Emergencies

Head injuries fall into two categories:

1. external injuries, usually involving the scalp
2. internal head injuries, which may involve the skull, the blood vessels within the skull, or the brain

Fortunately, most childhood falls or blows to the head cause injury to the scalp only. While these can be scary-looking, they usually aren’t dangerous. An internal head injury could be more serious because it may cause bleeding or bruising of the brain.

External (Scalp) Injuries

The scalp is rich with blood vessels, so even a minor cut there can bleed a lot. Sometimes the scalp’s veins leak fluid or blood into (and under) the scalp. This appears as a “goose egg” or swelling on the head. It may take days or even a week to disappear.

What to look for and what to do:

• Call the doctor if your child is an infant; has lost consciousness, even briefly; or if a child of any age has any of these symptoms:
  • won’t stop crying
  • complains of head and neck pain (younger or nonverbal children may be more fussy)
  • vomits several times
  • won’t awaken easily
  • becomes hard to console
  • isn’t walking or talking normally
• If your child is not an infant, has not lost consciousness, and is alert and behaving normally after the fall or blow:
  • Apply an ice pack or instant cold pack to the injured area for 20 minutes every 3 to 4 hours. If you use ice, always wrap it in a washcloth or sock; ice applied directly to bare skin can injure it.
  • Watch your child carefully for the next 24 hours. If you notice any of the signs of internal injury, call your doctor right away.
  • If the incident happens close to bedtime or naptime and your child falls asleep soon afterward, check in a few times while he or she sleeps.
• If color and breathing are normal, and you don’t sense a problem, let your child sleep (unless the doctor has advised otherwise). There’s no need to keep a child awake after a head injury.
• Trust your instincts. If you aren’t comfortable with your child’s appearance, partly awaken your child by sitting him or her up. Your child should fuss a bit and attempt to resettle. If he or she still seems very drowsy, try to awaken your child fully. If your child can’t be awakened or shows any signs of internal injury, call the doctor or 911 for an ambulance.

Internal Injuries

Cerebrospinal fluid (CSF) is a clear fluid that cushions the brain from damage. But a severe blow to the head can still knock the brain into the side of the skull or tear blood vessels.

Some internal head injuries can be serious and possibly life-threatening. These include a broken skull bone, torn blood vessels, or damage to the brain itself.

It can be hard to know how serious a head injury is, so it’s always wise to call your doctor.

Symptoms and What to Do

Call 911 if your child shows any of these symptoms after a head injury:

• unconsciousness for more than a few seconds
• abnormal breathing
• obvious serious wound
• bleeding or clear fluid from the nose, ear, or mouth
• disturbance of speech or vision
• pupils of unequal size
• weakness or paralysis
• neck pain or stiffness
• seizure

If your child is unconscious:

• Do not try to move your child in case there is a neck or spine injury.
• Call for help.
• Turn a child who is vomiting or having a seizure onto his or her side while trying to keep the head and neck straight. This will help prevent choking and provide protection in case of neck and spine injury.

If your child is conscious:

• Do your best to keep your child calm and still.
• If there’s bleeding, apply a clean or sterile bandage.
• Do not attempt to cleanse the wound, which can make bleeding worse and/or cause serious complications if the skull is fractured.
• Do not apply direct pressure to the wound if you suspect the skull is fractured.
• Do not remove any object that’s stuck in the wound.

Concussions

Concussions — the temporary loss of normal brain function due to an injury — are also a type of internal head injury. Repeated concussions can permanently damage the brain.

In many cases, a concussion is mild and won’t cause long-term damage. Kids who get a concussion usually recover within a week or two without lasting health problems by following certain precautions and taking a break from sports and other activities that make symptoms worse.

Playing sports is one of the most common causes of concussions. To help protect your kids, make sure that they wear the proper protective gear, and don’t let them continue to play if they’ve had a head injury.

If your child sustains an injury to the head, watch for these signs of a possible concussion:

• “seeing stars” and feeling dazed, dizzy, or lightheaded
• memory loss, such as trouble remembering what happened right before and after the injury
• vomiting
• headaches
• blurred vision and sensitivity to light
• slurred speech or saying things that don’t make sense
• problems concentrating, thinking, or making decisions
• difficulty with coordination or balance (such as being unable to catch a ball or other easy tasks)
• feeling anxious or irritable for no apparent reason

If you suspect a concussion, call your doctor right away.

Preventing Head Injuries

It’s impossible to prevent kids from ever being injured, but there are ways to help prevent head blows.

