When To Take Your Child to the Doctor

In our office the physicians take turns “on call,” which for our particular practice means being available by phone for patient calls that come in at night or over the weekend. Many times, these calls are from parents requesting advice on whether or not their child needs to be seen by a medical provider. Illness rarely follows a predictable schedule, and kids often become sick in the middle of the night or on a weekend day when the office is closed. These parents need help in determining how worried they should be, and how urgently they should seek medical care. 

Sometime these cases are easy to determine – the child having an active seizure, or in such severe abdominal pain that he cannot walk, for example, should go straight to the emergency room. Others are easy in the opposite way – the constipated infant who is otherwise in no distress can wait for an appointment when the office reopens. Other times, however, it can be difficult to decipher. 

As much as possible, we want to avoid taking children to the emergency room unless it is truly an emergency. Wait times in the emergency departments are increasingly long, in part due to unnecessary visits. These visits also add to the burden of health care costs, as it is much more expensive to be seen in the emergency room than at an urgent care or a Pediatrician’s office. Today, I hope to shed some light on how we decide who needs to be urgently or emergently seen, and why. 

When to go to the emergency room

• Respiratory distress – shallow or rapid breathing, inability to speak in complete sentences, retractions (pulling in of the skin around the ribs or the collarbones with breathing in). 
• Altered mental status – confusion, disorientation, or if you are unable to easily rouse your child from sleeping. Concussion with loss of consciousness should also be quickly evaluated. 
• Obviously broken bones – any injury resulting in visible bony abnormalities should be evaluated by a specialist immediately for treatment to promote proper healing. 
• Life-threatening allergic reactions – swelling of the lips or mouth, difficulty breathing, or severe vomiting. 
• Severe abdominal pain – inability to stand up straight, walk or jump up and down due to pain.  
• Seizure activity – sudden, jerky, rhythmic movements in a child that is unresponsive should be evaluated immediately if there is no history of seizures in that child. 
• High fever (105F) that does not come down with medication, or any fever in infants under 6 weeks of age
• Dehydration – dry mouth, lack of tears, less than 3 urinations in 24 hours. 
• Severe chest pain – persistent or associated with difficulty breathing
• Suicidal thoughts/intentions – all concerns for safety with mental health warrant an immediate evaluation at an emergency room if a mental health facility is not available. 

When to go to urgent care

• Ear pain not managed by medication -if your child is in significant pain despite treatment with pain medications, you may consider going to an urgent care for evaluation. 
• Vomiting that is persistent (multiple times per day) – the concern for dehydration is high and may require medication to treat. 
• Open wounds/lacerations that require stitches – this must be done within 12 hours of the initial injury to prevent infection and complications. Also, many primary care offices do not place stitches. 

When to wait for your Pediatrician

• Sports physicals and well child checkups – your Pediatrician knows your child’s medical history better than any other provider. These visits should be easily scheduled in advance. 
• Cold/flu symptoms – this includes mild to moderate symptoms such as cough, nasal or chest congestion, fever, runny nose, sinus pain, and body aches. 
• Fever that has responded to medication – fever is not dangerous unless it is too high (over 105 and not responding to medication). If your child is over 2-3 months old and it is safe to allow a fever to run for a few days while you wait for your Pediatrician. 
• Ear pain managed by medication – if pain resolves with medication but then returns after it wears off, continue to treat until your Pediatrician’s office is open. 
• Constipation – this is a non-urgent matter that can cause quite a bit of discomfort but can be managed easily in the office. 
• Mild abdominal pain – there are multiple causes for this, but unless your child is in unrelenting and severe pain, the evaluation can wait. 
• Vomiting/diarrhea that is not severe – the biggest concern is for hydration. If your child is able to hold fluids down and is urinating regularly, schedule with your Pediatrician.  
• Sore throat – it is always important to evaluate for strep infections but unless your child is unable to swallow this evaluation can wait until the office is open. 
• Mild chest pain or other discomfort
• Pain with urination – evaluations for urinary tract infections are easily done in the Pediatrician’s office. If there is severe pain or blood in the urine you may consider urgent care instead. 
• Non-urgent mental health concerns (anxiety, depression, ADHD) – these evaluations should be done by the provider who knows your child best. The exception to this is any suicidal thoughts or activities, or concerns for safety. 
• Mild-moderate concussion symptoms – while concussions can have long-term sequelae, those without vomiting, loss of consciousness, or confusion can wait for the Pediatrician. 

Final thoughts

The bottom line is, if you are concerned about your child’s health, you should reach out to your Pediatrician. We are there for guidance, reassurance, and treatment when necessary. We are invested in the children we care for, and we always want to see your child if you have concerns. Whether the issue is an emergency, an urgent matter, or something that can wait until the Pediatrician’s office is open is something that many parents struggle with. It is my hope that the information given today can help to guide you in your decision making. 

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