Special care required

Of course, pediatricians aren't the only doctors qualified to care for children in an emergency -- all types of ER docs save kids' lives every day. But problems can arise when someone isn't used to seeing kids and has an adult patient as his or her point of reference, says Laura Fitzmaurice, M.D., a pediatric emergency physician at Children's Mercy Hospitals and Clinics in Kansas City, MO. "He could miss the red flag that tells him 'I need to do more.' Or he could miss things that are more common in children."

That's because kids aren't just miniature adults -- research shows they react differently to illness, injury, and treatment, says Steven Krug, M.D., head of emergency medicine at Children's Memorial Hospital in Chicago. Their body temperatures can rise more quickly, and their fevers are more difficult to bring down. Illnesses, including infections like meningitis, tend to come on more suddenly and progress more rapidly than in adults. This means extremely ill kids can look and act as if they are not that sick, but then deteriorate quickly. And because children are also more vulnerable to toxins and have smaller blood volumes, even small amounts of blood loss can lead rapidly to shock or even death, say Dr. Krug. Add the fact that many are too young to explain exactly what hurts or how they feel, and it's easy to see how mistakes can be made and symptoms missed. Case in point: When researchers at Iowa Methodist Medical Center evaluated patient care at a community hospital for six months, they found that the staff overlooked 18 percent of pediatric trauma injuries.

Mariah Spry, a mom from Dayton, NV, experienced her own near miss. Her daughter Avery has a gastrointestinal disorder, so when the then 2-year-old threw up repeatedly and became lethargic, Spry was alarmed. On the advice of her doctor, Spry drove her to the closest local ER, half an hour away. Avery seemed a little drowsy, but the nurse who saw her didn't think any immediate tests were necessary. Although Spry explained that Avery had a history of hypoglycemia, a condition in which blood sugar can drop dangerously, she still had to insist on the blood screen before it was ordered. The test showed Avery was on the brink of a hypoglycemic coma.

Even when the staff took action, things didn't go well. It took another ER nurse two hours and 15 tries to insert an IV in the dehydrated child, despite Spry's pleas to the staff to call a pediatrician and get special equipment from the hospital's pediatric floor. Although inserting an IV line is a basic and often essential emergency procedure, it can be especially difficult in children, who not only have small veins (quickly made smaller when they're dehydrated), but who also are usually wriggling and crying. "I think it's one of the most difficult jobs," says Corey McLeod, M.D., an ER doc at the Mad River Community Hospital in Arcata, CA. And it's only made harder when the staff hasn't had enough opportunity to practice.

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