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ER or Urgent Care?

ER or Urgent Care?

If your child has a fever, or gets banged up playing soccer, should you bring him to his regular doctor, or an urgent care center? Or even the ER? Here’s how to decide.

You’ve probably noticed the trend. Urgent care centers, many of them dedicated to pediatrics, are popping up everywhere. Most parents in the NY metro area have one, if not several, nearby. This new option has some parents wondering what the right choice is. Of course, every family needs a relationship with a pediatrician whom they like and trust, who knows their child’s medical history, including allergies. But when does a visit to an urgent care center or emergency room make the most sense? 

The first step is learning what your local urgent care centers offers—and when. A few urgent care centers are open 24/7, while others’ hours are hardly any longer than a typical pediatrician’s. Most fall somewhere in between. Call and find out, and while you have someone on the phone, ask for an overview of how extensive the center’s services are. Some are like mini ERs, offering IVs, for instance, while others are more limited. Armed with this information, a 2am decision between the urgent care and the ER will be a lot clearer. If you do have a choice, keep in mind that the wait at the ER will likely be much longer than at the urgent care. 

When you go to an urgent care office or emergency room, ask questions. “You want to make sure the doctor explains exactly what medicine he is giving and why. And get the results for any tests or cultures that were done,” says Blair Hammond, M.D., assistant professor at Mt. Sinai Hospital in Long Island. 

If results are not available right away, follow up and be sure the information is sent to your pediatrician’s office, so she can maintain your child’s records accurately and advise you on any necessary follow-up. “When an acute illness necessitates an urgent care or emergency room visit, it is best if follow up is done with the pediatrician,” adds Kerry Fierstein, M.D., CMO, Allied Physicians Group in Plainview, Long Island.

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Here’s a breakdown of which way to go in different scenarios.

Seizure or passing out: Head to the ER, even if your pediatrician is open, Dr. Hammond advises. ER personnel can do blood tests, get X-rays, and offer oxygen if needed. Young children, especially if they’ve lost consciousness or had trouble breathing, are usually seen right away. 

Sports injuries: If your child is injured on the field or court, head to the nearest urgent care center. “We see a lot of cuts, sprains and fractures from practices and games,” says Judah Fierstein, M.D., of Mt. Sinai Hospital Urgent Care in Manhattan. “Patients appreciate the speed of our services, that we run more efficiently than an emergency department.” In this situation, kids are often in particular distress, and not only because of the injury. They may be upset they’re missing the big game or the pizza party afterward, or embarrassed at the attention their injury drew in front of friends. The noise, crowding, and atmosphere of an ER can be unnerving to kids in any circumstance, but it will be particularly so now. 

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Fever: A high temperature can be scary, but try to remember it’s a sign your child’s body is busy fighting an illness, not an illness in and of itself. There are two instances when you should call the pediatrician immediately, day or night, Dr. Kerry Fierstein says. Those would be when infants younger than 3 months have a rectal temperature of 100.4 or higher, and when a child older than 3 months has a fever of 106. The pediatrician will decide if the child needs to be seen immediately or if it can wait until the morning. “In general we recommend tailoring the treatment to the child and not reacting to the height of the fever,” Dr. Kerry Fierstein explains. “For example, if the child is drinking, resting quietly and not in pain, the pediatrician will likely say that it’s OK to wait until the morning to be seen, and Tylenol may not even be necessary.” 

Strep Throat: Signs of this include sore throat, fever, and sometimes a stomache ache. Your pediatrician can easily diagnose and treat it. If it’s off hours, it’s worth it to head to the urgent care for a strep test, especially if you’ve heard strep is going around your child’s school.  

Vomiting and diarrhea: As unpleasant as it is, you should try to manage this completely at home. Most of these illnesses are caused by viruses, so there really isn’t anything a doctor can do to make it pass more quickly. Besides that, bringing a child in that condition into an office can infect other patients. “The recommendation is to keep the child hydrated by giving small amounts of liquid, as much as can be tolerated,” Dr. Hammond says. However, if symptoms are severe, lasting more than 24 hours, or if the child isn’t urinating, call your pediatrician. The emergency room or urgent care might be necessary for rehydration through IV fluids. 

Cold: At this time of year, one of the most common complaints is the seasonal cold, easily picked up at school. It can be treated at home unless a child is so stuffed up she has difficulty breathing or it goes on for more than 3 to 5 days. In those cases, make a pediatrician’s appointment. This isn’t serious enough to warrant rushing to the urgent care center or the ER.

Croup: This variation of a cold, which causes a bark-like cough and noisy breathing, is also common during the winter months. “If it’s mild, try sitting with your child in a steamy bathroom. If it’s more severe, or that doesn’t work, head to your pediatrician’s office if it’s open,” Dr. Hammond says. “If it’s not open, then go to either an urgent care center or to an emergency room. If he’s really struggling to breathe, then the emergency room is the best place to be monitored.” 

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