Evo Terra (Host): This is Children's Health Checkup where we answer parents' most common questions about raising healthy and happy kids. I'm Evo Terra. And joining me today is Dr. Josh Haverland, a pediatric emergency medicine physician at Children's Health, for a conversation about when to take your child to the ER versus urgent care. Dr. Haverland, welcome to the show.

Joshua Haverland, MD: Hey, thank you guys for having me today. I'm happy to be here and happy to help out any parents who are wondering about their sick children, especially in these months coming up where cold viruses are pretty predominant

Host: Before we even get to the sick kids part, can you start by explaining the main differences between an emergency room and an urgent care when it comes to treating sick kids?

Joshua Haverland, MD: Absolutely. So, the biggest thing is that urgent cares are limited in what they can do and kind of limited in what they can take care of as well as the severity of what they can take care of. So, urgent cares kind of have the ability a lot of times to take x-rays, to do a simple strep or flu or COVID swabs. Sometimes they can check urine, but they can't do a lot of blood draws or more advanced imaging, and they can't really take care of kids if they're on the sicker side of things. In emergency department, we pretty much are the end-all, be-all, And we can take care of anything that rolls in the door from a kid whose parents think they're sick. But once we see them, we realize, "Hey, they're sick, but they're safe-sick" to the most severe ill kid that walks in the door. And so, in the emergency department, we have kind of everything at our disposal, everything at our access, whereas the urgent cares have a lot more limited resources.

Host: That makes sense and tracks with my knowledge of that too. I'm going to ask more about those situations where we want to go to urgent care. But before I do that, let's be very clear, what are the kinds of things, what symptoms, what situations arrive that a parent should always think of as a true emergency for children, and therefore going to the ER?

Joshua Haverland, MD: Yeah, absolutely. The biggest ones to think of when it comes to going to an ER is if your kid is having some severe difficulty breathing. And so, some kids may have a cough, but they're otherwise not working hard to breathe. That kid doesn't really need to go to an emergency room. But when your kid is actively working, and the way I sometimes explain it to a parent is it looks like that they just worked out or just ran up 30 flights of stairs and every breath they take, looks like they're breathing that way, they should be in an emergency department. Also, if they're working hard enough to breathe or they're having trouble completing sentences or not able to drink or feed themselves because they're too worried about their breathing, to do the other things like drink or talk, those are reasons to come to an emergency department.

Broken bones. So anytime, you see a deformity, so you look at an arm and, even as someone who's not medically trained, you're like, "Oh man, that looks broke," you should probably come to an emergency room as opposed to an urgent care. If it's a small amount of swelling, but the kid's-- let's say it's a wrist and they're still moving their fingers and it's just sore and it's like some swelling but doesn't look completely deformed, and you're like, "Oh, I don't know if this is broke or not," there's a good chance that an urgent care can probably take care of that. But if you see a deformity, that's a good reason to go to an emergency department.

Other things such as seizures, bad head injuries, those things should come to emergency departments as well as a lot of lacerations, which are cuts, should come to the emergency department. Very minor ones a lot of times can go to an urgent care. But a lot of times kids aren't super cooperative, especially if they're younger. So especially, like cuts on the face that might need stitches or some kind of repair, a lot of times if you go to an urgent care, they may refer you over to the emergency department to take care of those just because they may not be equipped to give the child something that allows them to repair it properly.

And so, larger cuts on the face of young children, bigger cuts in general anywhere should go to an emergency department, whereas little small cuts that may need a little bit of glue or maybe just one stitch or to be looked at, those a lot of times can go to an urgent care.

Host: That's very helpful. So flip side, some common things that you see in the ER that you really wish they would've went to urgent care,

Joshua Haverland, MD: Absolutely. We see a lot of kids that come in with a few hours of fever or one day of fever, but otherwise they're walking and talking and playing and eating. If your kids are still doing those things, the things that they normally do, but just a little bit less than they normally do, because they feel bad, those are usually a situation that can be seen in an urgent care. So, a lot of times, one to two days of fever can be seen in urgent cares. they can take care of that and they can kind of assess the child and make sure that they're safe for the time being.

