A toddler develops a high fever overnight. An elementary-school student falls from playground equipment. A teenager collides with another player during basketball practice.
For parents across Sachse, Northeast Garland, Rowlett, Lavon, Murphy and Wylie, the hardest part of a child's sudden illness or injury is often deciding what medical attention is necessary.
Will the doctor order bloodwork? Does a possible broken bone require an X-ray? Could a head injury need a CT scan? Why might a child with fever need a urine sample?
At TotalCare ER Garland/Sachse, board-certified emergency physicians evaluate infants, children and teenagers using their medical history, symptoms, physical examination and diagnostic testing when appropriate.
Available onsite capabilities include digital X-rays, CT scans, ultrasound, respiratory testing, bloodwork and urinalysis.
Not every fever requires bloodwork, and not every head injury requires a CT scan. Pediatric testing decisions depend on the child's age, symptoms, examination findings and suspected medical problem.
Why Is Pediatric Emergency Testing Different From Adult Testing?
Children's bodies are still developing, and their medical needs change considerably between infancy and adolescence.
A baby cannot describe abdominal pain or dizziness. A preschooler may struggle to explain where an injury hurts. A teenager may describe symptoms clearly but underestimate their severity.
Physicians consider these differences when evaluating pediatric emergencies.
Testing decisions may involve:
- The child's age and developmental stage
- How symptoms began and whether they are worsening
- Hydration, breathing, circulation and alertness
- Previous illnesses, medications and medical conditions
- Findings from the physical and neurological examination
Imaging also requires special consideration because children are more sensitive to ionizing radiation.
The American Academy of Pediatrics' HealthyChildren resource on pediatric CT scans explains why children with minor head injuries often do not need CT imaging.
The goal is to choose the right test for the medical question—not to perform every available test.
Does Every Child With a Fever Need Bloodwork?
No. Fever is common during childhood and often occurs with viral infections that do not require emergency laboratory testing.
However, a child's age, appearance, symptoms and medical history can change the level of concern.
Imagine a family in Lavon preparing for school at Dodson Elementary or NeSmith Elementary, part of Community Independent School District.
A child wakes up with fever and fatigue. Another develops fever with persistent vomiting, painful urination or unusual sleepiness.
Although both children have fevers, they may need very different evaluations.
When Might an ER Physician Order Blood Tests for Fever?
Bloodwork may be considered when symptoms suggest a significant infection, dehydration, metabolic changes or another medical problem requiring investigation.
Depending on the concern, testing may include blood-cell counts, blood glucose, electrolyte measurements or kidney-function tests.
A complete blood count can provide information about white blood cells and other blood components, but an abnormal result does not automatically identify the source of an infection.
The physician interprets findings alongside the examination.
Infants require particular attention. A baby younger than three months with a temperature of 100.4°F (38°C) or higher needs prompt medical assessment, even if other symptoms seem mild.
For older children, fever alone does not determine whether emergency bloodwork is necessary.
Parents can learn more through TotalCare's guide to fever symptoms and emergency care.
When Does a Child Need an X-Ray After a Fall or Sports Injury?
Falls and collisions are familiar concerns for families raising active children.
At Heritage Park in Sachse, children enjoy playground equipment, baseball fields and walking paths.
A child might fall onto an outstretched hand while playing, leaving a swollen, painful wrist.
Similar injuries can occur during the youth baseball, basketball and volleyball programs offered through Rowlett Parks and Recreation.
What Can a Pediatric X-Ray Show?
Digital X-rays help physicians evaluate suspected fractures, dislocations and certain joint or bone abnormalities.
An X-ray may be appropriate when a child experiences significant pain, swelling, visible deformity, tenderness over a bone or difficulty using an injured limb.
Children can experience fracture patterns that differ from adult injuries, including greenstick fractures and injuries involving growth plates.
A growth plate is an area of developing tissue near the end of certain bones.
Some growth-plate injuries may be difficult to see on initial imaging, making the physical examination particularly important.
