Keeping Your Kids Out of the Emergency Room: A Guide to Childhood Injuries and Illnesses

By Christopher M. Johnson, M.D.

Last year Americas 76 million children made 27 million visits to emergency departments. hat is aro!nd one visit "or every three children. #" co!rse some children acco!nted "or more than a single visit. $ven so, the "act that a third o" all o!r children going to the emergency department each year is a so%ering statistic. &as yo!r child one o" them' (" so, yo! pro%a%ly )no* the di""ic!lty in deciding i" and *hen it is time to ta)e yo!r child there. +ometimes it is easy to )no* *hen to ma)e the trip,,an o%vio!sly serio!s in-!ry, "or e.ample,,%!t o"ten it is very hard indeed to decide. his is especially so "or parents o" small in"ants, *ho acco!nt "or a large proportion o" children visiting the emergency department. /arents appropriately tend to err on the side o" pr!dence0 they %ring their child in *hen they are !ns!re i" the pro%lem can *ait or not. 1s!ally this means deciding i" their childs pro%lem can *ait !ntil morning, %eca!se three,2!arters o" childrens trips to the emergency department happen d!ring the evening or nighttime. (" yo! have ever visited an emergency department *ith yo!r child, yo! pro%a%ly noticed that, *hether %ig or small, emergency departments are not set !p "or e""iciency "rom a parents perspective. 3ather, they are designed to %e e""icient "rom a doctors perspective and that o" a critically ill or severely in-!red person. hey are set !p to %e ready "or anything on a moments notice. Li)e a "ire department, an emergency departments sta""ing and e2!ipment arrangements need to %e appropriate "or a *ide

variety o" *orst case scenarios. L!c)ily, very, very "e* o" the millions o" children *ho come to the emergency department need these things. B!t the "acility needs to %e ready, -!st in case. his need inevita%ly %!ilds an enormo!s ine""iciency into the system "rom the over)ill o" %eing al*ays prepared "or s!ch rare sit!ations. Many emergency departments also operate *al),in clinics "or children, o"ten ad-acent to the "!ll department. hese, too, are o"ten c!m%ersome, ine""icient places to get yo!r child needed care. 4or one thing, since yo!r childs reg!lar doctor is not there, they do not )no* her. 4or another, *al),in clinics are also e.pensive to r!n,,not so e.pensive as a "!lly e2!ipped emergency department, %!t still 2!ite costly. 5et another reason to avoid these "acilities is this6 i" yo!r ins!rance coverage has an o!t,o",poc)et co, pay, as most do, it *ill pro%a%ly cost yo! more than an e2!ivalent visit to a doctors o""ice. &hy is that' he main reason is, altho!gh they might have portions o" her previo!s medical record to cons!lt, really these ne* doctors do not )no* yo!r child at all. +o they are m!ch more inclined to order tests yo!r reg!lar doctor *o!ld not need. #" co!rse i" yo! do not have health ins!rance, yo!r %ill "or going to an emergency department or *al),in clinic *ill %e very m!ch higher than it *o!ld have %een "or getting the same care at a visit to a doctors o""ice. he "act that emergency departments are str!ct!red this *ay can %e an enormo!s "r!stration "or parents *hose child is not critically, or even serio!sly ill. (t is -!st hard "or parents to )no* *hich pro%lems sho!ld %e seen right a*ay, *hich can *ait "or later, and *hich pro%a%ly do not need to %e seen %y a doctor at all. D!ring my years *or)ing in the emergency department ( o"ten "o!nd that *hat parents really needed *as not so m!ch medical care "or their child as it *as simply in"ormation0 had they already )no*n *hat (

told them d!ring my eval!ation o" their child, they o"ten co!ld have avoided the emergency department visit altogether, or at least p!t o"" their midnight tre) !ntil the ne.t day. his %oo) *ill give yo! speci"ic in"ormation a%o!t the ailments that most commonly lead parents to consider %ringing their child to the emergency department or a"ter,ho!rs clinic. he goal is to give yo!, the parent, insight into ho* *e doctors loo) at things, ho* *e decide *hat is serio!s and *hat is not. (t *ill also descri%e "or yo! *hat care yo! sho!ld e.pect to receive *hen yo! %ring yo!r child there, as *ell *hen yo! sho!ld consider insisting on more than is o""ered to yo!. his %oo) is not a s!%stit!te "or a doctors eval!ation, and it is certainly not an invitation to practice medicine on yo!r children. 7othing can replace *hat a doctor does. B!t over the decades ( have practiced emergency pediatrics, ( have "o!nd that nearly all parents, *hen given speci"ic in"ormation a%o!t ho* doctors eval!ate children in the emergency department, ma)e e.cellent decisions a%o!t *hat their child needs. A"ter all, no one )no*s a child as *ell as his or her parents.