Merck Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

Video: Managing Your Child’s Emergency Room Visit

08/02/17 James Jeffrey Malatack, MD, Professor of Pediatrics, Thomas Jefferson University’s Sidney Kimmel College of Medicine; Medical Director of the Pediatric Liver Transplantation Program and member of the Pediatric Diagnostic Referral Division at AI duPont Hospital for Children

Transcript of interview with Dr. James Jeffrey Malatack


My name is James Jeffery Malatack. I’m a professor of pediatrics with an academic affiliation at Thomas Jefferson University, and primary clinical responsibility at AI duPont Hospital for Children.


There are a few obvious signs that should prompt you to bring your child to the emergency room.


It always depends on the age of the child. Obviously with a young child, a neonate, any fever requires an evaluation. In a somewhat older child, a toddler, the things that should worry you include if they’re having trouble breathing, if there is a rash, particularly a non-blanching rash. If there’s change in mental status with a fever, if a fever is associated with a seizure. These are reasons that one worries, and doubles down on the urgency and the need for the child to be seen.


So the pediatrician and emergency room doctor are often confronted with trying to decide if the signs and symptoms the child presents with are significant and serious, or of a self-limited nature. The numbers have changed much over the last 30 years with the development of Haemophilus influenzae B vaccine and pneumococcal vaccines.


Now, the child we so often worry about is the 4 month or 4 year old child who’s highly febrile, for instance. When he is seen in an emergency room setting, you know right from the beginning that only 1 in 1,000 of those children will turn out to be at the beginning of a serious illness. The other 999 are going to be suffering from a self-limited infection. Those numbers, though, are exactly what sometimes cause one to miss it.


And leaving the parent on edge as they leave the emergency room or the pediatrician is the appropriate strategy. Parents, often if they’ve been up all night with the child, are exhausted. They want to go to the doctor, they want to be told everything is okay, and they want to go home and go to bed. And very often, that follow-up requires they maintain a vigilance about their child—know what reasons they should call back or come back. And even though it’s rare, that’s the patient that you’re most worried about.


When can a parent of a child with an apparently acute illness relax? Well, they can only really relax when the child is well again. Some of these children will be at the beginning of a serious illness, though it’s infrequent. The vast majority have self-limited viral illnesses, but it happens from time to time, and a vigilant parent will get their child back to medical care in an appropriate and timely fashion.