Make sure that:

• your home is childproofed to prevent household accidents
• your kids always wear the proper headgear and safety equipment when biking, in-line skating, skateboarding, snowboarding or skiing, and playing contact sports
• kids always use a seatbelt or child safety seat
• your child takes it easy after a head injury, especially if there is a concussion
• your child doesn’t go back to rough play or sports until the doctor says it’s OK. If your child reinjures the brain while it’s still healing, it will take even longer to completely heal.

Our bodies create a tremendous amount of heat. Normally, they’re cooled through sweating and by heat radiating through the skin.

But in very hot weather, high humidity, and other conditions, this natural cooling system may begin to fail, letting heat in the body build to dangerous levels. The can cause heat illness, such as heat cramps, heat exhaustion, or heatstroke.

Heat Cramps

Heat cramps are brief, painful muscle cramps in the legs, arms, or abdomen that may occur during or after vigorous exercise in extreme heat. The sweating that occurs with intense physical activity causes the body to lose salts and fluids. This low level of salts causes the muscles to cramp.

Kids are particularly at risk for heat cramps when they aren’t drinking enough fluids.

Although painful, heat cramps on their own aren’t serious. But cramps can be the first sign of more serious heat illness, so they should be treated right away to help avoid any problems.

What to Do:

A cool place, rest, and fluids should ease a child’s discomfort. If possible, give fluids that contain salt and sugar, such as sports drinks. Gently stretching and massaging cramped muscles also may help.

Heat Exhaustion

Heat exhaustion is a more severe heat illness that can occur when someone in a hot climate or environment hasn’t been drinking enough fluids. Symptoms can include:

• increased thirst
• weakness
• fainting
• muscle cramps
• nausea and/or vomiting
• irritability
• headache
• increase sweating
• cool, clammy skin
• elevation of body temperature, but less than 104°F (40°C)

What to Do:

• Bring your child to a cooler place indoors, an air-conditioned car, or shady area.
• Remove your child’s excess clothing.
• Encourage your child to drink cool fluids containing salt and sugar, such as sports drinks.
• Put a cool, wet cloth or cool water on your child’s skin.
• Call your doctor for advice. If your child is too exhausted or ill to drink, treatment with intravenous (IV) fluids may be necessary.

If left untreated, heat exhaustion can develop into heatstroke, which can be fatal.

Heatstroke

The most severe form of heat illness is heatstroke. Heatstroke is a life-threatening medical emergency.

In heatstroke, the body cannot regulate its own temperature. Body temperature can soar to 106°F (41.1°C) or even higher, leading to brain damage or even death if it isn’t quickly treated. Prompt medical treatment is required to bring the body temperature under control.

Factors that increase the risk for heatstroke include overdressing and extreme physical activity in hot weather with inadequate fluid intake.

Heatstroke also can happen when a child is left in, or becomes accidentally trapped in, a car on a hot day. When the outside temperature is 93°F (33.9°C), the temperature inside a car can reach 125°F (51.7°C) in just 20 minutes, quickly raising body temperature to dangerous levels.

What to Do:

Call for emergency medical help if your child has been outside in extreme temperatures or another hot environment and shows one or more of these symptoms of heatstroke:

• severe headache
• weakness, dizziness
• confusion
• nausea
• rapid breathing and heartbeat
• loss of consciousness
• seizure
• no sweating
• flushed, hot, dry skin
• temperature of 104°F (40°C) or higher

While waiting for help:

• Get your child indoors or into the shade.
• Undress your child and sponge or douse him or her with cool water.
• Do not give fluids unless your child is awake, alert, and acting normally.

An Ounce of Prevention

To help protect kids from heat illness:

• Teach kids to always drink plenty of fluids before and during activity in hot, sunny weather — even if they’re not thirsty.
• Make sure kids wear light-colored, loose clothing and use sunscreen when outdoors.
• On hot or humid days, make sure your kids only participate in heavy activity outdoors before noon and after 6 p.m.
• Teach kids to come indoors, rest, and hydrate immediately whenever they feel overheated.

A person’s pulse, or heart rate, is the number of times the heart beats per minute. Taking someone’s pulse can tell doctors important things about his or her health.

Heart rate can vary depending on things like a person’s age and level of stress or activity at the time the pulse is taken. It’s normal for a heart rate to be irregular — meaning that the heart will slow down or speed up from time to time. But when it beats faster than what’s considered normal for an extended length of time, it could signal a problem.

What’s a Normal Heart Rate?

A child’s hearts normally beat faster than an adult’s. A healthy adult heart rate can range from 60 to 100 beats per minute during rest.

