Should You Panic?! When to Take Your Child to the ER Urgently with Dr. Kailey Buller
One of the hardest parts of parenting is figuring out when something is actually an emergency.
Your child has a fever.
They're crying.
They're acting differently.
Maybe they're breathing strangely.
And suddenly you're asking yourself:
"Do I need to go to the emergency room right now?"
Most parents have been there.
The challenge is that many common illnesses look scary, while some serious medical issues can be surprisingly subtle. That's why understanding common child health concerns and knowing when to take your child to the ER can make a huge difference in helping you stay calm and make informed decisions.
The good news?
According to emergency physician Dr. Kailey Buller, there are a few key signs that help separate true emergencies from situations that can safely wait.
Why Parenting Medical Decisions Feel So Hard
Children are unpredictable.
Babies make strange noises.
Toddlers do strange things.
Kids get sick frequently.
And unlike adults, they often cannot explain what they are experiencing.
This uncertainty creates anxiety for parents.
Many families seek parenting help because they simply don't know which symptoms matter and which ones don't.
The reality is that most childhood illnesses are not emergencies.
But parents are not expected to know that.
And as Dr. Buller explains, it is always better to seek medical care if you are truly worried than to ignore something that needs attention.
Trust Your Instincts
One of the most reassuring messages from this conversation is that parents know their children better than anyone else.
If something feels wrong, pay attention to that feeling.
As a parent, you spend more time with your child than any doctor ever will.
You know:
Their personality
Their energy level
Their normal behavior
Their typical reactions
Many serious child health concerns first show up as a parent simply noticing:
"Something isn't right."
That observation matters.
The Biggest Emergency Warning Sign
According to Dr. Buller, there is one symptom that stands above all the others.
Your child is not acting like themselves.
This goes beyond having less energy because they're sick.
This means:
They are difficult to wake up
They are unusually confused
They are unresponsive
They seem disconnected from their environment
They are crying inconsolably and cannot be comforted
These changes can signal serious medical issues.
When deciding when to take your child to the ER, behavior changes are often more important than the specific illness itself.
Understanding Inconsolable Crying
Babies cry.
A lot.
That is normal.
But there is a difference between a fussy baby and a baby who cannot be comforted.
If your baby is crying continuously and nothing helps:
Feeding
Holding
Rocking
Diaper changes
That is one of the child health concerns that deserves immediate medical evaluation.
Inconsolable crying can sometimes be a sign of a serious underlying problem.
Breathing Problems Always Deserve Attention
Another important factor when deciding when to take your child to the ER is breathing.
Children can sometimes appear relatively comfortable while still having significant breathing difficulties.
Watch for:
Wheezing
Noisy breathing
Struggling to breathe
Fast breathing
Visible effort with each breath
A child may still be smiling and playing while experiencing respiratory distress.
This is why breathing concerns should never be ignored.
Helping parents recognize these signs is one of the most important forms of parenting help medical professionals can provide.
Dehydration Can Become Serious Quickly
Many common illnesses involve vomiting, diarrhea, or poor fluid intake.
Most of the time, children recover without complications.
But dehydration can become dangerous.
One important clue is urination.
For babies, a lack of wet diapers for more than 12 hours can be a warning sign.
This is one of the child health concerns that often requires prompt medical attention.
Fever: When Should Parents Worry?
Fevers are one of the most common reasons parents seek medical care.
And they are also one of the most misunderstood symptoms.
For older children, a fever alone is usually not an emergency.
Many otherwise healthy children develop fevers as their bodies fight off routine viral infections.
However, babies are different.
A fever in a baby under one month old should always be evaluated immediately.
And according to Dr. Buller, babies under one year old who have a fever without an obvious explanation should also receive prompt medical attention.
Understanding these age-based differences helps parents know when to take your child to the ER and when it may be appropriate to monitor symptoms at home.
