ER versus urgent care, kid’s edition
A common question I get asked frequently as an RN is, should I take my child to the Emergency Room (ER) or urgent care? The answer to this question depends on several different factors, including age of the child, the injury or illness and also your child’s medical history. I’d like to go over some general tips to keep in mind when making this tough call we all are faced with as parents.
During regular business hours, and for non-life threatening emergencies, your child’s pediatrician is a good place to start with a phone call explaining the situation. From there they can give you advice on what your next steps should be. However, we as parents all know most illnesses and injuries strike during off hours, weekends or holidays. Most offices now offer an afterhours nurse triage line or an on call service. For non-life threatening emergencies, this is a great place to start. As a general rule of thumb, urgent care facilities are for minor, on-life threatening situations and the ER should be reserved and used for crisis situations.
Life threatening emergencies in children include some of the following:
• Loss of consciousness, fainting or no response when spoken to
• No breathing and no pulse, cardiac arrest (Dial 911 and start CPR immediately)
• Ingestion of a poisonous substance, foreign body or swallowed button battery or detergent pack
• Rhythmic jerking and a loss of consciousness/seizures
• Troubled or labored breathing, not being able to speak 2-3 words at a time
• Skin or lips that look grey, purple or bluish
• Coughing or vomiting blood
• Increasing or severe prolonged pain. Pay attention to any abdominal pain that starts around the belly button on right side, especially with a fever.
• Severe bleeding that will not stop
• A large or deep cut involving the head, chest or abdomen
• Broken bones with any bones sticking out
• Neck stiffness and a rash with fever
• Head trauma or a severe fall
• Severe asthma attacks or a severe allergic reaction (anaphylaxis)
• A severe burn involving large areas of the body or a burn to the hands, feet, face or groin
• A change in mental status such as becoming suddenly sleepy or confused
• A rapid heartbeat that does not slow down with rest, hydration or fever management
• Fever over 100.4 in children younger than 2 months of age
• A high fever over 104 degrees Fahrenheit that is not responding to fever reducing
medications (Tylenol or Motrin).
• Severe dehydration, in which infant or child cannot tolerate any oral rehydration, has a decrease in urine output or is not producing tears when crying.
• Very young infants (under 2 months of age) for any illness or injury
• A child that may be suicidal or felt to be a threat to themselves or others
For these emergencies, it is best to dial 911 immediately for ambulance transport to the nearest Emergency Department.
For other conditions, urgent care facilities, specifically pediatric ones can be a good choice.
Some of these conditions include:
• Mild allergic reaction
• Mild asthma attacks
• Cough, colds and sore throats that are not getting better or responding to at home supportive treatments.
• Minor cuts or burns
• Earaches that are not getting better
• Broken bones requiring splitting, but with skin intact and normal shape
• Vomiting without severe dehydration
• Pink eye
• Removal of ticks, splinters and other sharp objects
• Skin abscesses
• Minor sports injuries
• Urinary tract infections
• Rapid flu, COVID-19 or strep throat testing that cannot wait until normal office hours
Even the most seasoned parents sometimes will second guess their judgments. Parenting judgement calls are some of the most difficult to make especially when it involves a sick or injured child. I always stress for parents to listen to their gut. You know your child best. It always better to err on the side of caution then delay getting prompt treatment. As always, if you can, try to consult with your child’s primary care pediatrician first. If you believe you child has ingested something dangerous, a call to Poison Control (1-800-222-1222) can direct you what the next steps should be.
Maria H. Drzaszcz, a Hammonton resident, is a registered nurse with 14 years critical care experience and is the proud mom of three young children.