Kids’ heart rates can be as low as 60 beats per minute during sleep and as high as 220 beats per minute during strenuous physical activity. It’s normal for athletic kids to have slower resting heart rates, often in the 40s or 50s.

Before taking your child’s pulse, check with your doctor to see what range is considered normal for your child.

When to Take a Child’s Pulse

Usually, there’s no need to take your child’s pulse. Your doctor will check your child’s heart rate at well checkups.

But if your child has a medical condition that requires you to monitor his or her heart rate, your doctor may have told you when to take a pulse. You might need to do it regularly, or only on occasion. If you’re not sure, ask your doctor.

You also should take a pulse if your child ever complains of a “racing” heart or palpitations — when it feels like the heart is “skipping” a beat. Some kids say this feels like a buzzing, beeping, vibrating, or fluttering feeling in their chest. (Oftentimes, though, these feelings are nothing serious and sometimes not even related to the heart. Muscles in the neck or chest can sometimes twinge or spasm, making someone think it’s the heart skipping or racing.)

Other times to check a pulse include if your child:

• faints
• has chest pain
• has trouble breathing that is not caused by asthma
• has skin that suddenly turns pale or grey, or has lips that are blue

If your child has any of the symptoms above, begin taking the pulse right away. Make note of the activity that caused the symptoms and be sure to tell the doctor.

How Do I Take a Pulse?

To take your child’s pulse, you will need a watch with a minute hand, or a stopwatch with the minutes and seconds displayed (this is usually easier to use). Find a quiet place where your child can sit or lie comfortably.

If your child has just been active (running, jumping, crying, etc.), wait at least 5 minutes to allow the heart time to slow down and return to a normal beat.

To feel a pulse, you press two fingers — your index (“pointer”) and middle fingers — onto a major artery in the body. Press gently. Never press with your thumb, as it has a pulse all its own and can throw off a reading. When you’ve located the pulse, you will feel a throbbing sensation.

There are several areas on the body to read a pulse, but in kids these are generally the easiest places:

• On the neck (carotid artery pulse). The carotid artery runs along either side of the throat (windpipe). Run your fingers about halfway down the neck and press gently to the left or right side of the windpipe (carefully avoiding the Adam’s apple in teen boys). Press gently. You should feel the pulse. If not, try again or on the other side.
• On the wrist (radial pulse). This is the spot where most adults have their pulse taken. It can work well in kids, too. To find the right spot, place a finger at the base of your child’s thumb and slide it straight down to the wrist. On the wrist, press gently to feel for the pulse. This works best if your child’s hand is lying flat or bent slightly backward.
• In the armpit (axillary pulse). Press your fingertips into the armpit, feeling around for the arm bone. When you feel the arm bone beneath your fingers, you should also feel the pulse. This method works well for infants.
• In the crease of the elbow (brachial pulse). This location works best for infants. Place your infant on his or her back with one arm flat along the baby’s side (elbow crease facing up). In the crease of the elbow, gently place your fingers on the inside of the arm (the pinky side). Feel around for a pulse.

Once you’ve located the pulse (feeling a “throbbing” or “beating” sensation on your fingers), begin counting the beats within a 30-second timeframe. After 30 seconds, stop. Take the number of beats (for example, 45 beats in a 30-second period) and double it. So:

• 45 x 2 = 90 beats per minute. The heart rate for your child would be 90, which is within the normal range for most kids. (This is just an example; your child’s heart rate may be different.)

If you don’t feel comfortable taking a pulse this way, or have difficulty, there is another option. Many smartphone apps can give pulse readings simply by pressing a finger over the camera lens. For a good reading, your child needs to be very still, so this method works best in older kids who are more cooperative. Before using one of these, ask your doctor if it’s a good idea or if he or she recommends a particular heart rate app.

When to Call the Doctor

If your child’s heart rate is within the normal range, you don’t need to call the doctor (unless your doctor asked you to call with the reading, in which case you should call to report that it’s normal). There’s also no need to call if the heart rate slowed down or sped up while you were taking the pulse. Some variation in speed is normal.

If your child’s heart rate is above the normal range, or too fast to count, wait a little while and recheck it. It may return to a normal rate. If it’s still too high, call your doctor. If your child is having other symptoms in addition to a high heart rate, call 911 or drive your child to the nearest ER.

If you have any other questions about taking a child’s pulse, call your doctor.

Even healthy kids get hurt or sick sometimes. In some cases, you will know that you need to head straight to the emergency room (ER) at the nearest hospital. In other cases, it’s harder to determine whether an injury or illness needs the attention of a medical professional or can be treated at home.