Not Every Scary Thing Is Dangerous
One of the most comforting parts of this conversation is learning how many strange childhood behaviors are actually normal.
Babies may:
Make unusual noises while sleeping
Gag while exploring food
Experiment with their gag reflex
Display odd behaviors while learning about their bodies
Many of these situations look alarming but are part of normal development in otherwise healthy children.
This is why education matters.
The more parents understand what is normal, the less anxiety they experience.
When You Can Take a Breath
Most common childhood illnesses do not require emergency care.
If your child:
Is drinking fluids
Is breathing comfortably
Is alert and responsive
Can be comforted
You often have time to observe and contact your pediatrician if needed.
This kind of practical parenting help can prevent unnecessary panic while still keeping children safe.
Final Thoughts
No parent wants to make the wrong decision during a medical situation.
But the goal is not perfection.
The goal is knowing the warning signs that truly matter.
When evaluating child health concerns, focus on:
Changes in behavior
Difficulty breathing
Dehydration
Concerning fevers in young infants
These clues can help you determine when to take your child to the ER versus when it may be appropriate to monitor symptoms at home.
And remember:
Most healthy children experience illnesses, fevers, bumps, and strange behaviors that turn out to be completely normal.
The more knowledge you have, the more confident you'll feel navigating those moments.
And sometimes the best parenting help is simply knowing when you can take a deep breath and stop panicking.
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CONNECT WITH KAILEY BULLER:
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[00:00:00] Leah Clionsky: Welcome to The Educated Parent. I'm your host, Dr. Leah Klionsky, and I am back with a wonderful guest we had before, Dr. Buller . And today, we're gonna talk about when to panic as a parent with a medical problem. When do you panic, and when do you not need to panic? Which honestly are hard things to tell apart sometimes.
[00:00:22] Leah Clionsky: So as you recall, Dr. Kailey Buller is a double board-certified physician in emergency and family medicine, and this is why she's here with the emergency background. She's delivered hundreds of babies, and she has two of her own, and she combines her medical expertise with her lived experience to provide practical, evidence-based postpartum and newborn care for parents.
[00:00:44] Leah Clionsky: So I am so excited to have you back on the show. Thank you for coming.
[00:00:48] Kailey Buller: Thank you so much. I am so excited to be here, and this is a topic that I am very, very excited to talk about because my last one I think may have made people's anxiety worse, and here I'm gonna-- I'm really gonna talk about how to take it down.
[00:00:58] Leah Clionsky: Yeah. I think it is so hard to know when we should be panicking as parents.
[00:01:06] Kailey Buller: Absolutely. Yeah, and I get that all the time, you know, "I didn't know if I should be worried." It's so common to hear that, and I, I really don't want any parent to worry about whether or not they should be worried
[00:01:16] Leah Clionsky: All right, so tell me about your experience in emergency medicine with kids. Like, what are you seeing parents come in with, and how much of the time should they have panicked and brought them in?
[00:01:27] Kailey Buller: It's such a good question. I mean, fevers and rashes, like those are absolutely what I see the most because there are so many rashes. No one knows if it's a dangerous one or not. Um, and, and fevers or, or coughs and colds, we see those all the time. It's hard to say how many of those were true emergencies versus how many of those were justified visits,
[00:01:47] Leah Clionsky: Ooh, interesting. Explain the difference
[00:01:49] Kailey Buller: right?
[00:01:50] Kailey Buller: So I mean, 95% of those children probably could have stayed at home, right? They weren't true emergencies. They didn't need any medical intervention. But parents don't know that. Like, they don't know where to draw the line, and I would much rather a parent come into the emergency department and have part of their day be wasted than keep a really sick child at home
[00:02:13] Leah Clionsky: How do you think parents are making the decision whether they bring their child to the pediatrician versus... 'Cause to me, the emergency room is the panic button, right? Like, if I think there's something a little bit wrong with my child, you know, then we're gonna go to their pediatrician either soon or in a couple of days.
