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April 1, 2021

When to Visit a Pediatric Emergency Center

A child’s injury or severe illness can be scary for parents, especially if it requires a 911 call or visit to a pediatric emergency center. Danielle Mercurio, D.O., an emergency medicine physician at Johns Hopkins All Children’s Hospital, explains how to handle and prepare for an emergency.

First, plan ahead by knowing where the nearest emergency center is located. Due to the COVID-19 pandemic, find out whether the emergency center combines patients of all ages or has a separate care area for children to ensure your child will be away from others who may have/or been exposed to COVID-19. Also, it’s important to consider that in some emergencies, it may be better to call 911 rather than driving, because paramedics can begin care before arriving at the hospital.

Dr. Mercurio recommends bringing your child into a pediatric emergency center immediately for the following reasons:

  • An infant who is less than 60 days old with a rectal temperature higher than 100.4 °F
  • A child who has trouble breathing, demonstrates labored or fast breathing, or if you see their ribs and neck muscles prominently between breaths
  • Any child less than 5 with intractable vomiting (they cannot tolerate any fluids) for more than 4-8 hours with or without diarrhea and reduced urine output compared to the day before
  • Any child with altered mental status (child is unable to respond to you)
  • Any child having seizures without a history of seizure disorder
  • Any child experiencing symptoms of anaphylaxis (a severe allergic reaction) such as throat swelling, coughing, wheezing, trouble breathing, rash, vomiting, diarrhea or fainting just after eating new foods or being stung by an insect
  • Bleeding that won’t stop despite holding pressure for about 15 minutes
  • Any injury that looks obviously deformed or swollen. Sometimes kids have broken bones but hide it well. If you notice your child is not using their hands, arms or legs, they likely needs an X-ray.
  • Any male child or teenager with severe pain, with or without swelling, in the testicle
  • Any female child or teenager with sudden onset, severe, one-sided pelvic pain
  • Any child who cannot jump up and down because of abdominal pain, especially if pain is worse on the right side and accompanied by fever, vomiting or loss of appetite
  • Any child with severe headache, severe abdominal pain or one who is not engaging normally with the family and instead is sleeping excessively or refusing to drink fluids
  • If a child swallows an object, especially chemicals or medication, and is having any difficulty breathing, swallowing or speaking. If a child swallowed a potentially poisonous substance but does not have symptoms, you should still immediately call the Poison Control Center at 800-222-1222.
  • Any immunocompromised child with fever higher than 100.4 (patients on chemotherapy, receiving bone marrow transplantation, sickle cell anemia, neutropenia, spherocytosis, those without a spleen and those taking many immune-modulator medications)

For information on Johns Hopkins All Children’s Emergency Center, visit HopkinsAllChildrens.org/EC.


About the Author: Dr. Mercurio is a pediatric emergency physician at Johns Hopkins All Children’s Hospital. She joined the hospital staff in May 2017. Dr. Mercurio earned her degree in osteopathic medicine at the University of Medicine and Dentistry of New Jersey and completed her pediatric residency at St. Christopher’s Hospital for Children in Philadelphia. She completed a pediatric emergency medicine fellowship at Hospital for Children at Vanderbilt University in Nashville, Tennessee and at St. Christopher’s Hospital for Children. Dr. Mercurio is a member of the American Academy of Emergency Physicians, American Academy of Pediatrics and the American Osteopathic Association.


Originally published in April 2021

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