Ear pain, sore throats, those are a lot of things that we end up getting in the emergency department that could easily be seen in an urgent care. They're capable of doing a strep swab and looking at an ear and things like that. Minor injuries such as ankle sprain or, you know, jammed fingers, that kind of thing or like we talked about earlier, some swelling to an area after an injury that doesn't look obviously deformed, those can usually be taken care of at urgent cares. Or if a kid's having a little bit of vomiting or diarrhea, but it hasn't been going on for days, they're still making some wet diapers throughout the day, those kids usually aren't severely dehydrated and a lot of times can be treated with just some medication to resolve the vomiting and get them drinking again and taking things by mouth so that way they can keep themselves hydrated. Those types of things can go to an urgent care. But like I said, if they're walking, talking, those things are perfectly fine to be seen at an urgent care.

Host: My son at three years old got a massive goose egg on his head from running into a wall, because we were playing with him, freaked me out. If you would've been there with me, what would you have counseled me to go to, emergency room or urgent care?

Joshua Haverland, MD: Yeah. Head injuries are tough ones because they're definitely ones that worry parents a lot of times. Especially on the forehead, you can get huge goose eggs, a large amount of swelling. One thing that you can do is if you're kind of in that in-between area, you can actually call in urgent care and ask them, "Is this something that you can see me for, or is this something that I need to go to an emergency department for?" So, that's one way that you can look at it.

The other way to look at it is that if a kid has a goose egg, but is otherwise talking normally, didn't have a seizure with it, didn't have a loss of consciousness, isn't vomiting and is otherwise acting like themselves other than just having a big goose egg, a lot of times that's something that can be seen in urgent care or sometimes even watched at home depending on what it is. But definitely, if there's a loss of consciousness associated with it, vomiting, the child's not acting like they normally would, those were definitely good reasons to come to an emergency department to be evaluated.

And it doesn't necessarily mean that we're going to do anything or a lot of times we don't take pictures of these kids. But being evaluated by somebody such as myself who sees three to four head injuries every single time I go to work and I have three boys at home, so even on days I'm not at work, I usually see head injuries. Somebody like me who takes care of this all the time can take a look at your kiddo and decide, "Hey, we're in a Safe spot," or "Hey, we need to take some imaging such as a CT scan to make sure that there's nothing else worse going on."

Host: Something strikes me, you mentioned making a phone call to find out. Well, 35 years ago we didn't do this. But now, we have these virtual visits, now we can send messages to doctors. How do parents know? Should they even think about that? Should they think about going through these virtual options as well?

Joshua Haverland, MD: Yeah. Like we talked about, if your kid's eating and drinking and otherwise playing and walking and doing those things, but just they're sick along with those things, a lot of times that's something that can be taken care of with a virtual visit and you can kind of explain the symptoms and they can evaluate it.

And, a good doctor, whether it is your pediatrician or an urgent care, a virtual visit, if it's something that when they see it or hear about it, they're like, "This doesn't sound like it's a safe situation," the next step is usually referring to an emergency department where we can evaluate or we can take interventions if we need to.

And so, it never hurts to reach out to your pediatrician, or to have a virtual visit if you have that access and see what they think. And hopefully, when you explain to them what's going on, when they're looking at your child on that virtual visit or in the pediatrician office, if they're concerned, they hopefully will refer you to the emergency department. And we have a lot of patients that come in that way that have gone to their pediatrician office, and the pediatrician has seen them and recommends that they come in to see us in the emergency department or have gone to an urgent care. And it's beyond the scope of what they can take care of, and then get sent in to the emergency department to be evaluated further.

Host: I know that we try to be rational as parents, but sometimes it just kind of goes out the window at some times. And, you know, we're forced to choose what do we think the right thing is, if we are paralyzed by those choices, what should the default choice be?

Joshua Haverland, MD: The first step is make a choice. The good thing about the emergency department is we're there all the time, right? Whether it's 6:00 AM on a Saturday or midnight on a Wednesday, somebody's always there. And you don't always have that access with an urgent care with your pediatrician's office. And so, sometimes, as a parent who's not medically trained and you're like, "I think we're in a bad spot," you have to go off your intuition and say "Hey, I think we need to be seen by somebody." And we're totally okay with that in the emergency department. We're there to help out.