[00:02:30] Leah Clionsky: But it's like emergency room is like I think you need urgent care right now because I don't want to have to get there and sit through the whole process, you know. So like what do you think is that big difference?
[00:02:41] Kailey Buller: I think, well, I think it depends a little bit on where you are and what your access is like, right? So I know here in Canada, um, access might not be great for some of these families. They might not be able to see their family doctor or their pediatrician today or the next day. Oftentimes it's a week or two.
[00:02:59] Kailey Buller: So if your child is sick, it's a walk-in clinic where you don't know and they don't have access to labs, X-ray, whatever the case may be, or you come and you sit in the emerge for a while
[00:03:10] Leah Clionsky: Okay. So it sounds like a lot of the cases you're seeing are, like, not actually panicked parents. They're like, "We need to check it out," parents
[00:03:18] Kailey Buller: Yes. And today. We need to, we need to get some answers today
[00:03:22] Leah Clionsky: But I'm not like, I'm like, I would like to know, but I'm not like heart in my, in my throat rushing in, it's 2:00 in the
[00:03:29] Kailey Buller: No. The ones who come with their hearts r- like when they're really, really panicked and like most of those are emergencies. Maybe not the critical ones that I would panic. Well, I never panic, but maybe not the ones where I get really worried. Um, and they might just be, "Yeah, your child is having some trouble breathing.
[00:03:45] Kailey Buller: We're gonna give them some Ventolin or some dexamethasone," whatever the case may be. And so those parents are absolutely panicked. So usually when a parent is panicked,
[00:03:53] Leah Clionsky: Mm-hmm.
[00:03:54] Kailey Buller: a trip to the emerge is warranted
[00:03:56] Leah Clionsky: Right. So like p- parents should trust themselves when they have the panicked feeling
[00:04:00] Kailey Buller: And that's exactly, yes. And that's, that's the biggest thing. Like, I don't want parents to worry about whether or not they should be worried. If you're worried, there's a reason,
[00:04:06] Leah Clionsky: Mm-hmm. Like you're picking up on something even if you can't
[00:04:09] Kailey Buller: Absolutely. And when you come into the emergency and you tell me something's not right, something is wrong, any emergency physician worth their salt is going to take that seriously.
[00:04:18] Kailey Buller: They're going to consider that because you know your child best. If you say something's wrong, I believe you. And maybe, maybe that something that's wrong isn't that dangerous, but I still believe you
[00:04:31] Leah Clionsky: Right? So you're like believing the parent's perception that something is off. You're not maybe necessarily agreeing that like this is a like life or death situation, but you're gonna believe that like they are perceptive, they're picking up on something is going on with that child.
[00:04:44] Kailey Buller: Mm-hmm. Absolutely. So I think it's important to talk about strategies to know if you truly are in a space where you need to be panicking or if you're not. And that's, and that's where the difficulty lies because baby, babies are weird. Like, babies do weird things, and normal baby glitches can often look like emergencies.
[00:05:04] Kailey Buller: And I think, like, one of the biggest ones is when babies are sleeping, they're noisy sleepers. They will make grunting noises, and they'll go , and it sounds like they're gasping for breath, but really they're just sleeping,
[00:05:17] Leah Clionsky: Yeah, that makes sense. So you would, especially with babies, 'cause they can't tell you what's wrong with them, right? Like they can't say to you, "Don't worry, I'm just sleeping weird today," or, "I'm just crying 'cause like you introduced a new food and like it's not sitting well with me for whatever reason."
[00:05:35] Kailey Buller: Right. Yeah. And, and speaking of food, I think one of the, one of my favorite glitches, I call it a glitch, um, is when babies find out a new thing that their body does. So when they gag, when they gag for the first time eating solids, and then they take a finger or two and they shove them in their mouth to gag because they're like, "Oh, look at this wonderful new thing that my body is doing.
