Having young children at home is a perpetual rollercoaster ride. Nothing can be more delightful than waking up to the sound of their laughter, yet nothing can be more nerve-wrecking than seeing them injured or sick.
And it happens, every so often.
But the question every parent has is this: When do these common problems in children warrant a visit to the hospital’s accident & emergency department?
To help you answer this question, we bring you a webinar on ‘Common Problems in Children: When Is it An Emergency?’ with mumpreneur Dawn Sim and Dr Ooi Pei Ling, Paediatrician & Paediatric Rheumatology Specialist at Gleneagles Hospital, Singapore.
Learn more about top diagnoses seen in the Children’s Emergency department and common childhood problems such as fever, vomiting, trauma, respiratory distress and allergic reactions.
Common Problems In Children That Warrant An Emergency Visit
Our speakers will help you understand more about these conditions and when you should worry. Tune in to our informative webinar wherein our speakers discuss:
Vomiting
Vomiting commonly occurs because of a viral infection or gastroenteritis. It causes children to lose fluids, salts and minerals, so it is important to replace these to prevent dehydration.
Dr Ooi recommends these actions to be taken to manage vomiting:
- After a vomiting episode, allow your child to rest for 20 minutes before starting small amounts of clear fluids
- Clear fluids include water and oral rehydration solutions like Hydralyte, diluted fruit juice or breast milk if the child is still nursing
- If the child vomits again, wait for 20 minutes before starting again
- After 3 failed attempts to keep clear fluids in, the child should receive medical attention
- Increase amount of liquid over next 3-4 hours until child passes urine, which is a sign of hydration
- Resume bland food (soup, porridge, bread) if not vomiting for 6 -8 hours
- You can start with diluted formula and progress to normal milk if there is no vomiting. It is not advisable to keep diluting the milk as the child needs nutrients and minerals.
When to Seek Medical Attention for Vomiting
Dr Ooi shares that the main concern about vomiting is dehydration and insufficient salts and electrolytes in the body, or other causes for vomiting such as a twisted scrotum in boys. Look out for signs such as:
- Dehydration – not passing urine / dry nappies, very dry mouth / tongue, sunken eyes, sunken fontanelle for infants, crying without tears or lethargy, drowsiness and irritability
- Inability to keep even clear fluids down after 3 attempts (20 minute intervals between each)
- Vomit that is greenish-yellow (indication of bile), brownish or bloody
- Hard, bloated or painful tummy
- Extreme irritability
- Swelling or redness or pain in the scrotum for boys
- More than 3 episodes of projectile vomiting in a newborn
Respiratory Distress & Wheezing
Dr Ooi states that this is commonly caused by lung infections, asthma, hyperventilation, allergic reactions and quite commonly, foreign bodies. She adds that children have a tendency to insert things such as Lego blocks, rubber bands or pretty much anything into their nose, mouth or even their ears.
If a child has a common cold or viral infection, it is important to clear their nose and if the respiratory distress persists, one should seek immediate medical attention. She cautions that the condition can deteriorate quickly in children as their lungs are still developing and thus fragile.
Signs of Respiratory Distress
- Accelerated breathing
- Hard breathing – lift the child’s clothing to see if chest appears to sink in below the ribs and neck
- Nostrils flaring / grunting
- Noisy breathing / wheezing
- Bluish colour around lips / grey or pale skin
- Changes in alertness, lethargy, fatigue or restlessness
Fever
Our speakers share that in a poll conducted amongst parents, a 64% majority stated they would seek medical attention for a fever above 39 degrees while a 13% minority stated that they would do so if the child appears lethargic.
Contrary to popular belief, Dr Ooi explains that the temperature is not the biggest concern. Rather, it is the child’s behaviour.
Lethargy or loss of alertness can be an indication of something more sinister such as meningitis. If the temperature is brought down and the child starts playing and acting normal, Dr Ooi reassures that it is a good sign and you can wait to see if the fever resolves within a few days. A fever is usually not an emergency as it is the body’s natural response to fighting an infection. Most fevers are benign and short-lived.
