when to visit the emergency room

General Health & Wellness • Jun 13, 2016

Do you know when to visit the emergency room if your child is vomiting?

Summer has arrived! Neighborhood pools are open, we’ve fired up the grills … and those of us who staff pediatric offices and emergency rooms are starting to see the sick wave that rides the tail of the heat wave. Room after room of the Emergency Department is filled with children who have abdominal pain, fever, vomiting and diarrhea, all signs and symptoms of “stomach flu” and food poisoning. It’s not easy being green. Some only have one or two of these symptoms, some have them all. But how do you know when to visit the emergency room? Once we have explained the diagnosis to parents, one of the most frequent questions we hear is, “So, did we need to come to the emergency room or could we have stayed home?”

Most of the time, vomiting is a harmless symptom of a viral infection (stomach flu) or a mild case of food poisoning. Children develop vomiting more often than adults because they haven’t developed an immunity to that particular virus yet and they are learning about the world by using their hands and mouths. For toddlers, “good hygiene” means tasting each new toy, touching every surface in the public bathroom and then licking the soap. They are walking virus spreaders.

The good news is that having encountered most common viruses as children, they will grow up to be immunogenic superheroes, ready to fight each virus their future toddler drools onto them and not develop symptoms. Be aware, our arch-enemy – vomiting – rarely travels alone, often bringing with him other villains, such as fever, weakness, tiredness, diarrhea, sore throat, runny nose or cough.

“It’s the weekend or late at night, can we avoid a trip to the Emergency Department?”

Now, back to our story and the question, “Could we have stayed home?”

We know that despite the friendly decor, smiling, kid-friendly staff and parting gifts of stickers or coloring books, most parents would rather avoid a trip to the emergency room. Our feelings aren’t hurt, we understand.

So, below are the 3 main reasons children with symptoms of food poisoning or gastroenteritis come to the emergency room and a little information to help you decide if staying home is an option.

Abdominal Pain- Could it be appendicitis?

Most parents are comfortable with their child having a bit of vomiting or diarrhea, but when pain begins, so does the worry this could be something more serious, like appendicitis.

The textbook case of appendicitis is a child who, over a period of less than 24 hours (and most times less than 8 hours), goes from feeling completely normal to fever, vomiting, and severe abdominal pain which is unremitting (does not come and go) and makes the child want to sit motionless. The pain starts around the belly button and then increases in intensity and moves lower, usually to the right side of the abdomen. Appendicitis is considered an emergency. If your child has any of the above symptoms or severe abdominal pain lasting over 30 minutes, call his doctor to discuss the need to go to the emergency room.

In contrast, children with food poisoning or gastroenteritis, aka stomach flu, tend to have pain that is not just in one place, that is crampy, often coming and going, and they often also have diarrhea. Instead of wanting to hold completely still, children with gastroenteritis are generally very squirmy, finding it challenging to hold still because they can’t quite get comfortable. They will have pain-free periods in between the bouts of crampy pain. Usually, fever and vomiting begin hours to days before the diarrhea. They often have family members, classmates or friends with similar symptoms.


Many children with viral gastroenteritis present to the ED because of fever. When children get a fever, they generally appear much more ill, which then worries their parents. If your child is alert and interested in what is going on around her, even if she isn’t as playful as normal, and she does not have a severe neck pain or severe abdominal pain, then it is okay to give Tylenol or Motrin and wait an hour to reassess how she is doing. Generally, when temperature decreases, children appear much better, can drink and can sleep. If you see no improvement an hour after appropriate dosing of Tylenol (acetaminophen) or Motrin (ibuprofen), call your child’s doctor.

Is she dehydrated?

When a child has vomiting or diarrhea, he has more loss of fluids than normal and can become dehydrated. Signs of dehydration are: no wet diaper or urination in over 6 hours, saliva in the mouth that is stringy or completely absent and a child who is listless. Listless is an odd word. A listless child is one that is not sitting up, not playful, not talking and not interested in his surroundings. If this is how your child appears, call the doctor. It may be time to visit us for some medication and of course, some stickers.

You can avoid dehydration by taking specific steps when your child begins to vomit. She will feel thirsty and want to drink a large amount. Large amounts of fluids all at once often lead to more vomiting. So, when your child begins to vomit, rest the stomach for 30 minutes by not giving her anything to drink or eat. Then begin hydrating slowly with tablespoon-sized amounts of liquids given every 5-10 minutes. Using a spoon works well because the activity of scooping the liquid and then sipping it distracts the child and slows down the amount he gets over a period of time. Avoid solid foods if your child is vomiting more than a couple of times in a few hours. Liquids are tolerated better and decrease the likelihood of vomiting. If your child has diarrhea and is not nauseated, you can allow her to drink as much as she would like. Again, if she is having many diarrhea stools, avoiding solids for 24 hours may lead to less diarrhea and less abdominal discomfort.

Last thoughts:

  • Children under 3 months of age need to be evaluated when they are sick. If your baby is less than 3 months and develops any symptoms of an illness, call the doctor or come to the emergency room.
  • Many different viruses can cause the symptoms parents often call “stomach flu.” But, stomach “flu” is in fact, not caused by the Influenza virus. So, sadly, a flu shot doesn’t prevent it. Influenza kills many people during the winter months, so get your flu shot! But if you vomit 4 months after getting the flu shot, please don’t blame that on the failed flu shot.
  • Eat hot foods when they are hot and refrigerate quickly. Food poisoning is most often caused by foods left at room temperature for extended times, allowing the bacteria that causes food poisoning to multiply.
  • After working 7 days in the ER caring for multitudes of vomiting kids, I plan to leave for vacation which begins with a 13-hour drive. I can’t afford to get a vomiting illness right now. So, to avoid getting gastroenteritis during its peak times, do as I am doing, strict hygiene. Frequent handwashing– we wash or sanitize our hands every time we enter a patient’s room and then when we leave. We sanitize all surfaces at least once a day and wash our hands before we eat. Tell anyone you choose that you can’t possibly wash your hands 10 times a day, it’s impossible. Just don’t tell a nurse, doctor or other health provider this because we wash our hands well over 20 times a day, we know it can be done. Want to stay well but spare your hands a beating? Most viruses that cause these symptoms are spread by hand-to-mouth. Don’t cut corners on the handwashing before eating, it’s the most important time to wash.