[00:05:56] Kailey Buller: I wanna see if I can do that again." And that's a totally normal thing for your body to do or for-- Sorry. That's a totally normal thing for your baby to be doing, and it doesn't necessarily indicate that there's a problem, but that's scary when your baby is gagging over and over again.
[00:06:11] Leah Clionsky: Oh yeah, absolutely. You're like, are you sticking your fingers down your throat 'cause there's something in there that you can't get out and this is a danger sign?
[00:06:20] Kailey Buller: Yeah. So most of the time it's not mo- most of the time they're just experimenting
[00:06:24] Leah Clionsky: Yeah. Why do they do this?
[00:06:26] Kailey Buller: Honestly, I- it's because they're learning what their body can do, right? Gagging is a reflex. Sorry. Gagging is a reflex, and it's totally normal for them to experiment with that, and sometimes they will bang their head against the floor when they start moving. I just wonder what it'll feel like if I'm bashing my head against the floor, and that, that is concerning.
[00:06:43] Kailey Buller: But again, that could be totally normal, and I think one of the key indicators is, is this something that's consistent or a pattern? Or do they once in a while or one time try to gag themselves and then they go, "Huh, cool. I did it," and then they're done?
[00:06:58] Leah Clionsky: I remember always being deeply afraid that one of my babies would have, like, a hair tourniquet injury 'cause I have so much long hair. I was afraid, and that's, like, right when they, like, get it wrapped around a finger or a toe or something and you don't know about it. So I was, like, obsessively putting my hair up because I'd heard about that happening to a baby.
[00:07:17] Leah Clionsky: And I was-- Every time they cried, I'm, like, checking all of their appendages all
[00:07:22] Kailey Buller: Good. And you-- Well, I mean, you-- It sounded like you went a little above and beyond, but that's, that is, that is one, that is one of the true emergencies. Absolutely. And the medical dramas love that. Like, they always, they do. They love hair tourniquet because it's one of those things that people will come in with, "My baby's crying.
[00:07:36] Kailey Buller: I don't know why. They won't stop crying." It's a hair tourniquet. But yeah, I mean, that's something worth looking for.
[00:07:42] Leah Clionsky: Yeah. Yeah, it's so interesting where you're like, "Why?" and, "What's going on with you?" And I remember, um, getting a lot of education about purple crying when I brought my babies home too, where my pediatrician was like, "This is normal if they just cry inconsolably for long periods of time until they turn purple." Yeah
[00:08:01] Kailey Buller: crying is a bit, is a bit much. And it's interesting because the, the definition of purple crying includes up to like five hours of crying a day, but colic is three,
[00:08:10] Leah Clionsky: Oh
[00:08:10] Kailey Buller: which is so bizarre because purpl- purple crying really should be like a once in a while thing that you're getting a, a crying baby that much.
[00:08:16] Kailey Buller: But colic can be three hours a day and then that would be abnormal, but it's three days a week for three weeks or longer. Like, there's so many rules and there's so much that falls in normal and out of normal and like how could any parent possibly know that?
[00:08:28] Leah Clionsky: No, I have no idea
[00:08:29] Kailey Buller: So that's hopefully what, you know, we're talking about today is gonna be this is how I can talk you off the ledge when you're really panicked and how to know what to really watch for, right?
[00:08:38] Leah Clionsky: so if we're diving into strategies, if we're going into signs that you should panic or not panic, what are the three things we should be considering? And when I'm thinking panicking, I'm thinking like you're like rushing to the ER or you're calling an ambulance, like you are panicked.
[00:08:53] Kailey Buller: Yes. Yeah, like you do not pass go, you do not collect your $200, you go to the emerge. Absolutely. And there's, there's honestly, there's really only one. There's one scenario where I want you to panic and get your butt to the emerge, and that is if your baby or your child is not behaving normally. And I know that that's hard to distinguish, and I don't just mean like, oh, they're sick and they don't have as much energy, so they're spending more time on the couch and not running around.
