On Monday, February 27, 2012, we held a live chat on Seattle Children’s Facebook page with a team of doctors and practitioners from our Department of Emergency Medicine. The topic was when to take your child to Urgent Care versus the Emergency Department (ED). Below are the questions that were asked and the answers provided by our team.
Start of croup systems after nap that I know will be a ER visit at 11pm. Where and when do you go?
Dr. Shelton Chapman: Our Urgent Cares are open 5 p.m. to 10:30 p.m. on weekdays and 11 a.m. to 8 p.m. on weekends. If you can get in to see your doctor that is always preferable, however if it is after your doctor’s hours or an appointment is not available, croup is certainly something that can be managed at the UC. Obviously if a child is in distress and having trouble breathing you should call 911 or go immediately to the ER.
My 22-month-old son received stitches near his eye at Children's ED a few weeks ago. I am happy to report it's healing beautifully – our surgeon did a wonderful job! If he needs stitches again sometime in the future (which I hope he won't), is this something the Urgent Care could help with?
Karen Kilian, ARNP: Great question! All the Urgent Care Clinics can place stitches in children. We can also use sedation if needed for the younger folks to help them through the procedure. We use intranasal versed which acts more like an amnesic than sedation – we’re still the child’s best friend after the procedure! Some cuts require a specialist such as some cuts on the ear or nose; or if it is a deep hand cut we may need to have a surgeon evaluate it; which are things we can’t do in Urgent Care. But…we can evaluate your child and elect to transfer to the Emergency Department IF required.
Is broken arm a UC or ER matter?
Dr. Usha Sankrithi: If there is an obvious deformity to the area of injury, you should go to the Emergency Department. This is because your child may require a procedure to put the bone back into place. Therefore, make sure your child doesn’t eat or drink anything in the event he/she may require sedation for the procedure. If your child can walk (limp) on the injured leg, or the arm/wrist or hand is swollen and painful but not obviously deformed, you can go to the Urgent Care Clinic or your healthcare provider the next day. If your child is in a fair amount of pain, even if he/she is able to walk, you should go to Urgent Care. Does this answer your question?
What will cure hives?
Dr. Julia McDonnell: Hives, also known as urticaria, is an allergic reaction. Hives are itchy red patches on the skin. They can show up as a reaction to something your child touched, ate (a food or medicine), heat, cold, insect bites or a virus. They can even start as a reaction to a strong emotion. Over half of the time you may not be able to discover what triggered the hives. Hives can come and go for one day, several days or several weeks. If you know the cause of the hives you could avoid that cause. Hives are often treated with an oral antihistamine such as oral benedryl. If hives are associated with a fever, are accompanied by other symptoms, or last more than 2–3 days your child should be seen by a medical provider. Does that answer your question?
What is good for cough?
Dr. Rebecca L. Partridge: As all parents already know, cough is a really difficult symptom to treat. Although it can disrupt sleeping and eating, cough is actually good since it clears our lungs when we’re ill. If a child is under a year, using a humidifier and suctioning out his nose can be helpful. If a child is over a year, sometimes a teaspoon of honey at bedtime can help. The reason there are so many cough medicines available over the counter is because none really work well, and some are in fact dangerous in young children.
If my child gets what I think is a sprain in the evening, is it best to go to urgent care or wait for Sports Medicine to be open in the morning?
Dr. Bryan Dryer: Thanks for the question. Urgent Care would be the best place to go in the evening hours to take a look at the sprain. If it can wait to the morning your regular doctor would be more than appropriate to deal with the sprain. Heading to Sports Medicine would be helpful in instances when a sprain appears to be more complicated or requiring further studies.
Recently my daughter had a fever higher than 102, is it best to rush her to the ER or Urgent Care? She had strep throat and her fever broke but an hour later her fever came back and did not break until the wee hours of the morning.
Dr. Julia McDonnell: In general it would be best to bring your otherwise healthy to urgent care rather than the emergency dept. Life threatening fever is very rare. The cause of the fever might be dangerous, but in the vast majority of cases fever itself is not dangerous. Fever is a protective mechanism and temperatures up to 104 degrees are beneficial to sick children. If your child was already diagnosed with strep throat and she had started treatment for it you might be want to call your regular doctor or her nurse to see if your daughter needed to be seen again or if it would be okay to watch her until the office opened the next day. It often takes 1–2 days for an antibiotic to start working.
