Consider urgent care when you can’t see your pediatrician within a day or two and if: Your child has fever accompanied by cold symptoms and you suspect it may be something other than a run-of-the-mill cold.
When you can’t see your pediatrician right away, consider urgent care. If your child has a fever accompanied by cold symptoms and you suspect it may be the flu, head to the doctor’s office or urgent care where you can get an evaluation by a clinician who can treat your child onsite or send him home with instructions for self-care.
If your child has a fever and cold symptoms, consider urgent care. It’s often easier than waiting for an appointment with your pediatrician.
If your child has a fever and cold symptoms, take them to urgent care. An urgent care facility can quickly diagnose whether your child’s illness is something that needs further attention from a pediatrician.
Urgent care centers are designed to treat minor infections, lacerations and fractures in a timely manner. If your family member has high fever that is accompanied with cold-like symptoms, you may want to visit urgent care for a thorough checkup.
Urgent care for babies is a place where you can take your baby for prescriptions and emergency care when normal office hours are closed. Urgent care is not a substitute for urgent or emergency care.
Pediatric Urgent Care
t’s Friday afternoon and your 20-month-old son is running a fever. He is cranky, refuses to eat, periodically pulls on his ears, and isn’t his usual playful self.
Your reaction is:
a. No big deal. You call your pediatrician’s office and ask for an appointment the following week.
b. Dreading a fever-induced seizure — it happened to the child of a friend’s friend — you rush to the nearest emergency room.
c. Head to an urgent care center, such as Patient First.
If you picked A or C, you chose wisely. But unfortunately many clinical scenarios are not as clear-cut nor is the choice always obvious to parents and, for that matter, some clinicians, says Johns Hopkins Children’s Center emergency physician Therese Canares, M.D.
The result? A backlog of acute pediatric cases many of which don’t require emergency treatment, but a trip to the pediatrician’s office or an urgent clinic instead, Canares says. The problem gets particularly bad during the winter — cold and flu season — and in the summer, which brings its own set of childhood maladies.
Parents have a natural tendency to fear the worst when it comes to their children and often opt for a “better safe than sorry” course of action, Canares says, but the truth is many situations don’t warrant a trip to the emergency room. At the other end of the spectrum are cases that clearly require emergency attention but end up in urgent care instead — a less common scenario, Canares says.
“Urgent care versus the ER versus your doctor’s office: Some situations are no-brainers, but many fall in a gray zone of uncertainty. That choice can be particularly tricky when it comes to infants and young children, whose unique physiology dictates different levels of clinical assessment and treatment approaches from older children or adults,” Canares says.
For example, fever is always considered an emergency in infants under 2 months of age, but it’s less of a concern in toddlers or children, Canares says.
On the other hand, a fair number of children with broken bones are brought to an urgent care clinic when they should go to the ER, Canares says. Urgent care clinics can only deal with the simplest and most minor of fractures, yet many fractures are anything but. A fracture with a displaced bone often requires realignment under sedation, which is not something an urgent-care clinic can do. If you suspect a broken bone and you notice swelling, head to the ER, Canares says.
To ER or Not?
Sparing yourself and your child an unnecessary trip to the ER is not just a matter of convenience. A visit to the ER can expose your already sick kid to the ubiquitous hospital germs and other infections carried by fellow ER visitors. In addition, ER care generally more expensive than care received elsewhere. And because emergency departments are, by definition, designed to care for the sickest patients first, those with less severe illnesses are bound to have longer waits.
The Boom of Urgent Care: A Mixed Blessing
The rapid proliferation of urgent care centers over the last five years has been a mixed blessing, Canares says. On one hand, these walk-in clinics offer after-hours and weekend service, filling a much-needed gap in the care of patients who require prompt medical attention but who cannot be seen by their physicians on the same day. At the same time, many physicians and nurses who work at such centers may have minimal training in pediatrics and not comfortable treating infants and young children for anything beyond the simplest of ailments. A recent study published in the Rhode Island Medical Journal and led by Canares revealed that urgent care clinicians are particularly uncomfortable evaluating children for minor brain injuries, suturing a child’s facial cuts and caring for acutely ill young infants.
“Because many urgent-care providers are not comfortable treating certain pediatric cases, they preemptively triage them to the emergency department, even when these kids clearly don’t need emergency care,” says Canares, who has seen her fair share of referrals for basic colds and coughs show up in the ER, none of which warrant emergency treatment. The exception, Canares cautions, are children with underlying chronic conditions, such as asthma, congenital heart disease or sickle cell disease, which render patients with even benign viral illnesses susceptible to dangerous complications.
The lack of universal guidelines that stipulate what services should be offered in urgent care centers and what level of training providers should have, has spawned a mishmash of clinics, some offering fairly sophisticated care, while others providing only the most rudimentary, Canares says. For example, some urgent care centers have X-rays, ECG equipment and the ability to administer intravenous treatments, but many don’t. Some have in-house labs to perform on-the-spot urine and blood analyses, while others send the samples out.