Even when an X-ray appears reassuring, persistent pain or loss of function may require protection of the injured area, follow-up or additional evaluation.
TotalCare's guide to broken bones and ER visits explains common fracture symptoms and how physicians assess suspected bone injuries.
Does a Child Need a CT Scan After Hitting Their Head?
Not automatically.
Consider a young athlete participating in a basketball game at the Rowlett Community Centre.
After a collision, the child falls and strikes their head. Parents may immediately wonder whether a CT scan is necessary.
A CT scan uses X-rays and computer processing to create detailed images that can help identify certain skull fractures, bleeding or other serious abnormalities.
However, CT imaging is not routinely used to diagnose a concussion.
What Symptoms Make a Head CT More Likely?
Emergency physicians consider the circumstances of the injury, the child's age and neurological findings.
Possible concerns include repeated vomiting, worsening headache, loss of consciousness, unusual behavior, significant changes in alertness or other findings suggesting a more serious injury.
The CDC's pediatric traumatic brain injury guidelines recommend using clinical risk factors and validated decision rules rather than routinely ordering CT scans for mild head injuries.
Because CT uses ionizing radiation, physicians consider whether the expected diagnostic benefit outweighs the potential risk.
In some cases, observation and follow-up instructions may be more appropriate than immediate imaging.
Can a Child Have a Concussion With a Normal CT Scan?
Yes.
A concussion can affect thinking, balance, memory, behavior and other neurological functions without creating an abnormality visible on CT.
A normal CT scan does not automatically clear a child to return to sports.
Parents should follow the physician's activity instructions and discuss appropriate return-to-school and return-to-play steps.
Call 911 for a child who cannot be awakened normally, experiences a seizure after a head injury or develops other life-threatening neurological symptoms.
When Do Children Need Flu, COVID-19 or RSV Testing?
Respiratory illnesses frequently disrupt family routines, school attendance and recreational activities.
A child attending school in Wylie or spending the weekend with family in Northeast Garland may develop fever, cough, congestion or breathing symptoms.
The symptoms may resemble influenza, COVID-19, RSV or another respiratory infection.
However, not every child with a cough needs emergency testing.
Physicians consider symptom severity, breathing effort, hydration, age, medical history and whether identifying an organism could change treatment.
What Can Respiratory Tests Identify?
Depending on the available test, respiratory testing may detect influenza, SARS-CoV-2, RSV or other selected infectious organisms.
Some tests focus on a single infection, while molecular panels can check for several organisms.
BioFire is a molecular testing platform that uses defined panels to detect genetic material from selected pathogens.
The particular panel determines which organisms it can identify. A negative result does not rule out every respiratory infection.
Physicians may also recommend oxygen measurements, bloodwork or chest X-rays when symptoms suggest pneumonia or another complication.
Children with severe breathing difficulty, bluish or gray lips, unusual unresponsiveness or other life-threatening symptoms need immediate emergency assistance.
Why Would an ER Doctor Ask My Child for a Urine Sample?
This is one of the more surprising questions parents encounter during pediatric evaluation.
Urinary tract infections can cause fever, abdominal discomfort, vomiting or urinary symptoms.
Younger children and infants may not clearly describe burning or discomfort during urination.
For example, a toddler from Lavon may have an unexplained fever and poor appetite without obvious respiratory symptoms.
A school-age child from Sachse may describe lower abdominal pain, frequent urination or discomfort when using the bathroom.
A physician may recommend urinalysis to investigate whether a urinary infection or another abnormality could be contributing.
What Can Pediatric Urinalysis Reveal?
Urinalysis examines a urine sample for findings such as white blood cells, blood, glucose and other selected abnormalities.
Results may suggest infection or another problem, but a urine culture may be needed to confirm a bacterial urinary tract infection.
The collection method matters, particularly for infants and toddlers, because contamination can affect results.
Physicians select an age-appropriate collection approach based on the medical situation.
Urine testing can also contribute information about blood sugar concerns or hydration, although it cannot replace a complete clinical examination.
When Does Vomiting or Dehydration Require Pediatric Bloodwork?
