The decision of whether to take your child to the pediatrician, an urgent care clinic, or the emergency room when he does not feel well may seem like common sense, but for some parents, it raises some questions on what the right choice would be.
Parents should have a pediatrician that they like and trust for their child and who has a relationship with your family and knows the child well, including his past medical history and allergies. An urgent care center caters specifically to patients with ailments that can’t wait for an appointment with a physician several days out, but that aren’t severe enough to merit an emergency-room visit. The drawback to an urgent care center and emergency room is that the doctor will not know your child as well or have the same kind of follow-up as the pediatrician.
At this time of year, one of the most common complaints is the seasonal cold, which can be treated at home unless a child is having difficulty breathing, a high fever, or it goes on for more than three to five days.
“There is something called croup, which is when kids make a bark-like cough and have noisy breathing which, if it is mild, you can be put in a steamed shower or come to the pediatrician’s office. But if your pediatrician’s office is closed, it is a time you must go to either an urgent care center or to an emergency room,” said Dr. Blair Hammond, assistant professor at Mt. Sinai Hospital. If your child is more extreme looking and working hard to breathe, he should be monitored more closely, making the emergency room a better option than the urgent care center, which is a quick in and out.
Other frequently seen issues at this time of year are strep throat, with which your child could have a fever. The pediatrician can handle it, but after doctor’s hours, it would be great to go to the urgent care center and have a strep test.
“One of my concerns about urgent care centers and emergency rooms is that they do not have pediatric-trained doctors. Medicines are dosed differently in children, and the common types of diseases children get can be different than an adult,” said Hammond. For issues like ear infections, ear pains, or colds, many adults get antibiotics, whereas in kids, it is not always suggested.
“There is new data about not giving antibiotics for children with ear infections after age 2 unless there is moderate ear pain, it looks like it is bulging, and you have a fever with it,” said Hammond.
The emergency room is for medical emergencies like if your child is turning blue, has a seizure, or has difficulty breathing. Doctors can do blood tests, take X-rays, and offer oxygen if needed. Kids can usually get admitted right away if necessary. The downside is that there is a large copayment.
“For most insurances, it is $150, and there is often a long wait where you are exposed to other germs from sick people,” said Hammond. When you are discharged from the emergency room, you cannot expect someone to check on you, whereas the pediatrician may ask you how things are going. Follow up is extremely important in children’s healthcare.
“Many illnesses in children are caused by viruses and close observation is often the best management, but over several days is not possible in urgent care and emergency room settings,” said Hammond.
If your child will stress out at the thought of the emergency room, it may be avoidable.
“We can handle 80 percent of the cases in the urgent care that we see in the emergency room, but what we are not able to handle or handle well are people with life-threatening illnesses manifested by severe difficulty breathing, obvious injuries and conditions where it looks like a kid may need to be hospitalized,” said Dr. Judah Fierstein of Mt. Sinai Hospital Urgent Care. Urgent care is a nice option for weekends and holidays as well as minor injuries or illnesses.
“We see cold, flu, earaches and a lot of gastrointestinal illnesses, respiratory illnesses, asthma, sore throats, and injuries like cuts, sprains, and fractures from the playground,” said Fierstein. There are clear advantages to urgent care.
“Patients appreciate the speed, and how we run more quickly and efficiently than an emergency department, the lower cost, and that it is a safer and friendlier environment for kids,” said Fierstein.
While it is often overlooked, do not ignore the existence of urgent care.
“It is a great and convenient place to get care that fills a really important gap when you have two choices, to wait until tomorrow or go to the emergency room — and there is not a good choice other than the urgent care,” said Fierstein. Urgent care doctors are not replacements for their alternatives, but rather partners in good health.
“We have a specific role and are there when pediatricians are not and do things they cannot do. We do not try to take care of the emergencies, because they need to go where they belong, but when people come in who need real emergency care, we stabilize them and arrange the transportation to get them attended,” said Fierstein.
An urgent care center is easy and great when you want a quick diagnosis like a urinary tract infection or strep throat. With bacterial infections like strep throat, a child will usually start to feel better after being on an antibiotic for 24 hours and will no longer need to be seen. Sometimes parents go to an urgent care for reassurance when something can be managed at home.
“For vomiting and diarrheal illness, most are caused by viruses and the recommendation is to try to keep the child hydrated by giving small amounts of liquid and make sure he is peeing enough,” said Hammond. If a child is not urinating for long periods of time, the urgent care or emergency room might be necessary for rehydration or getting IV fluids. While you may feel a rash should be seen right away, you can usually wait and follow up with the pediatrician. For complicated rashes, you may be referred to a dermatologist.
Do not be scared of fever unless your child is younger than 2 months, in which case he should be seen.
“Fever is the body’s way of fighting infection, and children, unlike adults, have not been exposed to as many viruses, so they have less immunity,” said Hammond. Kids also tend to put more things in their mouth and touch everything.
“They may get eight to 10 infections a year, and when a child is done with one cough he may get a new cough, but that is classic and typical, especially between ages infancy to 3,” said Hammond.
Obviously, broken bones should be evaluated in the emergency room and deep wounds should be cleaned and seen as soon as possible to decrease risk of infection. Do not panic.
“There is good data that if children fall from a height of less than two feet and there is no loss of consciousness and they appear completely well, they can usually be observed at home for any signs of vomiting, severe headache, neurological changes, or balance problems,” said Hammond.
Particularly if you go to an urgent care or emergency room, ask questions.
“You want to make sure the doctor explains exactly what medicine he is giving and why and get the results for any tests or cultures that were done,” said Hammond.
Sometimes results are not available right away so you want to follow up and be sure the information is sent to your pediatrician’s office, so he is aware of what was done. Be sure that you think through your decision on where to go and when. Remember that in little kids, the immune system is not that great, so you want to stay home and talk to your pediatrician when you can, so your child is not exposed to unnecessary viruses and bacteria at the urgent care center and emergency room.
Jamie Lober, author of “Pink Power” (www.getpi
© 2015 Jamie Lober
