Nolan Alexander (Host): Welcome to Long Live Childhood, the pediatric health and wellness podcast presented by Rady Children's Health. I'm Nolan Alexander. And here to help us understand the differences between urgent care, the ER, and the pediatrician's office is Dr. Eric Ball, a Rady Children's pediatrician and Vice Chair of the American Academy of Pediatrics in California.

So, we're here to discuss the important distinctions and the best choices when evaluating urgent care, the ER, and the pediatrician's office when it comes to your child's health needs. So to begin with, first and foremost, Eric, how are you doing today?

Eric Ball, MD: I'm doing great. Thanks so much for having me today, Nolan.

Host: It's our pleasure. And as a father, I'm excited to hear your answers today. Let's start out with this. What are the key differences between a pediatrician's office, urgent care, and the emergency room when it comes to treating children?

Eric Ball, MD: I'd start by talking about the concept of what we call a medical home. So as pediatricians, we think it's really important for children to have one place, even one pediatrician where they can go for all of their medical needs. And this is important because we know our patients best. I have patients who I've known for two decades. And so, I know their past history. I know their families, I know what they need.

And so, ideally, you want to make sure that you are having a good connection with a stable pediatrician or other healthcare provider where you can go when you have emergencies or when you need help. We don't work 24/7. So, there are times where it's hard to get in touch with a pediatrician. We're always on-call. Someone could always reach a pediatrician if they need to, but there are times where a child needs to be seen urgently. And there's kind of two different options for that.

One is an urgent care center and the other is an emergency department. We like to leave emergency departments for true emergencies when you're worried about your child's imminent health or that they're in danger right away. Urgent cares are more for things that happen after-hours that you don't think can wait until the doctor's office opens the next day, but it's not severe enough where you need to actually take them to the emergency department.

Host: That's good to know. Can you share some common symptoms or situations where parents should go straight to the ER versus urgent care or calling the pediatrician first?

Eric Ball, MD: I think unless something is like dire, like your baby is bleeding out or having imminent breathing difficulties, it's often best to contact your pediatrician before you do anything and they can help you guide which way to go. So for example, in my practice here at Rady Children's Health, we have many options that patients can do and families can do after hours.

So if you call us, we could talk about those options. So, number one is there's almost always a pediatrician on call who can help and guide you to what's best for your child. Number two is at Rady Children's Health Primary Care Network. We actually offer after-hours telehealth services. So if it's something that doesn't need to be seen in-person or can be done via a telehealth call, we could actually do that at two in the morning if necessary.

Most pediatricians practices including ours, we also have advice nurses that work after hours. So if you need the dose of a medication or you want some guidance about what to do with your child, call the pediatrician's office and we could connect you to either a doctor or a nurse who can help guide you.

Host: So, you're saying don't be afraid to call after hours. There's a variety of ways you can be helped.

Eric Ball, MD: Correct. That's why we're here. Again, one of us is on-call 24/7, so you could always reach a pediatrician when necessary, and we can help guide the next decision.

Host: When do you feel like it's appropriate to wait for a pediatrician's appointment instead of seeking same-day urgent care?

Eric Ball, MD: There are lots of things that are very scary that happen to children that aren't necessarily emergencies or even urgent visits. So for example, fevers. Fevers are very scary when children have fevers. But if you have a healthy, well-vaccinated child who has a fever, even a relatively high fever, that often can wait until the doctor's office opens. We want to know why does that child have a fever? It's very normal for children to have fevers when they have viral illnesses such as colds or stomach bugs or those sort of things. So if the child is otherwise acting normally, not having breathing difficulties, not having such severe vomiting or diarrhea, or worried about dehydration, often you can treat that fever symptomatically and see the pediatrician in the morning. Same thing goes for things like vomiting and diarrhea, so those can often be treated at home symptomatically, and unless the baby or the child is showing signs of dehydration, that can often wait till the next day.

Host: What mistakes do parents most often make when deciding where to take their child, and then how can they avoid those?

Eric Ball, MD: I wouldn't necessarily call them mistakes, but there's a lot of things that are really scary. So, for example, when kids have fevers, they often are really tired or they're acting lethargic or just not themselves when they have a fever. So, sometimes there's an inclination to run to the emergency department where unfortunately they often get unnecessary tests and it's quite expensive. Whereas if you treat them symptomatically, maybe contact your pediatrician, find out some next steps, and then kind of see how this evolves at home when the medication takes hold, I think that's something that's an easily avoidable emergency department visit.