A child recovering from vomiting or diarrhea may temporarily lose their appetite and drink less than usual.
Imagine a Murphy family canceling a weekend outing to Murphy Central Park because their preschooler has been vomiting repeatedly.
Most childhood stomach illnesses do not automatically require emergency blood tests.
However, a child who cannot retain fluids, urinates much less than usual or becomes unusually sleepy may need medical assessment for dehydration.
What Can Blood Tests Show About Dehydration?
When medically indicated, blood tests may help evaluate:
- Electrolytes, including sodium and potassium
- Blood glucose
- Kidney-function measurements
- Other metabolic abnormalities
A comprehensive metabolic panel measures several substances that help physicians assess selected metabolic and organ-function concerns.
The physician considers these findings alongside symptoms, fluid intake, urine output and examination findings.
A single laboratory result does not determine whether a child is dehydrated.
Can Ultrasound Help Evaluate Pediatric Abdominal Pain?
Yes. Ultrasound may be appropriate for selected abdominal and pelvic concerns in children.
Unlike CT imaging, ultrasound uses sound waves rather than ionizing radiation.
Imagine a Wylie elementary-school student who develops worsening abdominal pain and nausea at home.
Depending on the location of pain and examination findings, the physician may consider appendicitis, urinary concerns or another abdominal condition.
Ultrasound may help investigate selected causes, including suspected appendicitis.
However, ultrasound cannot reveal every source of abdominal pain. Sometimes the appendix or another structure cannot be adequately visualized.
If concern remains, the physician may recommend additional imaging, testing or evaluation.
For parents, the important distinction is that an inconclusive ultrasound does not automatically mean there is no medical problem.
What Should Parents Bring to a Pediatric ER Visit?
Parents and caregivers can help the emergency team by providing accurate information about the child's symptoms and medical history.
Useful information includes:
- When symptoms began and how they changed
- The child's temperature, if measured
- Recent fluid intake and urination
- Current medications, doses and known allergies
- Relevant medical history and previous testing
- Details of any fall, collision or injury
For children who cannot explain their symptoms clearly, a parent's observations can be particularly valuable.
The physician uses this information to decide whether testing is necessary and which studies may provide meaningful answers.
When Should Parents Seek Emergency Care for Their Child?
Not every childhood illness or injury requires an emergency room visit.
However, emergency evaluation may be appropriate for concerning symptoms such as persistent vomiting with dehydration, suspected fractures, worsening abdominal pain, serious head injuries, severe allergic reactions or significant breathing problems.
Seek prompt medical assessment for infants younger than three months with fever of 100.4°F (38°C) or higher.
Call 911 for any potentially life-threatening pediatric emergency, including severe breathing difficulty, an unresponsive child, severe trauma, uncontrolled bleeding or a prolonged seizure.
When a child appears seriously ill, do not delay emergency care to research testing options.
24/7 Pediatric Emergency Evaluation at TotalCare ER Garland/Sachse
At TotalCare ER Garland/Sachse, board-certified emergency physicians provide 24/7 emergency evaluation for infants, children and teenagers.
Located on Murphy Road in Sachse, the facility serves families from Northeast Garland, Rowlett, Lavon, Murphy, Wylie and surrounding communities.
Depending on the child's age, symptoms and medical needs, onsite testing may include:
- Digital X-rays for suspected fractures and selected chest concerns
- CT scans for certain head injuries or other serious conditions
- Ultrasound for selected abdominal or internal concerns
- Influenza, COVID-19 and other respiratory testing
- Bloodwork for infection-related, metabolic or dehydration concerns
- Urinalysis for selected urinary and medical symptoms
Emergency physicians interpret diagnostic results alongside the child's examination and medical history, explain the findings and determine appropriate treatment, follow-up or further evaluation.
For regional families, the goal is not testing every symptom. It is understanding what may be causing a child's illness or injury and choosing appropriate next steps.
Explore TotalCare ER Garland/Sachse
For any potentially life-threatening emergency involving an infant, child or teenager, call 911 immediately.