These children’s health threats keep ER pediatricians up at night l Expert Opinion

As pediatric emergency doctors, we share parents’ concerns about the health and safety of their children. Most of the children we see in the emergency department can be discharged with minor treatment and guidance, but some conditions keep us up at night. Here are three common ailments that we can usually safely send home – and three that worry us.

Fever: Fevers are our body’s natural defense to infection and the leading reason we see children. We encourage children with fevers to seek appropriate medical attention – either from their primary-care doctor or in the emergency department – if the fever is accompanied by related concerns, such as difficulty breathing, a sickly appearance or not drinking enough or holding down liquids.

Fortunately, most fevers are from viruses, which do not require antibiotics. In the emergency department, we are usually able to rule out bacterial infections such as pneumonia or an ear infection through history and examination. Sometimes blood or urine testing are needed. Usually, if children can stay hydrated and feel better with a fever-reducer such as acetaminophen and ibuprofen, they are safe to go home.

Fevers in young infants and children with certain medical conditions may warrant a more extensive workup.

Head trauma: A blow or fall resulting in a head strike can be terrifying for parents. Fortunately, most head trauma in children is minor. Physicians use risk factors to determine how long we observe a child and whether imaging, such as a CT scan, is necessary. Most children go home safely with no imaging.

Sports injuries: Children with bruises, sprains, or strains can be sent home with rest, ice, an Ace wrap, and return precautions. Fractures may need a cast and orthopedics. Sports concussions should be taken seriously, but often recover within seven to 10 days. Given how beneficial sports activities are to children’s physical and mental health, we worry more about inactivity in children, leading to obesity, diabetes, and other chronic conditions.

Distracted and intoxicated driving: Motor-vehicle crashes are a leading cause of death in children and account for more than a third of teenage deaths. Related injuries can be reduced by wearing seatbelts, properly installing car seats, and donning helmets on bikes. Alcohol is involved in 23% of child passenger deaths, and most often, the child’s driver was the one drinking.

Discuss the danger of driving drunk or buzzed on marijuana with your teenagers. Consider a standing offer of a no-questions-asked ride home if they ever find themselves in a situation with a potentially intoxicated driver. Also, teens especially are at risk of crashes due to driving while using their cell phones.

Suicide: Suicide is the second leading cause of death among 10- to 24-year-olds. Parents and health-care providers should seek emergency care if children voice thoughts of harming themselves. Firearms deaths now exceed motor-vehicle crashes as the number-one cause of death in children and are the most common mechanism for completed suicide.

Lock guns safely and away from ammunition. If someone in the home is in crisis, consider storing your gun elsewhere or surrendering it to the police.

Ingestions: Accidental and intentional ingestions are on the rise, with young children, in particular, facing dangers from opioids and medications for diabetes, heart problems, and high blood pressure. At holiday get-togethers, older relatives often bring unsecured medications around young children.

Edible marijuana ingestion in young children is on the rise with highly concentrated products packaged and formulated as candy. Children can also mistake colorful laundry pods for candy. Never store cleaning products in beverage bottles. Children who swallow magnets and batteries can suffer from internal organ damage. Any of these ingestions should be brought to the hospital immediately. For any questions, call poison control at 1-800-222-1222.

Christopher Fay is a fourth-year medical student at the UMass Chan Medical School; Theodore Macnow is a pediatric emergency physician and assistant professor of pediatrics at the UMass Chan Medical School. He grew up in the Philadelphia suburbs and can be reached at theodore.macnow@umassmemorial.org.