Different problems require different levels of care. When your child needs some sort of medical help, you have many options:

• Handle the problem at home. Many minor injuries and illnesses, including some cuts, certain types of rashes, coughs, colds, scrapes, and bruises, can be handled with home care and over-the-counter (OTC) treatments.
• Call your doctor. If you’re unsure of the level of medical care your child needs, your doctor — or a nurse who works in the office — can help you decide what steps to take and how.
• Visit an urgent care center. An urgent care center can be a good option for non-emergencies at night and on weekends when your doctor may not be in the office. At these centers, you can usually get things like X-rays, stitches, and care for minor injuries that aren’t life threatening yet require medical attention on the same day.
• Visit a hospital emergency room. An ER — also called an emergency department (ED) — can handle a wide variety of serious problems, such as severe bleeding, head trauma, seizures, meningitis, breathing difficulties, dehydration, and serious bacterial infections.
• Call 911 for an ambulance. Some situations are so serious that you need the help of trained medical personnel on the way to the hospital. These might include if your child: has been in a car accident, has a head or neck injury, has ingested too much medication and is now hard to rouse, or is not breathing or is turning blue. In these cases, dial 911 for an ambulance.

As a parent, it can be hard to make these judgment calls. You don’t want to rush to the ER if it isn’t really an emergency and can wait until a doctor’s appointment. On the other hand, you don’t want to hesitate to get medical attention if your child needs treatment right away. As your kids grow, you’ll learn to trust yourself to decide when it’s an emergency.

Remember that in cases when you know the problem is minor, it’s best to contact your child’s doctor, go to an urgent care center, or handle it at home. ERs can be crowded and it can take a long time for minor problems to be treated.

Should I Go to the ER?

Here are some reasons to go to the ER :

• if your child has difficulty breathing or shortness of breath
• if your child has had a change in mental status, such as suddenly becoming unusually sleepy or difficult to wake, disoriented, or confused
• if your child has a cut in the skin that is bleeding and won’t stop
• if your child has a stiff neck along with a fever
• if your child has a rapid heartbeat that doesn’t slow down
• if your child accidentally ingests a poisonous substance or too much medication
• if your child has had more than minor head trauma

Other situations may seem alarming, but don’t require a trip to the ER. The list below includes some of the symptoms that may require calling your doctor:

• high fever
• ear pain
• pain in the abdomen
• headache that doesn’t go away
• rash
• mild wheezing
• persistent cough

When in doubt, call your doctor. Even if the doctor isn’t available, the office nurse can talk with you and determine whether you should go to the ER. On weekends and at night, doctors have answering services that allow them to get in touch with you if you leave a message.

Urgent Care Centers

Sometimes an injury or an illness isn’t life threatening but needs medical attention on the same day. If that’s the case, and your doctor doesn’t have office hours at the time, consider going to an urgent care center.

Urgent care centers usually allow you to walk in without an appointment, just as you would in an ER. But they’re equipped and staffed to treat minor, non-critical issues. Patients usually will be seen by a doctor and also might be able to get X-rays or blood drawn.

Most of these clinics offer extended hours on evenings and on weekends for patients to receive treatment when the family doctor is not available. Some are open 24 hours a day every day. In addition to accepting walk-in patients, some allow you to call ahead to be seen.

Some cases where you might take your child to an urgent care center include:

• cuts
• minor injuries
• vomiting or diarrhea
• ear pain
• sore throat
• infected bug bites
• mild allergic reactions
• suspected sprain or broken bone
• minor animal bites

The doctors who work at freestanding urgent care centers often are ER doctors or family physicians who focus on treating adult and pediatric diseases. Some centers are also staffed by nurse practitioners and physician assistants. The ERs in many children’s hospitals have special sections similar to an urgent care center for treatment of minor injuries and illnesses.

Find out about the urgent care centers near you — before a situation comes up where you need to go to one. Ask your doctor about local facilities. In general, you should find a clinic that meets the state licensing requirements and is staffed by doctors who are board certified in their specialties, such as pediatrics, family medicine, or emergency medicine. It’s also a good idea to find out if the center accepts your insurance plan.

Talk with your doctor before your child gets sick about how to handle emergencies and ask about the doctor’s policy on addressing medical needs outside of office hours. Having that information ahead of time will mean one less thing to worry about when your child is sick!

When providing emergency care, doctors, nurses, and emergency personnel like paramedics will have many questions about a patient’s medical history. And even the most organized parent might not be able to remember the details of a child’s health history in a stressful situation.