One of the things that we—like to me as pediatricians is we know our patients, so we often don't overtreat or overmedicate because I know my families and I know that if the child is not getting better the next day or the fevers persist, they'll call me. They know how to get in touch with me. If you take your child to an urgent care or an emergency department, there's a good chance that the person seeing your child there will never see them again. And so, there's a tendency for them to overtest, to overtreat, and sometimes that could be harmful for a child. So if it's possible, it's always best to take your child to someone who knows them and knows your family.

Host: Let's say it's in a situation that I feel like parents have been before, right? Two AM, there's a fever spotted within your child. Like, is there a checklist that comes to mind that parents can keep top of mind to help work through in a situation like that?

Eric Ball, MD: Yeah, that's a good question. I mean, I think the first thing I always look at is how is your child acting? So if your child is like, lethargic, not responsive, having trouble breathing, a lot of common sense stuff, go get help right away. I mean, sometimes those situations even require a 911 call if the child is otherwise acting relatively okay, but is just, you know, tired or little out of it because of the fever, and has other obvious symptoms that aren't too bad, a cough, a runny nose, things like that, it's very reasonable just to treat that fever at home and contact your pediatrician, if necessary, and possibly see them the next day.

The caveat with this is we're talking about children who are healthy, children who are vaccinated. If you have a child who has special healthcare needs, if they have a history of really bad asthma where they have a lot of breathing difficulties in the past, if you have a child who doesn't have their vaccines because they're too young or because they're unvaccinated, those are higher risk for kind of bad things happening when they have fevers and we treat those patients a little bit differently and a little more cautious. So, it's always best to contact your pediatrician or someone who knows their past history, because the guidance is so that's very different if you have a healthy 10-year-old with a fever versus, you know, a one month old with a fever or a two-year-old who has a lot of medical problems. So, contact your pediatrician and let us know so we can help guide you best.

Host: I think that's very important to distinguish a lot of differences there, Eric. I want to leave you with This, is there any other advice that you would give parents to help them make confident decisions in the heat of the moment, especially if it comes on nights, weekends, or any other stressful situations?

Eric Ball, MD: And this is what I do when my own children get sick or have fevers or, you know, wake up in the middle of the night with something, I always step back and kind of just look at the big picture. How was the child acting the day before? You know, what kind of symptoms do they have? How are they acting now? Most children when they're sick are still relatively okay or acting, you know, a little off, but otherwise are acting mostly themselves and that's really a good sign.

First thing I do as a pediatrician when I see a sick child and I walk in the room as I just assess, like, how is this kid acting? Does this look like a normal five-year old? Does this 10-year-old look like they're critically ill? And I start there. You know, if you have a child who otherwise is acting relatively okay, then you can kind of go through a checklist of symptoms like, are they breathing okay? Do they look dehydrated? So, are they like peeing? Are they able to hold down their fluids? And then, kind of make a decision based on that.

I try really hard with my own children and with my patients to try to keep kids out of the emergency department, as much as possible. We want to save those places for true emergencies—car accidents, breathing difficulties, heart attacks, strokes, things like that. And then also, medical spaces that aren't pediatric-oriented. For example, community emergency departments, most urgent care centers, they're not staffed by pediatricians or people who usually deal with children. And so, sometimes the care there isn't up to par and not the same care that someone would get in their pediatrician's office. So if it's something that can wait until the next day, if it's something could be handled by a pediatrician doing a telehealth visit or a phone call at night, I'd much rather do that because I think it's best for the care of the patient and the family.

Host: As a father, I feel so much more confident after hearing your answers today for when, unfortunately, the inevitable happens and you're dealing with a sick child. Dr. Eric Ball, thank you so much for your time and insight today.

Eric Ball, MD: You're welcome. Thanks for having me.

Host: Thank you for tuning in to Long Live Childhood, a pediatric health and wellness podcast, brought to you by Rady Children's Health. For more insightful conversations about kids' health and wellbeing, be sure to subscribe wherever you listen to your podcasts together. We can help keep kids happy, healthy, and thriving. If you enjoy today's episode, please consider downloading, subscribing, rating, and reviewing Long Live Childhood on Apple Podcasts, iHeartRadio, Spotify, or Pandora. Your support truly means a lot. And thank you so much for joining us today. Until next time.