If you have kids, you've been there... Its the middle of the night and something's not quite right with your little one. Is it an emergency? Should you wait until the morning? How about a compromise and just go to urgent care? I know, you try to get an appointment for your doctor and they don't have any openings for WEEKS. You can't wait that long.
There is a fairly new buzzword in the medical community called 'access'. Which just basically asks if your patients have access to your care in a reasonable amount of time. Most pediatrics clinics, as a result have put a high priority on getting same-day access to your physician. So hopefully the days of waiting days and weeks to get in to your child's doctor are over. In the busy winter months you may have to wait a day or so, but most clinics that are up to speed should be able accomodate.
I'll be honest. Most ER's and Urgent Cares don't have a guy like me (a pediatric guru/pediatrician)available to them, and when it comes to non-emergent cases, provide very poor care. Sure you may get your answer more quickly, but its likely to be the wrong one and you are going to pay more in copays,etc for it. Don't get me wrong, there are some excellent clinicians that work some of these late night places, but you, as a patient, aren't going to have any idea (see my first post ever). And, the numbers of good docs to bad docs in many of these places is pathetically low. To their credit, they are usually good in emergent situation, which is what they are trained for.
So I thought I'd give you a list of symptoms/situations your child may have and a breakdown of the severity in case one of these sneaks up on you in the middle of the night (this list is not exhaustive, but I tried to think of the most common - it may be a big mistake on my part to try it - remember disclaimer to the right):
Call 911:
Stops breathing/turns blue and stays blue
Seizure that doesn't stop
Passed out and not waking up
Difficulty breathing after contact with something they are allergic to
Concern that your child may have swine flu - PLEASE NOTE ITALICS HERE
ER:
Fever and stiff neck/baby's fontanelle(soft spot) is bulging
Persistant difficulty breathing (with asthma or otherwise) - this can be breathing fast that doesn't slow down, persistant skin sucking around the ribs, and/or difficulty getting out a few words
New or first seizure that stops on its own
Not very responsive, difficulty waking up.
Fever >105 (I might lower this to 104 for older kids >7-8 year old range)
A baby less than one month old with any fever (>100.4)
Your child is not acting like themself after having vomiting/diarrhea and being unable to take fluids
Fever and refusal to walk/excessive bone/joint pain
Lip/facial swelling after contact with something they are allergic to
Pain that is so intense it cannot wait for an appointment (wherever it is located)
Urgent care or ER:
Suspect a broken bone or may need stitches (actually these locations are probably better than your general pediatrician with these issues)
Head injury with loss of consciousness, but doing okay now
Persistant asthma that has difficulty breathing that comes back less than 3-4 hours after albuterol treatment.
**general note: Urgent Care facilities are good for injury-type complaints, but will otherwise usually give poor medical care for kids
Wait until the next day and see your pediatrician:
Almost anything else that is abnormal, but your child is eating, breathing, and acting normally otherwise
High fever, unless it gets above 105 or there are other symptoms you are concerned about
Anything that has been going or for days and didn't get suddenly much worse
Swollen lymph nodes
Persistant asthma but able to breath comfortably for several hours after breathing treatments
Baby is fussy and won't stop fussing (unless they really seem to be in great distress)
Your child is still acting like themself, but has been unable to keep and fluids down for >24 hours due to vomiting
Runny nose, cough, etc.
***If you have any additions/suggestions/questions feel free to comment, and I will try to update the list.
I am a big fan of mother's/woman's intuition, so if you REALLY think something is emergently wrong take your child to the ER, even if they don't fit a category above.
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6 comments:
Just FYI, the braille in this picture is way wrong and pretty much doesn't say anything.
maybe pediatric residents admit so many low acuity pediatric patients from the ER in the middle of the night because their pediatric clinic colleagues send low acuity patients to the ER instead of direct admitting...
such generalizations do not become you dr. jay...:)
For the record, the annoying calls I get in the middle of the night aren't for admissions, they are for basic medical problems that the ED staff doesn't know how to deal with because "well, its a kid". Issues that would be an easy clinic visit. And no, its definitely not all of them.
Knowing you Dr Paul... I would get no such calls from you (or any other ED doc who trained where you did), but unfortunatley they are not all privy to a Loma Linda education.
My point was not to desparage ED docs (or urgent care docs for that matter), but to keep the patients going to the right place for the right care. Keep the emergencies in the ED, keep the runny noses in clinic (and in normal waking hours).
For the record, I would trust you with the care of my kids than many pediatricians I know. Outside of Loma Linda, however, docs like you are a little more rare.
i like your approach here though. we in the ER are definitely not set-up to handle non-emergent problems that are better watched over time.
when parents come in for an answer right away, their kids are often subjected to more testing, IV sticks etc. etc. because there was not baseline familiarity with the family and the kiddo.
i couldn't resist commenting..:)
that last comment was paul (not amy...)
And for the record, I read over it again, and I do believe I said 'most' not all.
The current place I work actually has a pretty good urgent care, and most of the ED physicians are great with kids.
But there are many urgent cares (and EDs) that provide scary care for kids, so I think its best in most cases for parents to wait until they can see a pediatrician for non-urgent/non-injury cases.
I was thinking with the original post to add a statement like... "If you do feel the need to go to the ED in the middle of the night for a non-urgent case, at least go to one with a pediatric ED or children's hospital." But I thought that would be too confusing. Honestly going to such places, you will likely get just as good of care as the clinic, but copays will be higher and number of invasive tests (as you mentioned) are likely to go up. - so there I said it.
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