That’s why it’s important to keep a comprehensive record of your kids’ health information nearby. In many cases, this information can help a medical professional make quicker diagnoses and decisions during an emergency, when each second counts.

Some hospitals have computerized medical records that keep all medical information about a patient in one place. So when you get to the hospital, everything about your child’s history will be available. But it’s still a good idea to update your family’s records because something like a medication may have changed since the last visit.

Keeping Track of Medical Information

Refer to the categories below to create a complete health record for your kids; if applicable, also use the hospital’s computerized record.

Keep one copy of the record in an accessible place at home (such as on the refrigerator) or by the phone, one in each car, one at each parent’s workplace, and one in each parent’s bag or wallet. Also send a copy to your kids’ schools or childcare, and give one to any regular caregivers, along with the name and number of your doctor.

Allergies

Record on your list any known allergies your child has to medications, both prescription and nonprescription, and any known allergic reactions to insect stings and bites and food allergies. In addition, some kids may have latex allergies. In many cases, allergy information helps medical personnel discover a cause for problems like swelling or difficulty breathing.

Medications

Certain medications can’t be taken together, so paramedics need to know all medications (prescription and nonprescription) your kids take before they can administer certain drugs.

A child’s symptoms also could be due to side effects of medications, which is another reason it’s important to report everything being taken. In addition, you need to know the doses, the dosing schedules, and when and how much of the medications were recently taken.

Pre-existing Illnesses or Conditions

Pre-existing illnesses or conditions can have a great impact on the kinds of tests or treatments administered during an emergency. If your child has any health problem — from diabetes to epilepsy to asthma — emergency medical personnel must know. For additional protection, kids with chronic conditions (long term) should wear an identifying bracelet with this important information on it. This kind of immediate notification can help doctors save a child’s life.

For a child with special needs, you and your doctor can fill out a form created by the American Academy of Pediatrics (AAP) and the American College of Emergency Physicians (ACEP). The Emergency Information Form (EIF) for Children With Special Needs can be found at either aap.org or acep.org and can be updated as needed.

As with any other health record you create, keep the form in an easily accessed place at home.

Hospitalizations and Operations

List the dates your child has been hospitalized, the reasons for hospitalization, treatments received, and the types of operations performed. This information may help during and following an emergency situation.

Immunizations

Keeping an updated record of all your kids’ immunizations is important. If you need help remembering or compiling this, the staff at your doctor’s office can assist you. Be sure to include information about any reactions to an immunization, such as seizures, high fever, or severe discomfort.

Height and Weight

When calculating medication doses, it’s very helpful for doctors to know a child’s approximate height and weight. (Be sure to to keep this updated, since kids can grow quickly.)

It’s relatively easy to compile your child’s medical history, and it could mean saving critical minutes — when they count most!

Nosebleeds are common in kids 3 to 10 years old, and most are caused by nose-picking or dry air. They can be scary, but are rarely cause for alarm. Most will stop on their own and can be easily managed at home.

What to Do:

• Stay calm and reassure your child.
• Have your child sit upright in a chair or on your lap, then tilt his or her head slightly forward.
• Do not have your child lean back. This may cause blood to flow down the back of the throat, which tastes bad and may cause gagging, coughing, or vomiting.
• Gently pinch the soft part of the nose (just below the bony ridge) with a tissue or clean washcloth.
• Keep pressure on the nose for about 10 minutes; if you stop too soon, bleeding may start again.
• Have your child relax a while after a nosebleed. Discourage nose-blowing, picking, or rubbing, and any rough play.

Call the Doctor if Your Child:

• has nosebleeds often
• may have put something in his or her nose
• tends to bruise easily
• has heavy bleeding from minor wounds or bleeding from another place, such as the gums
• recently started taking new medicine

Seek Emergency Care or Call the Doctor if Bleeding:

• is heavy, or accompanied by dizziness or weakness
• is the result of a fall or blow to the head
• continues after two attempts of applying pressure for 10 minutes each

Different Kinds of Nosebleeds

The most common kind of nosebleed is an anterior nosebleed, which comes from the front of the nose. Capillaries, or very small blood vessels, inside the nose may break and bleed, causing this type of nosebleed.

A posterior nosebleed comes from the deepest part of the nose. Blood flows down the back of the throat even if the person is sitting or standing. Kids rarely have posterior nosebleeds, which happen more often in older adults, those with high blood pressure, and people who have had nose or face injuries.