How to Manage a Fever
- R - rest
- C – cool down the body by wearing light-clothing and being in a well-ventilated room, taking a lukewarm bath or sponging (avoid ice / cold water); Giving fever medications such as paracetamol or ibuprofen
- H – hydrate by consuming plenty of fluids
When to Seek Medical Attention for a Fever
- Lethargy even when the temperature is brought down
- Fever above 40 ◦C (or 38 ◦C for newborn)
- A fever that persists for more than 5 days
- Irritability or inconsolable
- Not feeding well, or signs of dehydration
- Difficulty breathing
- Seizures
Trauma – Fractures
Fractures are common amongst children and are commonly caused by a fall on an outstretched hand, such as when children try to break their fall. Dr Ooi warns that parents should never try to straighten out the deformity on their own.
Instead, form a splint (with a cardboard or the like) and immobilise the limb then seek medical attention as soon as possible. Symptoms of a fracture include swelling, deformity or inability to move the injured area. Dr Ooi also reminds parents not to let the child eat or drink in case there is a need for surgery.
Dr Ooi emphasises that while not every fracture can be prevented, the possibilities can be reduced. Using safety gates in homes with babies and toddlers, or helmet and protective gears while cycling or using anything with wheels goes a long way in preventing such injuries. She also strongly discourages the use of infant walkers.
Trauma – Pulled Elbow
Our speakers share that this is common amongst children below the age of 5. It is usually caused by a sudden pull on the child’s arm or wrist during a fall thus resulting in partial dislocation of the lower arm bone.
Symptoms include crying, hanging the arm by the side or not using the injured arm.
Interestingly enough, swelling and deformity are not symptoms. Dr Ooi stresses that it is important to see a doctor immediately to reduce the dislocation.
Do not leave it overnight as it would be more challenging to reduce the pulled elbow when inflammation sets in.
Trauma – Cuts
Dr Ooi explained that there is no necessity to rush to the emergency and most cuts can be safely treated at home.
First Aid at Home:
- Decontaminate wound by rinsing with water or saline
- Stop bleeding by applying pressure with clean gauze or cloth
- Raise injured part to stop bleeding
- If there is a body part that is cut off, place it in a sealed plastic bag immediately, then put the bag in another bag / container with ice water
- Do not give your child food or drink in case surgery is necessary
Medical Attention is Necessary if:
- The cut is large or gaping
- Wounds don’t stop bleeding even after applying pressure for about 15 minutes
- Cuts are on the mouth from inside to outside
- Injury is caused by animal or human bites
- Body part is cut off
Trauma – Head Injury
If your child has a fall from height or hits something, Dr Ooi advises comforting your child and putting a cold compress on the bump or bruise. Allow your child to rest and monitor closely for the next 24 hours for unusual behaviour or red flags.
Red flags requiring medication attention:
- If the height from which the child fell is greater than the child’s own height
- Changing mental state
- Loss of consciousness
- Persistent vomiting – more than 3 times
- Seizures
- Severe or worsening headaches
- Walking unsteadily
Dr Ooi shared that features of severe brain injury usually manifest within 72 hours so if your child is fine within that window, he or she should be fine.
Again, prevention is better than cure so here are some ways to reduce the possibility of head injuries occurring:
- Do not leave babies unattended on an adult bed / cot without barriers
- Do not use sarong cradles as the springs or attachments may break
- Do not leave child unsupervised in a walker
- Do not shake or rock child violently as it may lead to rupture of blood vessels in the brain
- School-going children should have protective gear, such as a helmet, for activities that involve them being on wheels
Allergic Reactions
Allergic reactions can be triggered by food, medication, animals, insect stings or pollen. Symptoms include hives, facial swelling, itching, skin redness, stuffy or runny nose, sneezing and watery eyes.
These are symptoms of a mild allergic reaction that can be managed at home with antihistamines.
Symptoms of severe reactions, known as anaphylaxis, include swelling of the mouth or tongue, trouble swallowing or speaking, wheezing or difficulty breathing, dizziness or fainting, abdominal pain or vomiting. In such cases, going to the emergency room is a must!
Takeaway
Dr Ooi concludes by emphasising that you must know where the nearest hospitals are in the various parts of Singapore. When dealing with common problems in children, look out for red flags that she mentioned and do not delay seeking medical treatment when needed. Call for an ambulance or make your way to the nearest hospital.
We hope that this comprehensive webinar has helped make identifying when common problems in children need immediate medical attention or a trip to the Children’s Accident & Emergency department.
With an average wait time of 30 minutes, Gleneagles Hospital's 24-hour A&E clinic is there to take care of your medical emergencies when you need it. For prompt medical transportation, you can call Parkway Emergency services at 1800-PARKWAY (7275-929).
Watch the webinar recording here