“Urgent care is a great concept and critically needed, but we really ought to figure out how to ensure appropriate triage so patients who need emergency treatment don’t end up in urgent care and vice versa,” Canares says. The Society for Pediatric Urgent Care, established in 2014, is on a mission to reshape this rapidly expanding niche by developing guidelines on pediatric urgent care.
In the meantime, how is a parent to make the right call?
Canares and fellow emergency pediatricians offer the following guidelines but caution that the first step should always be calling your pediatrician’s office or an after-hours answering service to discuss the symptoms with a triage nurse or a physician.
Head straight to the ER if:
- Your child is less than 2 months old and has a fever. Fever is defined as a temperature 100.4 degrees Fahrenheit (38 degrees Celsius) or higher.
- You suspect your child has a broken bone, particularly if there is visible swelling or unevenness and bumps in the injured area — a sign that the broken bone is misaligned.
- Your child hits his head and appears to pass out or lose consciousness for a few seconds
- Your child has had a seizure
- Your child has signs of dehydration, such as very dry lips and mouth, absence of urination for more than 12 hours, lethargy and confusion
- Your child has heavy, fast breathing, is gasping for air or manages to utter only two or three words before taking a breath.
- Gaping cuts on the face, especially in younger children who need sedation or behavioral support while the laceration is being repaired.
Consider urgent care when you can’t see your pediatrician within a day or two and if:
- Your child has fever accompanied by cold symptoms and you suspect it may be the flu.
- You suspect your child may have an ear infection; symptoms include drainage from the ear, earache and pulling on the ears.
- Your child has a sore throat with or without white patches on the tonsils, a possible sign of strep infection.
- You suspect your child may have pink eye, also known as infectious conjunctivitis, symptoms of which include red, inflamed eyes with or without discharge.
- Your child has had a few episodes of vomiting or diarrhea (without blood in the stool) but has no belly pain or signs of dehydration.
As a rule, if your child is able to walk, talk, interact and play, chances are whatever she or he has is not an emergency, Canares says.
In addition, Canares advises calling the urgent-care clinic ahead of time to ensure they treat infants — many have age limits — and describing your child’s symptoms.
“Ask them if based on the age and symptoms, they are comfortable evaluating your child,” Canares says. “And do ask to speak with a clinician, rather than the receptionist. The last thing you want is to show up at the clinic with a sick kid only to be told you should make your way to the ER instead.”
When to Take Baby to Urgent Care for Cough
Kids get hurt. They run into walls. They eat rocks. They stick crayons in their ears, and they lose peas and pebbles up their noses. It’s a given. (My son ran into a wooden checkout stand less than 24 hours ago.) And because you can pretty much count on kids getting injured or sick after normal business hours, most parents have found—or will find—themselves looking at whether they should take their child to urgent care or the ER. After all, both handle emergency situations. So what should you do? Where should you go?
Here’s everything you need to know about your emergency healthcare for children, from the difference between the ER and urgent care to where you should go for a high fever or stomachache.
What Is the Difference Between the ER and Urgent Care?
As a general rule, urgent care is for minor, non life-threatening situations and the ER is for crisis situations. If you think it’s the type of situation that needs a follow up, like a sprained joint, go to urgent care. If you think your child needs major medical attention, like a major bone break, or might require continual observation, like trouble breathing, the emergency room is your best bet.
When Should You Go to the ER and When Should You Go to Urgent Care?
According to Oreste Joseph Bruni, M.D., ED Liaison at St. Joseph Hospital in Bethpage and full time attending physician at CityMD Urgent Care in Massapequa, New York, if you have a child under two months old, no matter what the situation: a bump, a bruise, a fever—go to the ER. Urgent care clinics are not equipped to evaluate or treat children that young. An emergency room will give you immediate access to a range of staff and specialists for a child that age.
“Children of that age present their illnesses differently and give very different signs to underlying problems,” says Dr. Bruni. “You need to be in a place that has a full staff on hand for a child that age.”
If you have an infant over two months of age, call the urgent care clinic ahead of time to ensure they treat infants. Some clinics have age limits and won’t take patients under a certain age. Make sure the facility works with children and is comfortable treating them. When you call, be sure to speak with the attending physician and be specific about your child’s symptoms. You don’t want is to go to an urgent care with a sick kid only to be told you should head to the ER instead.
Which Common Kids Health Conditions Should Be Treated at the ER?
While most bumps, bruises, or cuts are minor (and are usually nothing to worry about), it can be hard to tell if your child has a concussion or if there is an underlying injury that needs immediate attention. If the child is vomiting, seems disoriented, or is complaining about ongoing pain, skip the urgent care and go directly to the ER.
“You need to be in a place where a child can be monitored over the course of 24-hours. It may not require that—they may send you home—but an urgent care can’t provide that kind of monitoring,” says Dr. Bruni. In short, if your child needs to be anywhere other than home for a head injury, it’s going to be an emergency room or a hospital, so make that your first stop.