Causes and Remedies

The chief cause of anterior nosebleeds is dry air. A dry climate or heated indoor air irritates and dries out nasal membranes, causing crusts that may itch and then bleed when scratched or picked. Common colds also can irritate the lining of the nose, with bleeding following repeated nose-blowing. Having a cold during dry winter weather is the perfect formula for nosebleeds.

Allergies also can cause problems, as doctors may prescribe medicine (such as antihistamines or decongestants) to control an itchy, runny, or stuffy nose. The medicine can dry out nasal membranes, leading to nosebleeds.

An injury or blow to the nose can cause bleeding, but most aren’t a serious problem. But if your child has a facial injury that causes a bloody nose and you can’t stop the bleeding after 10 minutes or have other concerns about the injury, get medical care right away.

While nosebleeds are rarely serious, there might be a problem if they happen a lot. If your child gets nosebleeds more than once a week, call your doctor. Usually, frequent nosebleeds are easily treated. Sometimes tiny blood vessels inside the nose are irritated and don’t heal, which happens more often in kids with ongoing allergies or who get a lot of colds. A doctor might be able to help in these cases.

For bleeding not due to a sinus infection, allergies, or irritated blood vessels, a doctor may order tests to find the cause. Rarely, a bleeding disorder or abnormally formed blood vessels could be a possibility.

Tips for Preventing Nosebleeds

Since most nosebleeds in kids are caused by nose-picking or irritation from hot dry air, using a few simple tips may help your kids avoid them:

• Keep your child’s nails short to prevent injuries from nose-picking.
• Keep the inside of your child’s nose moist with saline (saltwater) nasal spray or gel, or dab antibiotic ointment gently around the opening of the nostrils.
• Run a cool-mist humidifier (or vaporizer) in bedrooms if the air in your home is dry. Keep the machine clean to prevent mildew buildup.
• Make sure your kids wear protective athletic equipment during sports or other activities that could cause a nose injury.

Even with proper precautions, kids can still get a bloody nose occasionally. So if your child gets a nosebleed, try not to panic. They’re usually harmless and are almost always easy to stop.

Seizures are caused by a sudden surge of electrical activity in the brain. A seizure usually affects how a person looks or acts for a short time. Someone having a seizure might collapse, shake uncontrollably, or even just stare into space. All of these are brief disturbances in brain function, often with a loss of or change in consciousness.

Seizures can be frightening, but most last only a few minutes, stop on their own, and are not life-threatening. A person who has had two or more seizures may be diagnosed with epilepsy, also known as seizure disorder.

Seizure Basics

Usually, electrical activity in the brain involves neurons in different areas sending signals at different times. During a seizure, many neurons fire all at once. This abnormal electrical activity can cause different symptoms depending on the part of the brain involved, including unusual sensations, uncontrollable muscle spasms, and loss of consciousness.

Some seizures may be due to another medical problem, such as a fever, an infection, a head injury, accidental poisoning, or drug overdose. They also can be caused by a brain tumor or other health problem affecting the brain. And anything that results in a sudden lack of oxygen or reduced blood flow to the brain can cause a seizure. In some cases, a seizure’s cause is never found.

Febrile seizures can happen in children younger than 6 years old. While they can be scary to watch, these seizures are usually brief and rarely cause any serious or long-term problems, unless the fever is related to a serious infection, such as meningitis.

Syncope (SIN-ko-pee), or fainting, is not uncommon in older kids and teens. When it happens, kids might have a brief seizure or seizure-like spell. They might stiffen or even twitch or convulse a few times. Fortunately, fainting rarely is a sign of epilepsy. Most kids recover very quickly (seconds to minutes) and don’t need specialized treatment.

If Your Child Has a Seizure

First, make sure that your child is in a safe place where he or she can’t get hurt. Place your child on the ground or floor in a safe area, preferably on his or her right side. Also:

• Remove any nearby objects.
• Loosen any clothing around the head or neck.
• Don’t try to wedge your child’s mouth open or place an object between the teeth, and don’t try to restrain movements.

Once the seizure seems to have ended, gently comfort and protect your child. It’s best for kids to remain lying down until they have recovered fully and want to move around.

Call 911 immediately if your child:

• has difficulty breathing
• turns bluish in color
• has had a head injury
• seems ill
• has a known heart condition
• has never had a seizure before
• might have ingested any poisons, medicines, etc.

If your child has previously had seizures, call 911 if the seizure lasts more than 5 minutes or is for some reason very alarming to you and you’re worried for your child’s safety.

If your child is breathing normally and the seizure lasts just a few minutes, you can wait until it lets up to call your doctor.