We realize that this may be the sickest your kid has looked and it may be 20th sickest kid I've seen that day, but it may be the sickest your kid's looked. And even if it's something that we don't feel like there's a lot of interventions or anything we necessarily need to do, to give you the reassurance, to give you kind of the things to look out for, to give you kind of the recommendations for what we call supportive care, which is whether it's Tylenol and Motrin and hydration, the things that'll hopefully keep your kid from reaching that next level of being ill. And so, the good thing is in the emergency department, someone's always there. And so, if you can't get in to see your pediatrician, urgent cares are closed, or there's not an urgent care nearby that can take care of kids, we're always there in the emergency department.

And the other important thing for parents to understand is that with kids, not everybody is trained to take care of kids of all ages, right? And so, emergency room physicians and adult ERs, they can take care of children, but they just don't do it near as much as we do. So one of the things I like to tell my friends, especially when they're having kids is that, "Hey, if you need more than a throat swabbed or a fever to look at or an ear checked and you're legitimately worried about your kid and making sure that you're taking them to a pediatric emergency department, if there's one available. As long as your kid's breathing okay, and you can drive there safe, going to a pediatric emergency room over an adult emergency room generally leads to a better experience and better care, just because all we do is take care of kids, whereas adult emergency departments, they take care of kids, but they take care of a much larger section of adults than they do children.

And so, we're a lot more comfortable with the things that we see and feel more comfortable in that space. And so if your kid's doing okay, taking that extra five or 10 minutes or whatever the drive is to get to an emergency room at a pediatric facility, a lot of times can be beneficial and you can have a better experience as well.

Host: Final question, you got any tips to help parents stay prepared for those urgent situations or even the emergency situations, especially, you know, nights, weekends, and holidays?

Joshua Haverland, MD: During those times, I mean, things that I always keep around the house are Tylenol and Motrin. You never know when a fever is going to pop up. And then, just remembering as a parent, a few things that I like to tell people is that when your kid has a fever and you give them Tylenol or Motrin, that fever won't come down immediately. That takes time to happen. So, I see a lot of parents come in, they're like, "Oh, my kid had a fever. I gave them some medicine. It was higher an hour later." But it really just takes time for that medicine to start working. And as long as that fever is coming down in between, and it will, if you're giving the proper dose for their size, and then, they go back to eating and playing in between those fevers, it's something that, you know, can make you feel a lot better. Once that fever breaks, you have your kid back again for a little bit. And the fever will come back and they'll just kind of sluggish and glazy-eyed. And that kind of thing when that fever does come back. But usually, once that fever is getting better, they'll feel better.

The other thing I tell people is that making sure that if you have young children, because a lot of times if you've got a young child, it may be their first or second illness or maybe the first-time they're struggling with something. And even as adults, we don't eat and drink as much when we're sick. We sleep more. We feel like trash. And kids are the same way. And so, don't expect them to be their normal when they're sick. We just need to be doing good enough. And I usually tell people as far as like drinking goes and eating goes, as far as hydration goes, if you've got a young kid in diapers or a younger kid who's potty trained, we're making three wet diapers every 24 hours, or avoiding three times in 24 hours. Even if we're not drinking and doing our best, we're usually doing good enough, and that's all you need to really expect at that point.

The other thing to think about is if you have a small baby who's less than two months old. Those kids should always come to the emergency department with a fever, whereas older kids can be seen at urgent cares and things like that. But a baby that's less than two months old should always come to the emergency department for a fever. And that's one of those things that we didn't talk about earlier.

But generally, you know, like I said, the emergency department's always there. We stay open 24/7, holidays, weekends, all the time. And so, as a last case resort, we're always there to help out. And, you know, we don't mind, even if ultimately we're like, "Hey, your kid's doing fine." It doesn't bother us to help give that reassurance and help parents out in their time of need.

Host: Dr. Haverland, thank you very much for all the information today.

Joshua Haverland, MD: You're very welcome. Happy to be here, and thanks for having me on.

Host: And you can always refer to childrens.com/ervs-- as in versus-- urgentcare. Again, that's childrens.com/ervsurgentcare if you have any additional questions. Thank you very much for listening to Children's Health Checkup. If you found this helpful, please rate, review. And share the episode, and please follow Children's Health on your social channels.