Pediatrician, urgent care or the ER when your child needs care?
Having a good relationship with your child’s pediatrician is a wonderful thing but, depending on the illness or injury, sometimes the best care your child can receive is at an urgent care center or the hospital emergency department. Emergency medicine physician Jonathan Fletcher, MD, said there are certain times that urgent care is the best place to take your child, but he also stressed that you should not leave your pediatrician out of the loop.
“What I would actually recommend is, if your kid is sick, regardless of what it is, call your pediatrician first and get a sick child visit because that’s exactly what we’re going to tell them to do once they come see us,” he said. “At Urgent Care we’ll make an initial diagnosis, and maybe even start them on antibiotics. Then they already have a follow-up scheduled within one or two days with their pediatrician, who can make sure things are getting better.”
The mission of the Cape Cod Healthcare Urgent Care centers is to resuscitate and stabilize, Dr. Fletcher explained. Then follow-up care can either be at the hospital if the child is seriously ill or with a pediatrician if it’s not as serious. For example, a child with abdominal pain will always be sent to the Emergency Department because it could be appendicitis. While all Urgent Care centers have X-ray machines, Fontaine is the only one that has an ultrasound machine that can be used to diagnose appendicitis.
There are six Cape Cod Healthcare Urgent Care centers across Cape Cod. Hyannis, Harwich, Falmouth and Sandwich are open year-round and Orleans and Osterville opened in May for the summer season.
Reasons for ER Care
There are several other reasons a child might be sent to the Emergency Department for care.
“If a kid looks really sick from a respiratory virus and it’s croupy and they are wheezy and their oxygen is low, we’re going to probably give them a breathing treatment and maybe some steroids and then we’re going to send them to the hospital because a lot of times those kids need to be admitted,” Dr. Fletcher said.
Even though Urgent Care centers can handle broken bones, lacerations and burns, sometimes the child is so frightened or squirmy that the doctor can’t get a good exam, even with distraction. The hospital is able to offer sedation that might make the exam and treatment easier. This usually only occurs in children under five, he said.
In the case of burns and lacerations, Dr. Fletcher advises patients rinse the injured area really well with tepid tap water at home and then cover the wound with a clean dry bandage or hand towel and then come in to an urgent care center.
If the burn or laceration is in a sensitive area of the body, like the face, palm of the hand, sole of the feet or genital area, the Emergency Department might also be the best place to receive treatment for cosmetic reasons or because there could be nerve damage. Any laceration that has pulsatile bleeding where the blood spurts with every heartbeat is serious. Parents should call 911 in those cases.
If a child is disoriented or unresponsive, the differentiation of what it could be is too broad to be diagnosed at urgent care. The child could have gotten into grandma’s medicine or have a serious infection or vitamin deficiency. Since urgent care centers don’t have the ability to get bloodwork back or do advanced imaging, the emergency department is better equipped to treat those symptoms
Reasons for Urgent Care
That said, in general, 90 to 95 percent of all patients who show up at urgent care can, in fact, be treated there, Dr. Fletcher said.
If a child is vomiting a lot, an Urgent Care doctor can put them on anti-nausea medicine and put in an IV to give them fluids to prevent dehydration. Tick bites are also very commonly treated in the CCHC Urgent Care centers.
If your child has a fever that isn’t responding to acetaminophen or ibuprofen and they are tugging at their ear, have a productive cough and aren’t eating or drinking, Dr. Fletcher recommends that parents call your pediatrician to set up follow-up care and then come to Urgent Care for an immediate evaluation.
Parents sometimes see urgent care centers as a “one-and-done” solution, which can leave them frustrated when the doctors recommend sending the child to the hospital.
“If they understand that the expectation of the urgent care center is really to be evaluated by a medical professional quickly and then we make recommendations - and that could include going to the hospital - then I think if they have that expectation when they come in, they are much less frustrated.”
