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Wednesday, February 23, 2011

When to go to the ER

When to go to the ER

This is always a tough one. It sounds so drastic to take someone to the emergency room. And let's face it, kids with asthma seem like they're sick ALL of the time, especially when they are little.

So, when do any of you take your kids to the ER versus the doctors office or treating them at home?

I'm comfortable doing treatments every 4 hours on the nebulizer when the kids are sick, but as Asthma Doc says, "That's just a Bandaid approach. You've got to find out what's causing the inflammation." I always take the kids to Asthma Doc to start, he knows them so well, he knows how they respond (or don't respond to medication). Often times, we have to do a round of steroids (Prednisone bottles are always part of our medicine chest). Sometimes antibiotics if they have pneumonia.

But how do you know if you need to go back? What about after-hours doctor visits or skip that altogether and head to the ER? Webmd has a great section on their website called What is an Asthma Attack? It lists symptoms of an asthma attack and tells you when to call 911,

This is what I have learned over the last 11 years, but don't take my word for it-ask your doctor what he wants you to watch for!

The kids may:
  • look pale
  • have dark lips 
  • be listless
  • breathing very quickly-actually "panting". (That's what "asthma" means by the way-it's the Greek word for panting) 
  • unable to speak in complete sentences
  • can't stop coughing
  • medicine doesn't seem to be working.

Their skin may be pale or slightly gray. They may also have dark lips or fingernails. Some people say "blue lips or fingernails", but I have never seen that with my kids. Their lips will be VERY dark, it will almost look like they are wearing dark red lipstick. Couple that with the pale skin, and they LOOK terrible. (think vampire from the Twilight movies-minus the sparkly skin).

The other sign that is very serious is called "retraction" which simply means that they are using all of their muscles to breath. So the skin is "retracting" or sucking in around the rib cage, often times you can "count ribs" because the skin even sucks in between the ribs. Also watch the collar bone and the little "U" shaped bone just under the Adam's apple. The skin will suck in along that area too.

Sometimes the nostrils will flare out because they are struggling to breath.

If you see those symptoms, head to the Emergency Room - FAST! Or call an ambulance. When you get there, make sure they understand your child has asthma and breathing difficulties. My kids get seen before someone who needs stitches or who broke their arm. There is a reason they have triage-they take people in order of medical condition, not who got there first.

Speak up if you feel your child is getting worse, you do not want your child to pass out and have their airway collapse. Remember, 11 people die every day from asthma attacks. And they all think it's going to happen to "someone else"

So, I don't mean to scare anyone, but I have seen some scary situations with my own kids-they can go from bad to worse very quickly.

Talk to your doctor, see what he recommends and know what to watch for. You can do this! And if you feel like you are in over your head, go to the Emergency Room. That's what insurance is for, and that's what the doctors are trained to do. Take care of your kids.


  1. Thanks fot this post, I know you posted it a long time ago. but I always doubt myself when it seems like time to take my baby (now 8 mo) to the ER and tend to delay a ton because Im not sure. this is really helpful. Maybe I'll even bookmark it and come back to it when I am questioning. Its useful to have someone else's opinion. :)

    1. Angela Marie, here is a link to Webmd. They have a section about asthma symptoms and when to call 911.

      Trust your mother's instinct, they can treat your baby and send her home or they can admit her for further treatment. I would rather have the hospital make that decision! Sometimes I know I am in over my head and I need the hospital to take over.

      Your doctor should also tell you what to watch for and when to go to the hospital.

      Good luck!

  2. This is an incredibly helpful blog! Thanks for hosting it.

    Andrea - I am a female Founder of a NY-area company where we, experienced professionals, are working on a technology based service for reduction/prevention of asthma, allergy attacks. We are also very motivated by the tremendous impact our work can have on the lives of people.

    Given your experiences & knowledge with asthma, I would really appreciate discussing a few things with you. Would you mind if we emailed offline? Your time & opinions would be invaluable to our efforts!