Foreign object[s] in the ear
Sad but true, this one is worth a trip to the ER. If left in there, or accidentally pushed in deeper by a frustrated child, it can cause pain, infection, or hearing loss. If you can’t see the object, chances are it’s far enough in there that you are going to need a professional that has worked with kids to get it out and an emergency room is your best bet. Because kids are very creative, it’s always a good idea to have the doctor check both nostrils as well as the ear cavities, while they’re at it.
Deep lacerations and/or broken bones
This is where you may start to worry about damaged tendons or even infection. Both Dr. Bruni and Mark S. Mannenbach, M.D. pediatric emergency medicine specialist at Mayo Clinic Children’s Center in Rochester, Minnesota, say if it’s a serious break or cut, go to the ER. “If the bone is sticking out, or if there is a laceration where you think you may have cut a tendon, go to the ER,” says Dr. Bruni.
If you can’t move a joint or use it for strength like squeezing, you’ve likely severed a tendon and need a specialist to repair it and evaluate it for underlying abnormalities.
Dr. Bruni says it requires a skilled physician to determine if you are dealing with a child who is suffering from appendicitis or a ruptured appendix and is in danger of going toxic. If your child has a fever and vomiting, accompanied by pain that starts around the belly button and seems to be migrating to the right side, go to the emergency room.
“You would not want to miss appendicitis. It could be deadly,” says Dr. Bruni. Most of the abdominal pain experts see is attributed to constipation; however, you never want to delay an appendicitis diagnosis. If you suspect appendicitis, the first stop should be the emergency room.
If your kid has a fever over 104 degrees Fahrenheit, Dr. Mannenbach and Dr. Bruni recommend you go to the emergency room. A fever that high can lead to seizures or serious dehydration, and both scenarios are best treated in a hospital setting. “An urgent care isn’t for seizures and if your child is dehydrated and needs intravenous fluids, you are going to want someone that specializes in working with kids to be doing that,” Dr. Mannenbach says.
That said, you should call a doctor if your child is less than 3 months old with a fever above 100.4 degrees F, between 3 and 6 months with a fever above 101 degrees F, or older than 6 months with a fever over 103 degrees F.
Which Common Health Conditions Can Be Treated at Urgent Care?
An emergency room visit will cost you more than a trip to urgent care, it will expose your child to more illnesses, and the wait is typically longer. For something like a persistent cough, the urgent care is the way to go. “You’ll be waiting in the ER for a long time for something like this. A cough will not take precedence over a major injury,” says Dr. Bruni.
Urgent care should be able to run all the necessary x-rays to determine the cause and treatment of a persistent cough and it will allow for follow up to see how things are progressing.
Swallowing a foreign object
Dr. Mannenbach says this is largely dependent on how the child is presenting at home, and what they swallowed. If choking is a real hazard or they swallowed something corrosive like a button battery or a detergent pack, call 911—your child may need to be air-lifted. If your child proudly announces from the back seat of the car that they ate a rock, the urgent care should be fine.
Your child may need x-rays and will probably require a 24-hour follow up with additional x-rays, which is easily done in urgent care, and you’ll get out of there much faster. “The x-rays are important and urgent care is great if you need a follow-up appointment, which you most-likely will,” says Dr. Bruni.
Split lips, eyebrows, and/or chin
This all depends on the severity of the cut and the placement. If the cut is very deep, both Dr. Bruni and Dr. Mannenbach recommend an emergency room. This will give you access to a plastic surgeon, and Dr. Mannenbach says most ERs are equipped with topical anesthetics that can minimize a child’s trauma when they’ve been injured.
If you are looking at a fairly minor cut, however, urgent care is fine. “Honestly, derma bond works great, is simple, and doesn’t require any needles. Urgent care will get you in and out and it’ll be covered by your insurance. I’ve seen plastic surgery bills for $18,000; you really have to decide if you think your kid needs that before you make your choice,” says Dr. Bruni.
What Can Parents Do to Better Prepare for Accidents?
Do Your Homework. Find out which emergency facilities in your area work with children your kid’s age. Your pediatrician’s office can give you tips, and can even recommend which facilities they are affiliated with. Most urgent cares do not have pediatricians on staff, so research beforehand if yours does. “Pediatrics is a specialty and the emergency room pediatricians have training that takes care of the unique needs of children. There is extensive training and experience in handling and reading patients that needs to occur in an emergency setting,” says Dr. Mannenbach. “Find out which facilities near you have an emergency pediatrician on staff.”
Know the Hours. One of the limits of urgent care is their hours. Urgent care isn’t meant for prolonged observation or treatment. If you are seeking emergency care for something that might observation, like trouble breathing or a head trauma, bring your child to the emergency room. “You definitely don’t want to go to an urgent care only to be turned away because they close in an hour. Do your research ahead of time,” says Dr. Bruni.
The Bottom Line
In the end, your choice between urgent care and ER may depend on proximity of facility or gut feeling—something that both doctors say a parent should always go with. It’s okay to assume the worst and be pleasantly surprised that your worries were worse than the actual diagnosis. “I’ve never seen a parent regret going to the emergency room,” says Dr. Mannenbach. “When your child is hurt or in pain, you have to make the best choice for them.”