Health

Off to the ER! How to cope with a child’s crisis

For even the most attentive and protective parents, an emergency may arise and require immediate medical attention. As a mom to two boys with severe hemophilia, a genetic bleeding disorder, I’ve spent my share of time in ERs, and have learned what to expect and how to make the wait more comfortable for both myself and my child.

Types of services

We are lucky enough to have not only emergency rooms at hospitals but free-standing urgent or prompt care facilities. These offices have weekend hours and stay open much later than the 9-5s. They are able to see people without an appointment when a regular primary care provider (or PCP) can’t fit you in, especially those who may not be able to wait until the doctor is available. For some insurances, this is the same co-pay as a regular doctor visit. Knowing where these places are—and how long it will take to get there before needing them—is good preventative care.

Is it an emergency?

Knowing when to seek emergency services is important. As a registered nurse, I know that patients in the ER are triaged according to the ABCs: airway, breathing and circulation. Always call 911 to go to the hospital in a life-threatening situation. Otherwise, my doctor friends encourage their patients to call their PCP and speak with a doctor who may know them and their condition. An on-call doctor or nurse can guide a parent to the best course of action. A non-emergent ER visit may result in an extremely lengthy wait, and also expose you and your child to a stew of new and nasty germs.

What to bring

If there’s time to plan before running out the door, take a few minutes to get ready. Parents and kids will spend a fair amount of time waiting, so everyone should dress in loose, layered clothes that might get dirty. You might get a bit of walking in, being moved from room to room, so wear sneakers or other low-heeled shoes. Child patients are usually put in hospital gowns, which are thin and short-sleeved. Bring a small blanket or throw to keep your child warm.

I used to go to the ER so often I had a pre-packed duffle. Once sucked into the vortex of a hospital, time takes on new meaning. It can take hours to be seen and treated so I viewed it as an overnight adventure even if it wasn’t. In my bag were a full change of clothes for myself and my son, along with toothbrush, toothpaste and comb. I even included a plastic bag for dirty items. Stress headaches wrecked me, so I always carried some pain reliever.

Don’t forget the phone charger. A small change purse is a lifesaver because we rarely think about money as we’re heading for emergency care. Garage fees, coffee and cafeteria meals are often overlooked and add up quickly. I also stocked juice boxes and travel-friendly food like granola bars or crackers. (Generally, avoid giving the child anything to eat, drink or chew until you’re told it’s okay by the doctor or nurse. Anesthesia, surgery and some tests require an empty stomach.)

Always be aware of allergy information, and bring a current list of medications, the dosage, and when they were last taken. A timeline is always helpful. Doctors appreciate parents who know when symptoms started, what worked and what didn’t.

Brielle Swerdlin is a child life specialist with Upstate Golisano Children’s Hospital in Syracuse. A child life specialist helps patients and families deal with the fear and anxiety of the hospital experience using play and developmentally appropriate explanations of the hospital process.

Swerdlin encourages families to bring whatever counts as comfort items, such as books, toys, stuffed animals and crayons. Even tablets and games are welcome. And if you left the house too quickly to gather favorites, just ask Upstate hospital staffers. “If you need music, we’ll find music. If a particular board game is what the child wants, we’ll try to find it, or something close.  We also do parent interviews to find the best way to approach the youngster because the parent is the expert.”

Dos and don’ts in the ER

Children follow the lead of their parent, so staying calm will help children manage their own emotions. This includes being honest. Throughout her four years at Upstate, Swerdlin has seen good intentions backfire.

“Don’t lie to your child by setting expectations that you don’t know,” she says. “Avoid saying you’ll go home soon because they may be admitted. Telling Johnny he won’t be getting a shot sets him up for a ‘No, you promised!’ when he is told he needs one. That’s hard on the kiddo and the staff. Kids are generally okay when we tell them what we’ll be doing.”

Swerdlin also asks for patience and understanding. “The ER is a process and we have to treat by acuity—even if the little one is coming directly from a doctor’s office or urgent care.”

Bring a pad of paper and pen for listing questions. This saves time so all concerns can be addressed when you see the doctor.

Waiting room games

Trying to keep a sick child relaxed when the atmosphere isn’t necessarily child-friendly can be a challenge in the ER. That’s where I pull out my waiting room games. These activities require little energy or effort and are appropriate for almost every age.

For instance, think of that crinkly white disposable paper on the examination table as the largest blank slate ever. It’s a great distraction for coloring or games, especially during exam time, and it can be ripped off to start over if needed. (I’ll admit I’ve drawn on them myself, and it did briefly pull me out of the despair I was feeling.)

Spot the Dog is a game I made up when my oldest daughter was an infant. It allowed me to cuddle her on my lap while keeping her focused on something other than not feeling well. I discovered just about every magazine has a dog or pet in it. Either have the child turn the pages, count the pages together, or just keep flipping through to see where the dog is hiding.

My favorite game is the Back Blackboard. This also helps reinforce ABCs. “Draw” a letter on your child’s back with your finger and have him guess which letter it is. Most don’t guess correctly the first time so repeating is necessary. When he gets it right, turn around for your turn. I’ve found touch helps reduce anxiety in both patient and parent.

I Spy is a classic that can be played anywhere. It is also versatile enough to be played by colors, shapes, or by identifying only the first letter of the object. This can also work using “hot” or “cold” as directions.

Homeward bound

All patients are given an AVS, or after visit summary, when they are discharged, whether it’s for a brief visit or a hospital stay. ERs only treat crisis situations and then hand the care back to the PCP, who has been notified. It’s important to read the papers, know what is recommended for follow up, and see the doctor for that continued support within a day or two.

Visiting the hospital can be traumatic for everyone. Begin a conversation with your child to weigh her need to talk about what happened because it’s not an experience we’re able to teach our kids about beforehand.

No matter how much my sons cried or whined while we were there (or me for that matter), I always told them they were brave and did a good job and I love them. Sometimes, after the emergency has passed, that’s the best medicine.

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