  3. Sorry just saw this. My email is Maybe we can take it from there.. Thanks & really looking forward to connecting soon.

  4. Thanl you for this great advice! I am always second guessing myself when it comes to my daughters asthma symptoms. She is only one, and it breaks my heart to think about how many times she has gone to the ER. I have been giving her albuterol and pulmacort via nebulizer, but she still sounds pretty bad. It helps for about an hour, then it's back to coughing and coughing. But, even after the treatments, she still sounds like she's snoring through her lungs and some wheezing. She even is breathing somewhat rapidly, but it's more of an off breathing pattern. Her lips are darker, but she's not pale. No retractions. Just irregular breathing. Deep. I'm just getting uncomfortable with her breathing and wheezing, even though she has no retractions.

    1. Oh my word! This blog is supposed to notify me when people comment, and this was from 6 months ago!!

      I hope your little one is better.

      If there is EVER a question about what to do - call your doctor or head to the emergency room. Kids with asthma can go from bad to worse very quickly.

      The hospital may send you home (I have only had that happen once) my kids are usually admitted.

      If this happens again with your daughter, take action - FAST!!

  5. I just get so nervous with my little one, lol. I didn't mean to vent. But, maybe you've experienced the same and it could be normal. I have a mild asthma, my son has allergy and excersise induced asthma, but my daughter has severe asthma. Any little thing triggers her asthma. But at 4:00 in the morning, I can't think of anything that's triggering it now? Also, have your kids ever vomited while coughing in their sleep from gagging on the mucous? Sorry, tmi.

    1. Yes, I understand all to well what it is like!

      My asthma, and my kid's all have different triggers and are all treated differently. One has mild asthma, one has moderate and one has severe.

      It's hard to know what causes an asthma attack. I had an asthma attack two days in a row in my office, and I have NO idea what caused it!!

      Yes, they throw up from coughing. I've almost done the same thing myself. It's hard to calm down yourself or a child during an asthma attack.

      I hope your kids are doing well now! :)

  6. Those are really good advice. There are telltale signs when a child needs immediate attention, and one should be aware of them, so that the person can respond accordingly and swiftly. But if you think something is wrong, do not hesitate to take them to the doctor, even if they’re not exhibiting those markers yet. Thank you for sharing your thoughts on the matter. Good day!

    Paul Quinn @ MedCare Pediatric

    1. I agree. I often took my kids to the ER because I knew "something wasn't right". I couldn't put my finger on it - but I just had a feeling I needed to take them to the hospital. And they would end up being admitted to the pediatrics ward for pneumonia! Yikes!

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  8. I really appreciate this. My son has had asthma aince he had RSV at 2 months old. He is now 6. This is the first time it has flared this bad. Hurricane, lots of dust thanks to a demo'd house, and damp, cold weather. I can't decide if I should take him in to the ER. The Urgent Care gave him 4 different meds, and they aren't helping. I have never been so worried. How do you deal with all of the anxiety?!

    1. Ulcers. Seriously - I had a lot of stomach problems from worry!

      Yoga helps me watch my breathing, and also to feel calmer. I'm really not flexible and terrible at yoga! But, I have a beginner DVD I can do at home. It also helps me to talk things out with my friends, husband and doctor.

      Listen to your gut as a mom - if you are worried, call the doc. Sometimes, I would take the kids back to the doctor (or ER) if I was worried. Sometimes my kids would be sick at the doctors office, but then get much worse after we would leave.

      A few times, I would see the after hours doc at 8pm, and be at the ER at 10pm and one of my kids would be admitted to the hospital.

      Worrying is what we do as moms! Especially when we feel like we can't do anything to help.

      Sometimes, a diversion can help. I would watch cartoons or movies with my kids. I would make special treats for them, or just snuggle with them on the couch.

      They are all in college now, and I still worry about them!

      Good luck!