After a seizure, kids are often tired or confused and may fall into a deep sleep (called the postictal period). You do not need to try to wake your child as long as he or she is breathing comfortably. Don’t try to give food or drink until your child is awake and alert.

For a child who has febrile seizures, the doctor may suggest giving fever-reducing medicine like ibuprofen or acetaminophen to ease discomfort.

After a seizure — particularly if it is a first or unexplained seizure — call your doctor or emergency medical services for instructions. Your child probably will need to be seen by a doctor as soon as possible.

Kids with severe allergies can be at risk for a sudden, potentially life-threatening allergic reaction called anaphylaxis. This reaction can be frightening — a child may feel like his or her throat is closing or might faint, for example.

But the good news is that when treated properly, anaphylaxis can be managed.

Anaphylaxis isn’t common, but some kids with allergies are more at risk for it. So if your child has allergies, it’s important to know about it and be prepared.

Signs of Anaphylaxis

As with other allergies, anaphylaxis can trigger symptoms in any of these four body systems:

1. skin
2. digestive system
3. respiratory system
4. cardiovascular system

An allergic reaction might be a medical emergency if it happens in two or more of these systems — for example, hives on the skin together with stomach pain.

The most common signs that someone might have anaphylaxis after exposure to an allergen are:

• difficulty breathing
• tightness in the throat or feeling like the throat or airways are closing
• hoarseness or trouble speaking
• wheezing
• nasal stuffiness or coughing
• nausea, abdominal pain, or vomiting
• fast heartbeat or pulse
• skin itching, tingling, redness, or swelling

Fast Treatment Needed

Anaphylaxis requires immediate treatment. It can get worse very quickly. This is why doctors usually want people with life-threatening allergies to carry a medication called epinephrine. Epinephrine enters the bloodstream and works quickly against serious allergy symptoms; for example, it decreases swelling and raises blood pressure.

Epinephrine is given as an injection. This isn’t as scary as it sounds, though — there’s no big needle and plunger involved. Instead, doctors will prescribe an auto injector about the size of a large pen that’s easy for parents — and older kids — to carry and use. If your child is prescribed epinephrine, your doctor will show you how to use it.

Your doctor also might instruct you to give your child over-the-counter (OTC) antihistamines, too — but they won’t work alone. OTC antihistamines are never a replacement for epinephrine in life-threatening reactions.

If Your Child Has a Serious Reaction

If your child shows signs of a serious allergic reaction:

Step 1: Give the epinephrine auto-injector right away. Seconds count during an episode of anaphylaxis. If you are alone with your child, give this medication first, then call 911. If you are not alone with your child, have someone else call 911 while you give the medicine.

Step 2: At the emergency room, additional treatment can be given, if needed. Also, your child needs to be under medical supervision for at least 4 hours because even if the worst seems to have passed, a second wave of serious symptoms (called a biphasic reaction) often happens.

Serious allergies can be alarming. But they’re a lot easier to recognize and treat now than in the past, thanks to greater awareness and the availability of epinephrine. Also, make sure that any caregivers, teachers, or coaches know about the allergy and what to do in an emergency.

One of the challenges of being a parent is arming your kids with the skills to handle the obstacles life presents. Teaching them how to use 911 in an emergency could be one of the simplest — and most important — lessons you’ll ever share.

Talking About 911 With Kids

Not that long ago, there was a separate telephone number for each type of emergency agency. For a fire, you called the fire department; for a crime, you called the police; for a medical situation, you called an ambulance or doctor.

But now 911 is a central number for all types of emergencies. An emergency dispatch operator quickly takes information from the caller and puts the caller in direct contact with whatever emergency personnel are needed, thus making response time quicker.

According to the National Emergency Number Association, 911 covers nearly all of the population of the United States, but check your phone book or go online to be sure that 911 is the emergency number to use in your area.

Everyone needs to know about calling 911 in an emergency. But kids also need to know the specifics about what an emergency is. Asking them questions like, “What would you do if we had a fire in our house?” or “What would you do if you saw someone trying to break in?” gives you a chance to discuss what constitutes an emergency and what to do if one occurs. Role playing is an especially good way to address various emergency scenarios and give your kids the confidence they’ll need to handle them.

For younger children, it might also help to talk about who the emergency workers are in your community — police officers, firefighters, paramedics, doctors, nurses, and so on — and what kinds of things they do to help people who are in trouble. This will clarify not only what types of emergencies can occur, but also who can help.

When to Call 911

Part of understanding what is an emergency is knowing what is not. A fire, an intruder in the home, an unconscious family member — these are all things that would require a call to 911. A skinned knee, a stolen bicycle, or a lost pet wouldn’t. Still, teach your child that if ever in doubt and there’s no adult around to ask, make the call. It’s much better to be safe than sorry.

