To Go Or Not To Go? Emergency Room Visits For Kids

Knock on wood…we haven’t needed to go to a hospital emergency room in quite some time.  I did have to rush my girl to an urgent care last Spring when she had her second allergic reaction to cashew nuts that were mixed in a cupcake frosting.  I was so mad at myself for forgetting to ask the restaurant if the cupcakes were tree nut free before she took a bite.  She did require treatment, but all was taken care of at the urgent care.  But how do we parents know when our kids’ medical problem warrants an emergency room visit versus urgent care or the doctor’s office?  This is an excellent question, so I was thrilled when Dr. Tami Romano, MD volunteered to answer this question.  Dr. Romano practiced as an emergency room physician for years and she is also a mother to two children, so read on for some good advice on the one place that we hope we never have to take our kids to, but just in case….

Dr. Romano says:

To go or not to go: When is a visit to the emergency room necessary?

Historically the top two reasons parents rush their children to the Emergency Room are fever and injury. When we dig a little deeper we discover that parents of younger children frequent the ER when their little one spikes a fever, while parents of older children come in most often when a son or daughter has experienced an injury.  The most common injury that brings kids to the ER is broken bones. Strains and sprains are also high on the list of injuries seen frequently in the ER, and the third type of injury is a deep cut or wound.

Under any of these scenarios, it is certainly understandable that worried Moms and Dads want their children checked by a doctor, but a trip to the ER is not always necessary or the best solution.

Let’s first look at what it means when your child has a fever. A fever is not an illness, but a response to illness. More importantly, a fever actually has beneficial effects in fighting disease.

What to do when your child has a fever

Technically, a child has a fever when their rectal temperature is greater than 100.4, and a rectal temperature is the most accurate. Take note, that when you are taking a child’s oral temperature it will read about one degree lower than a rectal temperature, and an axillary reading is about two degrees lower. That said, a child with a rectal temperature of 100.4 may not raise concern.  An infant less than four months-old with a fever of any kind should always be evaluated by a doctor. Babies in their first few months are susceptible to serious infection, and a fever may be the only indicator.  For older children the symptoms associated with fever will dictate whether a trip to the ER is in order.

Symptoms associated with fever that may warrant a trip to the ER:

• If the child is having difficulty breathing they need to be seen.
• If there is excessive vomiting or diarrhea and there are concerns about dehydration they need to be seen.

If a fever persists or is spiking high or you have additional concerns, contact your child’s doctor or take them in for an exam.

What to do when your child is injured

When you suspect your child has a broken bone, they need an x-ray and an evaluation from a physician to determine the situation. If your pediatrician or a local urgent care office is not available, then take your child to the nearest ER. A sprain or a strain is not an emergency therefore a trip to the ER is not necessary. The same holds true for open wounds. If you are able to stop the bleeding, clean the area and temporarily wrap the wound, you are generally safe to wait to see your pediatrician.

Evaluate the situation and determine the best course of action

 When you are in the moment and have an ill or injured child, it is difficult for a parent to know if they need an emergency evaluation or not. What you need to realize, is there are a number of options available today to help you make the right decision.

• You can call the pediatrician’s office and see if there is a nurse or doctor on-call to listen and advise.
• If it is after hours or difficult to get a hold of your pediatrician, you can choose to make a visit to your local urgent care office, but that may not be necessary.
• Technology now provides 24 hour access to doctors via telephone, email or video conference through a variety of telemedicine service companies, and they can quickly evaluate the situation and help you decide if a visit to the ER is necessary or if you can wait to see the pediatrician.
• Physicians associated with telemedicine service providers can often provide treatment instructions over the phone and can call in prescriptions to your local pharmacy, which not only save you time, but can also address you and your child’s needs immediately. Many parents don’t realize that telemedicine benefits are available through their insurance and can be utilized as the first line of defense in medical care.

Emergency rooms are impacted with people that don’t necessarily need to be there, and as a result the waits can be long for those that are not experience something serious or life threatening.

When it comes to our children nothing is more important, and whenever it involves the health and well being of a child, no one knows them better than a parent. If you are worried that something is wrong, rule one is to always trust your gut. Then, ask yourself what options are best at this moment to get my child the medical care they may need.

About our guest writer, Dr. Tami Romano:

Tami Romano, MD is a mother of two and practiced for many years as an Emergency Room physician. She now dedicates her career to educating others on adopting proactive health care practices.  She is teaching medical student through University of Arizona, serves as the Chief Medical Liaison for Healthiest You, a company based in Scottsdale that delivers personalized, smarter-with-use online health programs that empower and engage employees to improve health and lower health costs. Romano also speaks to companies and organizations educating the public on developments and options in health care..To learn more from Dr. Romano visit www.facebook.com/drtamiromano or follow her @drtamiromano.