. Open wounds not healing on their own: Wounds can be common for kids after a fall or other injury.  Wounds that are large enough to be considered lacerations should be repaired soon in order to obtain better wound healing and less scarring. In addition, good cleaning and irrigation will help to prevent infections.
6. Prolonged vomiting and diarrhea: Infants and young toddlers can rapidly become dehydrated, so even a few hours of symptoms can make them sick.  Lack of a good amount of wet diapers or failure to urinate for a prolonged amount of time is a worrisome sign of dehydration for any child.
7. Fainting or seizure activity: These symptoms should be assessed by a physician or advanced practice provider to determine why these episodes might be happening, especially if they are frequent or prolonged occurrences. A trip to the ER is warranted if your child has not been previously evaluated for fainting or seizures by a pediatric cardiologist or neurologist. Sometimes these symptoms are harmless, but they could also be related to serious medical conditions.

While this list is not exhaustive, these are just a few reasons why your child might require a visit to one of our emergency rooms.  When available, discuss any questions you might have regarding the need for emergency care with your child’s pediatrician.

The Children’s Hospital of San Antonio Emergency Center – Stone Oak is open and ready to help in any emergency medical situation.

To better meet the needs of our community, The Children’s Hospital of San Antonio recently opened a freestanding emergency center in north-central San Antonio at 1434 E. Sonterra Boulevard, near Highway 281.

In 2015, we opened the city’s first freestanding children’s ER at Westover Hills located at 11130 CHRISTUS Hills, Medical Plaza 3 (located off Highway 151).

The main campus of The Children’s Hospital of San Antonio is one of the largest pediatric emergency rooms in the city. It is located at 333 North Santa Rosa Avenue in the heart of downtown San Antonio.

At The Children’s Hospital of San Antonio, we care deeply about the children in our community and want to help your child during a medical emergency. Please visit our website to learn more about our three emergency department locations.

Staying Safe Around Pets

Luis A. Castagnini, MD, MPH, Infectious Disease Specialist

Marisol N. Lazarte, DVM, Veterinarian

Jendi Haug, MD, Emergency Services

This pandemic certainly has brought many changes to our lives. We have changed the way we interact with one another. We spend more time at home and many children around the country are adapting to distance learning. We now must wear masks while in public, stay six feet apart and wash our hands at every opportunity. These are all important measures to stay safe from COVID-19 and other infections. However, more time at home also means more time with our beloved four-legged friends. Whether a dog or a cat, many Texas households include a furry member. These longer and more frequent interactions with our pets increase the risk of a bite or a scratch. Since the beginning of the pandemic, The Children’s Hospital of San Antonio emergency departments downtown and at Westover Hills have seen an increased number of children who have experienced dog and cat bites. With this in mind, it is important that all members of the family follow safety measures around pets. This is particularly important for toddlers and school-aged children, as they are the most frequent age groups affected.

9 Tips for Staying Safe Around Pets

You can prevent bites and other injuries from animals by remembering these recommendations:

1. Never play or bother a pet while it is eating or drinking. This is one of the most common scenarios that lead to an attack.  A child or an adult can suffer a bite during the pet’s eating time.  Given the smaller size of a child, this type of attack is more likely to occur in the upper body, including the face.
2. Do not interrupt your pet’s sleep.
3. Do not try to ride on your pet or pull its tail.
4. If your pet recently had kittens or puppies, do not get near them as the protective instinct of the mother may lead to an attack.
5. Make sure your pet has all its vaccines.
6. Kids should be instructed not to pet strange or unfamiliar animals without the expressed consent of the owner. Even then, it is always a good idea to be careful and have an adult directly supervise. Some experts recommend staying away from strange animals or pets altogether.
7. If you are approaching your pet, talk first so it will know you are coming and will not be surprised. Please always respect pets as you respect people. 
8. Any sign of aggression (i.e. growling, hissing) or signs the pet might be scared (i.e. tail hiding between the legs, ears pinned back) should be taken as a sign of “alert.” A child should not approach such an animal that is showing signs of aggression or fear.
9. Never get close to a strange animal that is alone.

Teach your children not to bother pets when they are eating or drinking. Pets can become aggressive if they feel their food may be taken away.

What should you do if you or your child are attacked by an animal?

First, thoroughly wash the wound with soap and water. If the injury is minor, calling your physician may be all that is needed. However, your child might need emergency care if the wound continues to bleed, is large, or involves multiple locations. If the wound is located on the face, hands or if the animal is unknown to the patient, visit the closest emergency department for further management. Some bites, especially from cats, require the use of antibiotics to prevent infection. Others may require stitches and even preventative measures for rabies. Finding out the rabies vaccination status of the animal is important for your child’s health. If this information cannot be determined, please consider contacting Animal Control and seek medical attention. 

What to Expect in the ER by Dr. Jendi Haug

At the emergency room, we will ask about the rabies status of the animal. If this is unknown and Animal Control has not been contacted, we will have you fill out a form that will be sent to Animal Control. We will screen for rabies risk and the need for rabies prevention or observation. Also, we will provide pain control and clean and irrigate the wound. We might start antibiotics depending on the characteristics of the injury and stitches may be needed to close the wound. For complex or extensive wounds, such as wounds that involve the face or hands, a surgical specialist might be consulted to repair the wound in the operating room to reduce scarring.

We can all contribute to staying safe at home while loving our pets. Please always treat animals with kindness and respect.

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November is Epilepsy Awareness Month

By Samiya Ahmad, MD
Pediatric Neurologist and Sleep Medicine Physician
The Children’s Hospital of San Antonio
Diplomate of the American Boards of Sleep Medicine, Neurology and Psychiatry with Special Qualification in Child Neurology
Assistant Professor of Pediatrics
Baylor College of Medicine

November is Epilepsy Awareness Month, which brings an opportunity to educate others about epilepsy, its symptoms, and treatment options. Epilepsy is the fourth most common neurological condition in the U.S. One in 26 people will be diagnosed with epilepsy at some point in their lifetime. Epilepsy remains misunderstood and research initiatives are underfunded.

What is epilepsy?
Epilepsy is also known as a seizure disorder. It is a neurological condition that effects the nervous system and is usually diagnosed once a person has two or more seizures.

 What is a seizure?
A seizure is a sudden onset of an illness, such as a convulsion, caused by disturbances in the electrical activity of the brain. Seizures can present in numerous ways, such as staring, shaking, stiffening, or flailing. Seizures can last a few seconds to a few minutes. In serious conditions, seizures may last for hours.

September is Sepsis Awareness Month

By Dr. David Newby
Emergency Medicine Physician

Sepsis takes the lives of over 18 children each day in the U.S. yet many Americans are unaware of this serious condition that can result in fatal complications.

Sepsis Alliance’s annual sepsis awareness survey reveals awareness of sepsis reached a new high with 65 percent of U.S. adults reporting they have heard the term sepsis, compared to 44 percent four years ago. Unfortunately, the survey results also show that sepsis symptoms are not well known, with only 12 percent of those surveyed knowing the symptoms of sepsis. And there is a lack of urgency in seeking medical attention, despite sepsis taking more than 270,000 lives a year in the U.S.