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Emergency! A No-Panic Guide to Health Scares

How would you handle it if your child was unconscious, choking, or having a seizure? A little knowledge can help you approach an emergency as a doctor would: calmly and confidently.

The first step: "If you're really worried  -- particularly about your child's breathing or a drastic change in his behavior  -- go directly to the ER," says Marc Gorelick, M.D., medical director of the Emergency Department at Children's Hospital of Wisconsin in Milwaukee. What else you need to know about some of the scariest childhood emergencies:

Febrile seizures
A response to fever by a young child's immature brain, febrile seizures typically occur between the ages of 6 months and 5 years in 2 to 5 percent of all children. They come on suddenly, with no early warning signs.

Fortunately, there is no long-term cognitive or behavioral damage. "Febrile seizures generally require urgent evaluation but almost always have a benign outcome," says Kathy Shaw, M.D., chief of emergency medicine at Children's Hospital of Philadelphia. Most are "simple," meaning they last less than 10 or 15 minutes and don't recur within 24 hours. Typically, a child is evaluated and released, and is fine.

But in a small number of these cases, children with febrile seizures have something more serious, such as meningitis (see the next section). And some have "complex" seizures  -- longer than 15 minutes or recurring within the day  -- which might indicate epilepsy. (However, a simple febrile seizure can never "bring on" epilepsy.)

You can't really prevent febrile seizures. Most often, a fever of 103°F or higher sets one off. Even giving your child a fever reducer at the first sign of a temperature won't prevent one.

If a febrile seizure occurs once in a child over 18 months, there's a 30 percent chance it'll happen again. It's even more likely if these seizures run in your family, if your baby was 18 months or younger the first time, or if it was triggered by a milder fever, such as 101°.

So be prepared. If it's a first-ever seizure, call 911, but don't try to take her to the ER yourself while she's having one. Instead, without restraining her, lay her down on her back on a rug so she won't fall or bang her head against something hard. Gently turn her head to the side to prevent choking (don't put anything in her mouth, including medicine). Cool her down (unbutton her clothes, use a cool cloth). After it's over, let her sleep and then take her to the ER.

If it's a second seizure and the first one was simple, there's no need to call 911 (unless it lasts more than five minutes). When it's over, call your pediatrician. If it's off hours, go to the ER for an evaluation.

Laurie Tarkan, a frequent contributor on health topics for The New York Times, is writing a book on pregnancy. She's a mom of two in Maplewood, NJ.

Meningitis

Bacterial meningitis can be deadly. The good news: It's on the wane because most children now get immunized with two protective vaccines, Hib and pneumoccocal. Most cases of meningitis (an infection of the spinal fluid and the fluid surrounding the brain) are now viral, not bacterial, and not life-threatening. Still, it's considered an emergency because bacterial meningitis does need to be ruled out.

Classic signs:
Headache
Fever
Stiff neck
Fatigue

The red flag is a fever (even a mild one) and a stiff neck. If your child has both, get him to the ER.

For infants and toddlers, who may not be able to tell you their neck feels stiff, look out for irritability, eating poorly, vomiting  -- plus a big fever spike. One clue: paradoxical irritability. "Usually when babies are fussy, they want to be picked up and held, but this often hurts if the spinal cord is inflamed," says Dr. Shaw. A baby may cry more when you change his diaper because it hurts when you lift his legs.

If you've given your child a fever reducer, that's fine, but call your doctor at once if you suspect meningitis. If he's not available, go to the ER immediately. Call 911 if your child's severely lethargic, a possible sign of advanced illness.

In the ER, your child may be given a lumbar puncture to diagnose bacterial meningitis. He'll probably be put on IV antibiotics in case it is bacterial. If it turns out to be viral, he may still need IV fluids if he's dehydrated, as well as pain- and fever-reducing medication, and will stay in the hospital for a day or two. If it's bacterial, he'll stay at least a week, until the meningitis clears.

Choking

If your child appears to be choking but is coughing, it means the airway is not completely blocked and the object might become dislodged by itself  -- encourage him to keep coughing. If he can't cough, breathe, or speak, perform first aid if you know how and then call 911 if you're unsuccessful. (Or ask someone else to call while you do first aid.)

Once breathing resumes, go to the ER for medical care even if your child appears fine. He could have breathing difficulties, injuries to the abdomen from the first aid, damage to tissue in the throat, or swelling of throat muscles, according to the American Red Cross.

The Red Cross recommends that parents take a first-aid course annually to practice techniques and learn prevention tactics. Reading about abdominal thrusts is not the same as doing them on a dummy. (To learn more about prevention and first aid, see the printable guide [XREF {http://www.parenting.com/parenting/article/0,19840,1160387,00.html} {"How to Save a Choking Child"} {_blank}].)

Head trauma

An estimated 600,000 kids go to the ER for head injuries every year. Mostly, they fall while running, going up or down stairs, or turning over in bed. Some get hurt in sports. Most injuries are relatively minor. A fall is not even an emergency unless your child has been knocked unconscious, is having a seizure, or is bleeding heavily. If so, or if she's confused, has a severe headache, vomits many times, experiences a loss of balance, or has trouble with vision or memory, go to the ER.

But if the symptoms are mild (a minor headache, one episode of vomiting), simply call your pediatrician. If you can't reach him, just monitor your child for the next four to six hours if the symptoms don't worsen. It's safe to give her acetaminophen or ibuprofen for a headache. And don't worry if she falls asleep  -- just keep an eye on her. If she starts to feel better, you can follow up with your physician the next day.

If you do take her to the hospital, she'll be evaluated for neurological function, like vision, balance, and movement. "What we worry about is the rare instance where there's some internal bleeding that needs to be treated," says Dr. Gorelick. About half of the kids who go to the ER for head trauma are given CT scans, but only about 5 percent of them have any bleeding at all  -- and many of those cases are minor and don't require surgery or treatment.

Croup

No mother can mistake the barking-seal cough that is the telltale sign of croup, a viral infection of the large airways that often starts out as a common cold. First aid (a cool-mist humidifier, a steamy shower, or cool outside air) is usually effective. But if breathing is still labored after 15 minutes  -- he can't speak, he makes a whistling sound that gets louder with each breath, he's hunched over  -- go to the ER. On the way, crack the windows of the car a bit to bring in cool air.

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