ER vs Urgent Care
4/5/2021
How to choose the appropriate emergency care
Children like to keep us on our toes. After spending time picking the perfect primary care provider, your child will most likely suffer an emergency situation or become ill when the office is closed! The best place for your child to receive care is with their primary care provider. But where do you go when your child needs care and their primary care office is closed? Is the ER the right place to go? Is urgent care better? Can your child wait until the office opens?
PEDIATRIC EMERGENCIES
If your child is sick, they will receive the best care from their medical home. Your child’s medical home includes your primary care provider and associated staff and specialists. Your primary care provider knows your child and your child’s medical history. Your child’s primary care provider at CHC is specially trained in pediatrics. Children are not just little adults! They often require different medications dosed in different ways for illnesses. We want your child to receive child appropriate care that is up to date with current pediatric recommendations.
When your child is sick CALL US FIRST. We have triage nurses available during our business ours and providers on call whenever our office is closed. We want to help you make a smart decision about the care your child needs.
Often most illnesses kids are seen for do NOT require immediate attention or care. By calling your primary care provider before seeking care, we can help determine if a visit is necessary, the best location for that visit, or how to help your child until our office is open.
CHILDREN'S HEALTH CARE OFFERINGS
Remember, at Children’s Health Care, we are open 365 days a year! We see patients for sick visits every day including Saturdays, Sundays, and holidays! That means we are open even on Christmas morning!
Our no-appointment needed sick call hours:
8-9am Monday-Friday in both of our Newburyport offices and our Haverhill office
8-9am Saturday, Sunday and all holidays in our Newburyport Lower Level office
Our scheduled sick appointment availabilities:
9am-5pm in all offices
5pm-7pm Monday-Friday in our Newburyport Lower Level office
5pm-7pm Monday, Wednesday, and Thursday in our Haverhill office
Please call our office to schedule these appointments.
ONLINE RESOURCES
You can also check out our website for great information on how to help your child if they are sick or injured and for dosing for common medication (HERE). The American Academy of Pediatrics also has a great website with pediatrician-approved advice HERE. If your child ingested a substance, please call poison control at 800-222-1222.
WHEN CAN I WAIT FOR MY CHILD TO BE SEEN?
We want your child to be seen as quickly as possible but there are times when waiting for the office to open is more appropriate than seeking care. These include:
• Fever
• Earache or suspected ear infection
• Pink eye or conjunctivitis
• Suspected urinary tract infection without fever in an older child
• Sore throat or suspected strep throat
• Minor burns
• Minor wounds (simple, not requiring sutures or glue)
• Minor skin infections
• Rashes
• Diaper rashes
• Gastrointestinal issues with no signs of dehydration
• Upper respiratory infections or coughs if there is no trouble breathing
• Allergies
• Mild headache
• Lice, scabies or ringworm
• Sprains and strains
• CHRONIC ISSUE REQUIRING CARE BUT NOT EMERGENCY CARE
FEVER
Many of the phone calls we receive from parents and the reason for frequent emergency care visits are for advice or treatment of fever. Remember, fever is a healthy part of your child’s immune system. Fevers very rarely require immediate care in children over 2 months of age (it is an emergency in children 2 months of age and younger). If you would like more information on fever and fever management, please see our previous blog HERE. A new onset fever does not need to be seen immediately in children over 2 months of age if they are able to stay hydrated and comfortable. Bringing a child with a new fever for emergency care in the ER or urgent care centers may result in unnecessary procedures, potential trauma to your child from those procedures, as well as a very expensive dose of acetaminophen or ibuprofen!
EMERGENCY ROOM VISITS
Despite most childhood illness and injury being mild enough to wait for the office to open, there is a time and place where you may need to use the ER. Every year there are 30 million emergency room visits by children! The emergency room (ER) is a place to receive care for very critical life or death injury or illness that may cause permanent harm. Over 30% of the 30 million visits are NOT life threatening. They are often due to a chronic illness or an acute illness that is not an emergency. This cost the health care system an EXTRA $8.3 billion dollars every year.
ERs can be lifesaving but there are some downsides to using an ER, especially when used inappropriately. Because the ER provides a specialized level of care is very expensive resulting in your insurance charging you a much higher copay to use an emergency room. You may also be financially responsible for tests and procedures done in the ER which can be costly.
ERs also can have a long wait. ER care is NOT first come, first serve. Patients are triaged and seen based on severity. The more urgent or severe the medical emergency is the higher in the “triage cue” that patient will be. The harsh reality is that if you present with your child to the ER with a non-emergent issue such as ear pain or a rash, you will most likely have a long wait because emergency patients will always be prioritized for immediate care. We do not have the ability to “call ahead” to change your place in the triage cue.
MAKING THE DECISION TO HEAD TO THE ER
We recommend calling 911 for significant emergencies requiring immediate care. Calling 911 should be reserved for severe life-threatening situations where it is not safe to move or transport your child to an ER or to delay care.
If you think your child may need to be seen in the ER, the American Academy of Pediatrics recommends calling your primary care provider before making that decision. Your primary care provider will be able to help you determine if your child needs care. They will also help you determine if your local ER versus a pediatric ER is the appropriate choice. Of course, in a true emergency, the closest ER is the best ER. If your child requires specialized pediatric care but presents to the closest ER, the ER and pediatrician on call will determine that and help arrange transport.
If your child ingested any medication or substance, such as cleaning products or something not edible, we recommend calling Poison Control at 800-222-1222. They have a database that will advise you if you need to worry or need to take immediate action. It is very specific to each chemical or substance. They will also tell you how to proceed whether to monitor your child, take your child to the ER, call 911, or be seen by your primary care provider.