By your standards what would be considered an emergency? Many times I have been told that not all things a person goes through is an emergency. I don't how else to word my question :) sorry but hope you understand the question.
Dr. Usha Sankrithi: Good question. Sometimes, it can be difficult to know where to go. Seattle Children’s website has a list of common injuries and illnesses that help determine if you should go to Urgent Care or the ED. Also, nurse consulting lines can be of assistance; either through your insurance company or Seattle Children’s (206-987-2500). Many pediatric practices in the area prefer you to call them first to help determine where you should take your child. It is a good idea to obtain this information and put it near your phone for use if you should need it.
Hello, I’m a football coach and concussion recognition has become pretty big recently. If I suspect one of my players is concussed where is the best place to go? I know there are plenty of providers around but is there a compelling argument to have parents go to Children’s ER or Urgent Care over other providers.
Dr. Shelton Chapman: For a sports concussion, where to be evaluated has a lot to do with how severe the injury was and what residual symptoms the child still has. Any time there is a loss of consciousness, the child should be evaluated. If there is brief loss of consciousness and no residual symptoms the Urgent Care would be a good place to start. If there is persistent vomiting, worsening headache, vision changes or other neurologic symptoms the child should be seen in the ER. Also, keep in mind that with the Lystedt Concussion Law in Washington, a child with head injury will require clearance to return to sports and this cannot be done at the ER or UC , but can be done by your primary care physician. In my opinion, it would always be beneficial to be seen by physicians who are specially trained to manage pediatric injuries. However, in a life threatening emergency, you should always go to the closest ER.
A couple of years ago, we were at a summer party and my 2-year-old burned his fingers on a barbecue. We took him to our local Emergency Room where they basically just soaked his fingers in ice water and gave him some pain meds and we sort of felt like it was a wasted trip. Is there a way to tell if a small-ish burn is severe enough that it needs urgent medical attention vs. just home care?
Dr. Rebecca Partridge: Sorry to hear your son burned his hand! Burns can be tricky…and painful. We worry about burns that are over a joint, involve the hands, feet, face, private area, or are large (bigger than the child’s hand) or have a lot of blistering. If the burn is also very painful also they may need to be seen just for pain control.
My 3-month-old has a cold. She was coughing so hard & nonstop she vomited & then had some white foamy substance coming out of her mouth I assume was mucus. Once she settled down I looked at her torso & she was retracting. I called her pediatrician's office & they got her in quickly. I felt like I handled it okay but later wondered if I should've treated it more like an emergency since she's so young. Any thoughts or suggestions?
Karen Kilian, ARNP: That’s a very timely question, since we are in the middle of viral season. You mentioned a couple of items that are red flags: 3 months of age, coughing so hard she vomited, and retractions. Since you were able to get into your primary care provider (PCP) so quickly – that was just fine! This is just the type of situation where she should be seen and in a timely manner – key word being timely. Either the ED or Urgent Care would have been fine to go to. We would worry about pertussis (whooping cough) based on your daughters symptoms and can send off a test for that illness (and others) from the ED as well as Urgent Care. If she was blueish colored in the face and not responding to you well – that’s a call for 911.
I also wanted to point out the observation of noting your daughter's retractions. That is a sign of breathing difficulty as you very well recognized. Young babies tend to breathe through their nose more than their mouth....so clearing the nose with a bulb suction may help infants breathe better and lessen their work of breathing. Nice job on the observation!
Our son has mitochondrial disease, and has an ER Protocol Document in place that specifies he needs to be taken in for any fever or vomiting for a special IV solution. He has a G feeding tube, suffers from seizures and has a very low threshold for admission. We have always taken him to the ER but live in Bellevue and wondered if Urgent Care could handle a complex kiddo like ours. Thanks for all you continue to do for so many of our families. Hope. Care. Cure.
Dr. Bryan Dryer: Hi. Thank you for your question. In the instance that your child developed illness that included fever or vomiting (as an example) it would be best to follow your doctor's original orders. Children with complex medical conditions do visit the Urgent Care and are welcome to visit for non-emergent concerns. If we felt it was serious enough we would coordinate and refer you to the ED for further evaluation.
If my child's tooth gets knocked out and I cannot get in to the dentist, would urgent care or the ER be able to treat/reinsert it (adult tooth)?
