When should you seek emergency care for an injured child?

We received a panicked call from a family member last night asking for our advice when their child got injured.

Their child had fallen face-first on to a hardwood floor. He was bleeding quite a lot from the nose and mouth and his nose was very swollen and bruised. I could hear him whimpering so I knew he was conscious.

These first time parents were in worse shape than the child.

They felt so guilty. Dad was playing with the little guy when he fell. As we talked I was going through a mental list, I guess, I have compiled over the years of visits to doctors offices and emergency rooms with our own kids. We have seen our share of bumps and bruises not to mention full out medical emergencies where an ambulance was definitely required.

My questions went something like this:
  • Is he crying? (Yes)
  • Do you think he needs stitches? Can you see any open wounds on his lip? Inside his nose? (I don't know)
  • Is it still bleeding? (Yes)
  • If you apply pressure does it stop? (No)
  • Are any of his teeth missing? (No, I don't think so)
 With that they decided to take him into our local emergency department. Mainly because they weren't sure why it hadn't stopped bleeding and his nose continued to swell and bruise. (Note: Noses and mouths tend to bleed a lot, even when they don't need stitches) And besides, I am just a mom of seven and not a medical expert so better they get him checked out by a doctor if only to give them piece of mind.

The basic way that we assess our emergencies is this.
Toronto EMS

Call 911 if:
  1. The child is unconscious. This means no crying at all. No reaction. Just falls and is out cold.
  2. The bleeding is profuse. This means liberal amounts of blood, in large amounts that will not slow with pressure.
  3. If your child CANNOT move. Do not move them. It can make it worse. Wait for the ambulance.
  4. If your child is having difficulty breathing. Talk to your child. If they can answer you, they can breathe. Toddlers especially tend to have things in their mouth. Make sure nothing is lodged in their throat.
Do take your child to a clinic, doctors office or emergency department if the injury or concern isn't as critical as above but more than a minor scratch or bump. Our experience has been that about 70% of the times we have walked in with a fall or cut, our child has needed a few stitches (a few times a lot of them) and  100% of the time we have been told to watch them for the first day of so. Waking them every four hours and making sure they can communicate as they did before the fall.

I don't like to go into the emergency department if I don't have to but sometimes the only way to know is to get checked out. Even if you are a first time parent, listen to your gut.

A parent's intuition isn't usually too far off.