[00:09:18] Kailey Buller: I mean, something's off. So inconsolable crying is on that list. If your baby is crying and you cannot comfort them, you cannot soothe them no matter what is happening, I would go to the emerge for that.
[00:09:30] Leah Clionsky: Mm-hmm.
[00:09:31] Kailey Buller: I mean, if you know what a hair tourniquet is, and you can check for a hair tourniquet, and you find one and you can remove it, and the problem is solved, great.
[00:09:38] Kailey Buller: But hair tourniquet, emergency. Meningitis, emergency. And meningitis is one of those things that can make a baby cry inconsolably. So if your baby is crying inconsolably, you go.
[00:09:48] Leah Clionsky: Mm-hmm.
[00:09:49] Kailey Buller: Lethargy, if they are so sleepy you cannot wake them up, or if they're unresponsive, or if they've just had some abnormal movements and now they're confused or dazed, that could have been a seizure, right?
[00:10:01] Kailey Buller: So if they're not behaving normally, that's a huge red flag, and those are the kids that I'm really worried about, the ones that lay on the hospital bed while we put in an IV, and they just watch and they don't even flinch. That's a sick child
[00:10:12] Leah Clionsky: Mm-hmm. Right, because any reasonable child is not wanting that to happen
[00:10:16] Kailey Buller: out. No, they're gonna, they're gonna scream, they're gonna pull away, they're gonna fight. I-- When kids are crying and fighting and screaming, that's a very reassuring sign
[00:10:23] Leah Clionsky: Mm-hmm. Yeah. I guess unless you've listened to our episode about how to make it less painful, and then hopefully they won't be doing those
[00:10:29] Kailey Buller: That's fair. They're still not gonna want you to do it though,
[00:10:32] Leah Clionsky: Yeah, they're still, they're still not into it. They're not like, "You have..." It's not that, yeah, you've used those strategies and they're lying there allowing it. Yeah.
[00:10:40] Kailey Buller: I don't want..." Yeah. Yeah. Absolutely. So that's, that's the big time to panic. Absolutely. There's other reasons to go to the emerge, but I wouldn't panic in those situations 'cause you still have time
[00:10:48] Leah Clionsky: Okay. So like, so what you're saying is, is if your child is behaving really out of character for them, like they're nonstop screaming, clearly in agony, or they are, um, just like so lethargic and weird that they kind of don't care about
[00:11:03] Kailey Buller: Where like they, normally your toddler can speak and make coherent sentences, but now they're not making sense,
[00:11:09] Leah Clionsky: Mm-hmm.
[00:11:09] Kailey Buller: right? Like if-- And you will know. You'll know. Your spidey senses will be tingling, and you'll know that something's up. And that's when our doctors have to say, "I believe you." Because we might not see it, but you'll be like, "No, this is not, this is not what my child's normally like."
[00:11:24] Leah Clionsky: Yeah, and so th- those are the ones where you're not like, "Let's wait it out until tomorrow." It's like, "No, get in the car. Go to the hospital." Great. Okay, what are the things that don't need that level of emergency, but, like, you know, maybe should get checked out, but... Or maybe nothing happens, but people think they're emergencies?
[00:11:42] Kailey Buller: Absolutely. Well, the-- and, and these ones are the ones that are true emergencies, and I call them, in my book, I call them category black symptoms. So I have, like, a color-coded system: green, yellow, red, black. Green, don't worry, it's totally fine, et cetera. So the category black symptoms, number one is abnormal behavior.
[00:11:55] Kailey Buller: We've already talked about that. That's the only one that you truly panic, but there's others that you need to worry and get to the emerge. So trouble breathing, right? So you might have a child who's totally happy and totally fine, but they're making noise when they breathe in, or they're wheezing when they breathe out, or they're working really hard to breathe.
