Should I Take My Child to the Emergency Room?
Robert P. Lindeman, MD, PhD
Natick Pediatrics, PC

When I was growing up, the phrase "emergency room" was always preceded by the phrase "rushed to" as in "He had to be rushed to the emergency room." By the time I graduated from medical school, however, the two phrases had become separated. To be sure, thousands of seriously ill or injured patients are rushed to emergency rooms every day. Increasingly, however, emergency rooms are being used for, well, non-emergencies.

The fear factor
It’s scary to take care of a sick child. The later in the evening it gets, the scarier it gets. This is a natural human response. We’re much calmer and more rational in the light of day. Many parents will take a sick child to an emergency room without calling the child’s doctor first. Granted, the parent may be suffering from cloudy thinking, due to the lateness of the hour and the stress over the child’s illness. Or, the parent may not want to wake up the doctor in the middle of the night.

This is an understandable response, but it’s a mistake. We doctors keep our beepers by the bedside because we want parents to call us, at any hour of the day or night. I feel bad when a parent tells me he didn’t call because he didn’t want to bother me. Most of the time, if I speak to the parents, I can help calm their fears, but more important, I can offer suggestions for making the sick child more comfortable until I can see him or her in the morning.

The doctor told me to go!
Sometimes, the parent calls the doctor appropriately in the middle of the night, but the doctor on call inappropriately tells the parent to bring their child to the emergency room. Some doctors are so afraid of being sued that they will always err on the side of caution when a worried parent calls in the middle of the night, especially when the doctor doesn’t know the family and cannot be sure the child will be brought to a doctor the next day. This happens less often when the doctor takes calls for his or her own patients. If the doctor knows the child and has a bond of trust with the parents, doctor and parents can more easily work together and plan for the child to be seen the next morning.

ER doctors vs. primary care doctors
Another reason why parents are bringing their children to emergency rooms for non-emergencies has to do with a common misunderstanding about what emergency rooms are designed to do. Many people believe that the medicine practiced in ERs is essentially identical to medicine practiced by primary care doctors. This is far from the truth.

Emergency rooms are for critically sick and injured people. ERs are set up to diagnose, treat, and, if necessary, transfer sick and injured people to places where they can be properly cared for. ERs are not designed to diagnose and treat non-life-threatening problems. This is part of the reason why children with non-emergent problems and their families are made to wait for hours to be put into a room, and then there are further waits to see a doctor. Non-emergently ill children have to wait while the busy ER staff takes care of patients who are coming in by ambulance, and who require immediate time and attention.

Emergency physicians generally lose contact with the sick child after the child leaves the emergency room. Because it is likely that these doctors will never see or hear from the sick child again, emergency room physicians will likely "err on the side of caution." This often means writing prescriptions for an antibiotic that a child might not need, or ordering blood tests and x-rays that might not be necessary. By contrast, when a sick patient is brought to see me in my primary care office, I already know the family, I know their phone numbers, and I can call the patient the next day to make sure the treatment plan is working. And I’m not tempted as often to err on the side of caution. This means my patients get fewer unnecessary tests, x-rays, and prescriptions.

Sometimes it’s okay to be sick
There are two more factors driving families to emergency rooms for non-emergencies. One is our society’s impatience with illness. When we have kids, we need to get them to school so that we can get to work on time, so that we can get back to take the kids to after-school activities, and get home in time for dinner…a sick child can really disrupt the day. It’s natural for some parents to want their sick child to get better as soon as possible. Unfortunately, 24-hour access to physicians in emergency departments is not the proper prescription for shortening the course of most acute illnesses. In fact, the amount of sleep that is typically lost waiting in emergency rooms can make recovery from many illnesses slower!

One more problem: too often parents are given positive reinforcement for bringing their children to the emergency room for non-emergencies. With the best of intentions, the emergency room staff, and even the child’s own pediatrician, will tell the parents that they did the right thing by going to the ER in a non-emergency. It’s only natural that parents, their neighbors, and finally entire communities learn (mistakenly) that one is supposed to take a sick child to an emergency room in a non-emergency! I try to dispel this myth with my patients. In my office, I often spend a few minutes at well-child visits to go over with parents how to identify an emergency situation, whom to call, and what to do. I’ve outlined these guidelines below.

The importance of being pediatric
If my patients do need to go to an emergency room, I always recommend that, if it is safe and reasonable, the parents take their child to the nearest emergency room that is staffed by pediatric emergency doctors. Pediatric emergency specialists tend to be better at knowing when a sick child doesn’t need antibiotics or lab tests. Many hospitals in larger cities employ pediatric emergency specialists 24 hours a day. Today a growing number of hospitals in the suburbs have pediatric specialists for at least part of the day. Unfortunately, it is often the case that the pediatric emergency specialist is not working past midnight, just when anxious parents are most likely to take their children to the emergency department. That’s why I recommend that parents with sick children call me earlier rather than later in the evening, before the anxiety level gets too high!

The bottom line: When to go, when not to go

You should take your child to an emergency room when your child has:

• severe difficulty breathing
• multiple or serious injuries, including broken bones
• severe allergic reaction (swollen lips, swollen tongue, difficulty breathing)'
• bleeding that won't stop

Even so, it is a good idea, when possible, to call your primary care provider before taking a child to an emergency room.

You should call 911 if the child:

• is not breathing or is turning blue
• has sudden unconsciousness or cannot be awakened
• is having a seizure (convulsing)
• has severe unstoppable bleeding

You should call the Poison Center at 1-800-682-9211 if you believe your child may have eaten a poison or other toxic substance.

Unless directed to do so by a primary care provider, you should not take your child directly to an emergency room for the following reasons:

• fever
• ear pain
• flu
• colds
• minor sprains
• nausea
• stomach pain
• headaches
• sore throat

And when in doubt, call your child’s doctor. That’s what he or she is there for.

For more information about Natick Pediatrics, or to talk to the doctor, please call the office at (508) 655-9699.

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Medical Office Building
MetroWest Medical Center
Leonard Morse Campus
67 Union Street, Suite 305
South Natick, MA 01760

(508) 655-9699
(508) 655-2984 fax

Posted: November 15, 2002