There are a few reasons we would recommend you to see care for your child in the ER. These include both emergencies from illness or sudden emergencies due to injuries or accidents.
EMERGENCIES FROM ILLNESSES OR CONDITIONS
Emergencies from illness may be related to many different types of illnesses but include the below symptoms:
• ANY FEVER 100.4 IN AN INFANT 2 MONTHS AND UNDER
• Less alert behavior/severe lethargy
• Becoming unconscious
• New seizure activity
• Trouble breathing
• Blue or purple lips or skin
• Severe asthma exacerbation
• Neck stiffness with fever
• Increasing or severe persistent pain
• Severe abdominal pain especially with fever or vomiting
• Severe eye pain
• Signs of moderate or severe dehydration
• Severe psychiatric distress
EMERGENCIES FROM ACCIDENTS/INJURIES
Your child may also need to be seen in the ER after an injury or accident. Symptoms that require emergency care include:
• Unconsciousness due to injury
• Shock
• Fainting
• A large or deep cut
• Bleeding that won’t stop
• A burn covering a large area of the body
• A head injury where your child is confused or vomiting after or lost consciousness during
• Smoke inhalation
• Carbon monoxide inhalation
• Choking
• Near Drowning
• Injury due to firearms/weapons
• Electrical shack
• Poisoning
• Ingesting a button battery
• Ingesting a magnet or magnets
• Venomous bite
• Knocked out teeth when your dentist is not available
Remember, if you are unsure if your child’s illness or injury requires treatment you can always call the on-call provider and we can help direct your child’s care to the most appropriate place. And if in doubt, follow the American Academy of Pediatrics mantra “ If your child can walk, talk, interact and play it is NOT an emergency!”
URGENT CARE CENTERS
Urgent care center usage has risen significantly in the past few years. Urgent cares are often used for medical issues that do not require emergency care but need quick attention or for adults who do not have access to care through their primary care provider for acute illnesses. It is estimated that there is 150 million visits to urgent care centers every year (and this was before COVID-19!!!). Urgent care centers are often less costly than the ER, including a lower copay, and they can often provide care faster than an ER. Your insurance may actually prefer you to seek care at an urgent care center…but remember, their advice comes from a financial perspective NOT a medical perspective.
Despite their rise in popularity, we recommend caution in using urgent cares for children. The American Academy of Pediatrics recommends NEVER USING URGENT CARE FOR CHILDREN UNDER THE AGE OF 2. Most providers at urgent care centers have no or very little training in pediatrics. Many urgent care center providers are not comfortable or familiar treating infants and young children. Some urgent care centers have set age restrictions to avoid having to treat younger children.
Infants and young children often have different protocols for illnesses and medications, and without specialized or continuing pediatric education, the providers at these sites may not be familiar with these differences. A wrong antibiotic or treatment choice can be detrimental to anyone but particularly small children. The urgent care may also make needless referrals to the ER if they are not comfortable managing the issue or age of the child.
Of course, calling your primary care provider, can help determine if your child’s issue needs immediate attention and if an urgent care is appropriate for the care required for that issues. There are specific concerns that we must address with urgent cares. Most urgent cares can handle minor sprains and fractures but not severe injuries or pediatric specific injuries. If the injury is severe, the ER is a more appropriate place to seek care. Urgent care centers do not always have a radiologist reading the imaging. All x-rays ordered by our office or in the ER are reviewed by a radiologist who has specialized training in interpreting these images. There are urgent cares who do utilize a radiologist to read their x-rays (this is usually done after the face, the provider on often reads the image immediately and the days images are sent in bulk for radiology to review later). We advise checking to see if imaging is reviewed by a radiologist before being seen by an urgent care center.
Additionally, if your child needs specialized care, the urgent care does not have access to immediate consults with local specialists. For example, they cannot consult with orthopedics on an injury or plastic surgery before suturing a laceration. The ER has this availability as does your primary care provider.
We are lucky to have a local ER that recognizes the need for a faster more streamlined ER experience for non-emergent but urgent visits. Anna Jaques has the ‘Fast Track’ center that specializes in visits for minor illness or injury that operates much like an urgent care center but has better access to radiologist and a higher level of hospital care if required.
PREPARING FOR THE ER OR URGENT CARE
If your child needs to utilize an emergency room or urgent care, it is best to follow the following steps to ensure a safe visit:
• Bring a list of your child’s medications including doses
• It is okay to give your child acetaminophen or ibuprofen before being seen just note the time and the dose of the medication you administered
• Know your child’s immunization status or bring a copy of their immunization record with you
• Make the provider aware of their allergies, especially to medications
• Be prepared to give a brief overview of your child’s medical history to the provider
• Be prepared to share a short timeline of events leading to the visit for the provider
• Have the ER or urgent care center send their notes to your primary care provider and follow up with your primary care provider as directed
• Do not bring sibling if possible
• Bring your child a comfort item
Having an ill or injured child can be a scary experience. Our team at CHC wants your child to have access to the best most appropriate care. Please utilize our team, our website and the above information to make the most informed decision for your child and family.
Children’s Health Care of Newburyport, Massachusetts and Haverhill, Massachusetts is a pediatric healthcare practice providing care for families across the North Shore, Merrimack Valley, southern New Hampshire, and the Seacoast regions. The Children’s Health Care team includes pediatricians and pediatric nurse practitioners who provide comprehensive pediatric health care for children, including newborns, toddlers, school aged children, adolescents, and young adults. Our child-centered and family-focused approach covers preventative and urgent care, immunizations, and specialist referrals. Our services include an on-site pediatric nutritionist, special needs care coordinator, and social workers. We also have walk-in appointments available at all of our locations for acute sick visits. Please visit chcmass.com where you will find information about our pediatric doctors, nurse practitioners, as well as our hours and services.
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.