Dr. Shelton Chapman: Having an “adult” tooth knocked out is a dental emergency and needs be seen right away. The tooth needs to be splinted back in the socket. This can only be done by a dentist. Some dentists will see their own patients after hours for this problem. You can call them and see. If not available, we are fortunate to have a dentist on call at Seattle Children’s Hospital ER that can be called in to see emergencies. If a tooth is knocked out (avulsed) rinse off the dirt, but do not scrub the tooth as this can damage the part that is needed to reattach. For older kids (that are not at risk of swallowing the tooth) the tooth can be placed in the socket and the child can bite down on a moist cloth. If not then the tooth can be placed in (in order of preference): skim milk, water or wrapped in a moist cloth, until you see the dentist.
I have chronic asthma and have been intubated several times to protect my kids from unnecessary visits to the emergency room what is the easiest way to tell if their not getting enough air?
Dr. Usha Sankrithi: I am sorry hear that you had severe asthma requiring intubations several times. Many children suffer needlessly because those around them aren’t aware of the warning signs of asthma and do not bring the signs to their pediatricians’ attention. Asthma can masquerade for years as chronic or recurrent bronchitis, recurrent pneumonia, chronic cough, or lower respiratory infections. Discuss with your pediatrician the possibility that your child has asthma if he/she has these masquerading conditions. Also call your pediatrician for an appointment if your child wheezes, coughs regularly, especially at night or with exertion, has a tight feeling in the chest or is often short of breath. Symptoms may not always be there; instead, they may occur occasionally, such as when your child plays energetically, laughs or cries, or sleeps. Perhaps you notice that your child wheezes or coughs when visiting a home in which someone smokes or has a cat. If symptoms come on at particular times, be sure to mention the circumstances to your pediatrician. The more facts your pediatrician has, the easier it is to diagnose asthma and the sooner treatment can start. I hope you find this helpful.
How can you tell if a child has a sinus infection or just allergies? And when treatment is needed?
Dr. Shelton Chapman: First, sinus infections are very unusual in younger children as the sinuses that typically become infected don't open until 7–9 years of age. There are some symptoms that can help differentiate. Allergies typically will be seen with sneezing, itchy watery eyes and clear runny nose. Sinus infections will often have fever and headache. However your are correct that some of the symptoms overlap and therefore it is good to see your pediatrician to help decide which your child has.
With a complicated (and amazing!) kid (mult. heart defects) should we default to going to Children's ER or take the closest option when needed? Like say a broken arm... drive to Children's since they have his history/cater to kids/etc... or head to Evergreen since it's close?
Dr. Rebecca Partridge: It can be hard to decide where to go when your child knows Children's well. For children with a complicated medical history, it's often best to go to Children's, where we will have access to his history and specialists like you said. If your child is having a life-threatening emergency, though, I always encourage parents to go to the nearest ER or call 911. We're also glad now to have three urgent care clinics in the area where we have access to a child's medical record and can communicate with Children's specialists as well...it may make your drive easier!
My child has chronic constipation and was told by her PCP to use Miralax for this. She has been seen in the ER several times for disimpaction. Should I continue Miralax or consult a GI?
Dr. Bryan Dryer: Thank you for the question. Her constipation may have many different causes for which you should continue to work on with your PCP. Miralax is one approach that has been effective in keeping constipation at bay and keeping your child out of the ER. GI doctors, nutritionists and your PCP may need to work together to prevent constipation from worsening if you find yourself needing disimpaction.
If a child’s fever isn’t breaking is urgent care as good as the ER? ( if it’s after doctors clinic hrs)
Dr. Bryan Dryer: Thanks for the question. A lot depends on the child's age when discussing fever. Under 2 months of age this child should be seen right away at the ED. For an infant 3 months and older the Urgent Care would be fine. And with older children (over 5) with not significantly ill appearing, follow up the next day with their pediatrician should be OK. It is also important to use the appropriate dose of either acetaminophen or ibuprofen and note that these fever reducers typically only bring fevers down 2–3 degrees. If the fever does not break and you can't wait to the next morning then urgent care is the best place to go. Although how a child appears when their fever comes down says a lot about how sick they are. Most children will look ill when they are having fever, but seriously ill children that need urgent evaluation will often look ill even when their fever resolves.