Make sure your kids understand that calling 911 as a joke is a crime in many places. In some cities, officials estimate that as much as 75% of the calls made to 911 are non-emergency calls. These are not all pranks. Some people accidentally push the emergency button on their cell phones. Others don’t realize that 911 is for true emergencies only (not for such things as a flat tire or even about a theft that occurred the week before).

Stress that whenever an unnecessary call is made to 911, it can delay a response to someone who actually needs it. Most areas now have what is called enhanced 911, which enables a call to be traced to the location from which it was made. So if someone dials 911 as a prank, emergency personnel could be dispatched directly to that location. Not only could this mean life or death for someone having a real emergency on the other side of town, it also means that it’s very likely the prank caller will be caught and punished.

How to Use 911

Although most 911 calls are now traced, it’s still important for your kids to have your street address and phone number memorized. They’ll need to give that information to the operator as a confirmation so time isn’t lost sending emergency workers to the wrong address.

Make sure your kids know that even though they shouldn’t give personal information to strangers, it’s OK to trust the 911 operator. Walk them through some of the questions the operator will ask, including:

• Where are you calling from? (Where do you live?)
• What type of emergency is this?
• Who needs help?
• Is the person awake and breathing?

Explain that it’s OK to be frightened in an emergency, but it’s important to stay calm, speak slowly and clearly, and give as much detail to the 911 operator as possible. If they’re old enough to understand, also explain that the emergency dispatcher may give first-aid instructions before emergency workers arrive at the scene.

Make it clear that your child should not hang up until the person on the other end says it’s OK, otherwise important instructions or information could be missed.

More Safety Tips

Here are some additional safety tips to keep in mind:

• Always refer to the emergency number as “nine-one-one” not “nine-eleven.” In an emergency, a child may not know how to dial the number correctly because of trying to find the “eleven” button on the phone.
• Make sure your house number is clearly visible from the street so that police, fire, or ambulance workers can easily locate your address.
• If you live in an apartment building, make sure your child knows the apartment number and floor you live on.
• Keep a list of emergency phone numbers handy near each phone for your kids or babysitter. This should include police, fire, and medical numbers (particularly important if you live in one of the few areas where 911 is not in effect), as well as a number where you can be reached, such as your cell phone, pager, or work number. In the confusion of an emergency, calling from a printed list is simpler than looking in the phone book or figuring out which is the correct speed-dial number. The list should also include known allergies (especially to any medication), medical conditions, and insurance information.
• If you have special circumstances, such as an elderly grandparent or a person with a heart condition, epilepsy, or diabetes living in your home, prepare your child by discussing specific emergencies that could occur and how to spot them.
• Keep a first-aid kit handy and make sure your kids and babysitters know where to find it. When kids are old enough, teach them basic first aid.

Boy, your child’s freckles really stand out in the sun — but wait, that one looks like it’s moving! It isn’t a freckle at all. It’s a tick. What should you do?

First, don’t panic. It’s true that Lyme disease is the most common tick-borne disease in the United States, but your child’s risk of developing Lyme disease after being bitten by a tick is very low.

To be safe, though, you’ll want to remove the tick as soon as possible because risk of infection increases between 24 to 48 hours after the tick attaches to the skin.

What to Do

Step 1: Use tweezers to grasp the tick firmly at its head or mouth, next to the skin.

Step 2: Pull firmly and steadily until the tick lets go of the skin. Do not twist the tick or rock it from side to side. If part of the tick stays in the skin, don’t worry. It will eventually come out on its own.

Step 3: Release the tick into a jar or zip-locked bag in case you want to have it identified later on.

Step 4: Wash your hands and the site of the bite with soap and water.

Step 5: Swab the bite site with alcohol.

Never use petroleum jelly or a hot match to kill and remove a tick. These methods don’t get the tick off the skin, and can cause the insect to burrow deeper and release more saliva (which increases the chances of disease transmission).

Next Steps

Call your doctor after the tick has been removed to find out if your child should be evaluated. In certain cases, a doctor will prescribe antibiotics if a child is at high risk of developing Lyme disease.

Call the doctor right away if your child develops a red-ringed rash or if the skin becomes red and irritated. Also call if your child has flu-like symptoms, joint pain or a swollen joint, or facial paralysis. Although other conditions can cause similar symptoms, you’ll want to have your child evaluated early on so that if it is Lyme disease, treatment can begin as soon as possible.