[00:12:11] Kailey Buller: 'Cause kids, unfortunately, they're okay until they're not, and they decompensate really fast. They go downhill really fast. So they might be happy and playing, but if they're having trouble breathing, they're making funny noises, you should go to the emerge sooner rather than later,
[00:12:25] Leah Clionsky: Okay
[00:12:26] Kailey Buller: right? Um, the other one, which is hard- harder to tell, is dehydration.
[00:12:30] Kailey Buller: So dehydration is another thing. When kids are dehydrated, when they're not taking in enough to eat and drink, and they stop peeing. So for babies, that's hard to tell, but you-- if they haven't had a wet diaper in more than 12 hours, they're dehydrated. That means that something's wrong,
[00:12:44] Leah Clionsky: Okay
[00:12:44] Kailey Buller: right? So we need to see them in the emerge.
[00:12:46] Kailey Buller: Um, and those are really the, the biggest ones for children. There are two more for babies. So a baby under a year, if they have a fever and you don't know why, emerge, right? So they have a fever but no other symptoms, that's weird, go to the emerge. And babies under one month, if they have a fever, you go.
[00:13:04] Leah Clionsky: 'Cause they need the spinal tap, right? Yeah.
[00:13:08] Kailey Buller: Yeah. They might not. I mean, if a, if a baby under 30 days looks well and has a runny nose and you're pretty sure it's a cold, we might still do an X-ray and a urine to look for a, like a bladder infection or a pneumonia. We might not do a lumbar puncture. But if they're a sick baby with a fever, yeah.
[00:13:26] Kailey Buller: Yeah, they're gonna be getting a lumbar puncture
[00:13:28] Leah Clionsky: I remember being so relieved when both of my kids got past one month, and I was like, "Yay, if you have a fever now, I won't freak out."
[00:13:36] Kailey Buller: don't have to be quite so worried, right?
[00:13:40] Leah Clionsky: Yeah,
[00:13:40] Leah Clionsky: absolutely. So it sounds like there are very few circumstances where you need to, like, go to the ER. One where you do need to, like, imminently go to the ER, and this is hopefully really helpful.
[00:13:53] Leah Clionsky: And everything else is like, get to your pediatrician, sometimes wait it out, things will be okay
[00:13:59] Kailey Buller: The only other time, um, that you would need to go is, is for like lacerations because those need to be closed within 24 hours to reduce the infection risk. But everything else, right, is probably okay to wait a day or two and see, see what happens over time
[00:14:14] Leah Clionsky: You know, I'm glad to know when to panic. That's good to know
[00:14:18] Kailey Buller: Right? It's good to know when to panic and when not to. So if something's going on and you are panicked, it's nice that you can say, "Is my baby fussy but consolable? Yes. So they're not behaving abnormally. And can they breathe? Yes." Like, you can go through that checklist and then you know, "Okay, I have time."
[00:14:33] Leah Clionsky: Mm-hmm. Yeah. Well, I think that's, again, yeah, that's part of the scary thing about being a parent with a new, with a baby or even an older child is no one tells you when to panic. So then you panic about things you shouldn't, and maybe sometimes don't panic when you should.
[00:14:48] Kailey Buller: I think that happens a lot. People sometimes don't panic when they should because, you know, your kid's got a fever, but they otherwise seem fine. But a fever and not knowing why they have a fever is, is actually concerning under a year old.
[00:15:00] Leah Clionsky: Under a year old. We should say that again. Under a year
[00:15:03] Kailey Buller: Under one year. Yes.
[00:15:04] Leah Clionsky: Yes. If your five-year-old has a fever and you don't know why, wait it out
[00:15:08] Kailey Buller: You can give it some time and they'll probably get some symptoms later. Yeah.
[00:15:13] Leah Clionsky: Well, I am so glad that you came on again to tell us when to panic. First you reassured us in a different episode. Sorry, Evan, give me one second. And now we're talking about when we should not panic at all.
[00:15:25] Leah Clionsky: So thank you again for coming on the show, Dr. Kaley, and we will see you later.