It is 3 a.m. and your three-month old baby has just awoken, screaming. You feel his forehead, and, though he feels hot, you are just not sure. What should you do?

Before you pack the baby up and head to the emergency room, stop.

Most parents would rather be safe than sorry and won’t hesitate to make the trip to the hospital, which can include long waits. However, according to Dr. Ed Schultz, director of the emergency department at King Edward VII Memorial Hospital, there are times when the trip is, and is not, worth it.

“I think there are certain situations where clearly a child should come to the emergency department — a child with respiratory distress, a child with altered mental status — those are things you could call 911 for. A child with significant injuries,” the doctor explains.

It is the grey zone areas that make the decision difficult.

“I think often the resource of paediatricians is underused by parents. Paediatricians are specialists in the field of care of, particularly, small children— I would say, I think if it’s not a real emergency situation, parents would be well advised to contact their paediatrician for advice,” he advises.

When should a child definitely be brought into emergency, without hesitation?

According to Dr. Schultz: Serious allergic reactions where the child is getting hives, or is starting to wheeze; any airway problems, as a child’s small airways can obstruct rapidly; a child that has been vomiting or having diarrhoea and is now becoming less alert, which is a sign of dehydration or, worse, possibly diabetes; toxic ingestions; and any severe traumatic injury to the head, chest, abdomen or spine, or if you suspect a fracture or the need for sutures. Sutures, especially in the extremities, need to be done within eight hours of injury.

Head injuries are always a major concern for parents, especially in newborns.

“Things that cause concern are any loss of consciousness in a child, any seizure activity in a child, certainly vomiting after a head injury. Vomiting is very, very common, but protracted vomiting, or even infrequent vomiting, always raises the possibility of increased cranial pressure in the brain. Any child vomiting after a head injury needs to be evaluated.”

Judgment on the part of parents is vital, as even minor bumps to the head can cause large areas of swelling or bruising, Dr. Schultz says.

“As physicians, we look at the mechanism of injury,” he explains. How old the child is, how did the child fall, from how high and onto what kind of surface are all important considerations.

“If the child becomes increasingly lethargic, or has any problems with coordination, those would be things we’d be concerned about.”

Neonatal medicine is especially scary, for parents and emergency physicians, Dr. Schultz concedes, and he recommends that, especially during daytime hours, parents make use of their paediatrician.

Dr. Schultz recommends that all parents have acetaminophen and a rectal probe thermometer at home to take accurate temperatures. Any fever in a newborn, aged zero to three months, can be dangerous, but current hospital protocol says that temperatures over 38 degrees Celsius is considered a high fever. For children over three months of age, high fever is over 39.4 degrees Celsius.