At some point, all children are going to get sick or injured. It’s an inevitable part of life. Often, it’s going to occur at inconvenient times for you and your pediatrician. Murphy’s Law requires that it happens at exactly 3 am, when you should be sleeping. As you can imagine, that’s a time when you’re not going to be the most alert; however, the cries of your child will compel you out of bed.
As a practicing board-certified emergency medicine physician, I am often the one you will see when you bring your child into the ER. I’d like to give you some advice to help navigate the experience and turn it from a dragged-out, frightening event into a reassuring, harmless, and hopefully, painless one. Here are some tips to help you advocate for your child’s care; avoid sleepless nights and large bills; and most importantly, avoid possible life-threatening harm to your child.
Often, the best advice is the one you already know, and that is, when your child has fallen or is grabbing his ear in pain, the first thing you do is call your trusted physician. Although, as parents, we’d rather not awaken anyone at 3 am, your physician would rather have you wake him and hopefully take care of the situation over the phone, if possible, than have your whole family in a crowded ER all night. So, make the five-minute call, and hopefully, care can be initiated over the phone, and the trip to the ER avoided in the first place. We all know ERs are scary for adults, let alone children. So, if we can avoid that visit, that may be the best option. It’s one of the reasons we opened Premier Care — we’d like parents to be seen by ER specialists in a friendly environment, without the long wait.
However, at some point, your physician will say: “Take him to the ER.” That opens up a Pandora’s box of fears — especially at 3 am — as to what’s wrong with your child, and what will happen to him. Images of TV shows flash in your head as you drive to the hospital, register, and inevitably, wait to be seen. Hopefully, this advice will lessen those fears.
First, stop, take a breath, and calm your nerves. Although human nature imagines the worst, the fact is, thankfully, that 95 percent of the children who go to an ER will be discharged. That tells us that the vast majority of children will have self-limiting illnesses — such as the common cold — that will go away with the passage of time, and will not leave any lasting effects. The main job of the ER physicians is to find those really sick children who need to be admitted. Thankfully, the others (who owe a great amount of that former statistic to vaccines) can be safely discharged, possibly with medicine that will make them feel better until they actually get better. So, drive slowly and safely to the ER to avoid any accidents that can harm you and your family.
When you go to the ER and register, it would be great if the staff there had the time to focus solely on your child. It’s what we parents all want; but the staff is often attending to critically ill patients, and while they would love to spend 10 minutes explaining what’s going on with your child, they simply cannot. Medical and nursing school hasn’t taught how to be in two places at once. Thus, parents often feel — correctly — that they have become lost in the shuffle.
Physicians tend to feel compelled to order tests and treatments that turn out to not be needed for the care of the child. I won’t go into specifics for each test, but if parents can ask a few questions — as is their right — I think that the treating physician, who has their child’s best interests at heart and wants to work with the parents, will often agree to do what’s really needed, and avoid the pull for needless, painful, and even harmful tests and treatments. I would rather not have my child who has diarrhea stuck multiple times with a needle to “see” if he’s a little dehydrated, if the treatment will be drinking Pedialyte, regardless of the blood test’s results. If he’s really dehydrated and cannot tolerate fluids, that’s a different story. But to cause him pain from a needle — especially when multiple scientific studies show the testing doesn’t clinically make a difference — would be useless and even cruel.
Thus, the first question parents should ask the doctor would be: “Is the test/treatment really necessary?” Physicians should explain the reason they are doing every test — and more importantly — what the result of that test will do to change their management. If an experienced physician truly feels that your child needs a CT scan of his abdomen because of the chance that he has appendicitis, then the result of the test really changes the plan of action. If it’s positive, the child goes to the operating room; if it’s negative, the child can go home. In certain instances, it’s a great test. Often, some tests are falsely positive and require other tests to prove the first test was incorrectly positive!
After the physician has explained why he feels that the test is important, the next question is: “Does this test cause any harm in it’s own right?” The cost of the test, aside from considerable expense, is often pain (from attempts at drawing blood) or even the likelihood of a life-threatening illness at a much later date in the child’s life. We have recently been learning the effects of radiation from diagnostic tests, such as a CT scan, on children. There is a chance that the child is at an increased risk of getting cancer from the CT scan. Another study implied that the radiation to the growing child’s brain might drop that child’s IQ a few points. Certainly, we wouldn’t want to risk those side effects on our children unless the test was truly needed.
The last question parents should ask is: “Can we try a more conservative way?” Once a physician has decided that nothing emergent is going on, then there are many courses of treatment. Often there are some that will make the child feel better until he gets better, such as anti-nausea medicine when he has a virus causing him to vomit. If an illness will go away on its own, does a child need an expensive antibiotic or a drug that will give him medicine-induced diarrhea? Sadly, physicians often feel that one way to make parents happy is to prescribe something — when really, nothing was needed in the first place. Asking this question removes the idea that the only way for the physician to make you happy is to write a prescription.
I think that if parents have a few basic questions in mind, then the physician will gladly work with them to avoid useless pain, large bills, sleepless nights, and — most importantly — possible life-threatening harm to your child when you need to bring him to the ER.
Vincent D’Amore, MD, is an emergency medical physician and author of “Common Sense: A Parent’s Guide to a Harmless ER Visit.” D’Amore grew up in Maspeth, Queens. He is a graduate of Albert Einstein College of Medicine, and completed his post-graduate training at St. Barnabus Medical Center and Mount Sinai Medical Center. He had an emergency medicine residency at St. Lukes/Roosevelt Hospital in Manhattan. D’Amore now works at Premier Care, a walk-in urgent care center in Maspeth. He currently resides in Long Island with his family.