Prakash Chandran (Host): For children, getting sick or injured from time to time is normal, but how do you know if it's time to call their pediatrician, go to urgent care, or go to the emergency department? Here with us to discuss is Dr. Rudy Kink, a pediatric emergency medicine physician at Le Bonheur Children's Hospital.

 Welcome to the Peds Pod by Le Bonheur Children's Hospital. I'm Prakash Chandran. So Dr. Kink, thank you so much for joining us today. I really appreciate your time. I wanted to just get started with a very broad question. Where should I go, I have two children, for my child's medical care.

Dr. Rudy Kink: You know, that's a great question. Some of it depends on what do you think is going on with your child and the time of day. A lot of pediatrician's offices close or some do have extended hours. So if your child has a simple fever, a headache, a sore throat, something that could be taken care of by evaluating at a pediatrician's office, it would be a great place to go. After hours, or if you think it's a little more serious, like laceration repair, a broken bone, an urgent care is a great place for that where x-rays can be done and kids can have cuts sutured and fixed. If you feel it's more life-threatening like an acute appendicitis or trouble breathing, that's when you need to go to the emergency department.

Host: I see. So, you have to try to evaluate what is the severity of what my child is experiencing, right? Like, if it's seems like a serious cut that needs to be addressed immediately, that is probably something where the emergency department might be good to go to, but if it's something that, "Hey, this isn't going to heal, it should be attended to," then maybe urgent care might be a better bet. Is that fair?

Dr. Rudy Kink: Yeah, that's a fair assessment. And just always remember, your first call can be to your pediatrician's office and you can ask them their recommendation. And it usually has someone on-call 24/7.

Host: Okay. I think that's an important point that most parents may not know that at the pediatrician's office, even though they may not be able to see you immediately, they can best advise you, right?

Dr. Rudy Kink: Correct. Triage you, per se. And they know your child.

Host: Okay. That totally makes sense. So when we talk about the emergency department, now you talked about one circumstance like appendicitis that, "Hey, this kind of requires emergency department," is there other rules of thumb where you might say, "Hey, I think it's time to go to the emergency department for something my child is experiencing"?

Dr. Rudy Kink: Oh yeah, couple things. One, if you're in a serious motor vehicle collision, if your child was struck by a car, obviously, the paramedics are called, those need to be taken to the emergency department. If your child has serious chronic medical conditions like diabetes and things like that, and those are getting to be high blood sugars or problems with those medical conditions, those are the ones that really do need to go to the emergency room.

Host: Yeah. I can understand that. And sometimes, I actually just experienced this the other day with a friend, their child had taken a fall and I think a rock had gotten in their eye. And he was crying and crying and crying and just really not crying like anything you've experienced before or that parent had experienced before. I think there was a concern and this urgency to want to run to the emergency room, but that situation specifically doesn't sound like one of the ones you mentioned. That seems like something that urgent care could be able to handle. Is that fair?

Dr. Rudy Kink: That's a fair assessment. So when you look at injuries to kids, it's kind of hard because you have to assess it. Now, we do have children who are playing sports and they break their arm and it's pretty obvious, those injuries do need to go to the emergency room and not to an urgent care. But if they think that the kid's arm may be broken or may be sprained, an urgent care is a great place to start off with because they can do x-rays and things like that.

Host: Right. I had heard once this whole evaluation of loss of life or limb. And I think that it's the same with the child, right? If it's something where, you're concerned about a child's actual life here with what they're experiencing, or their limb is potentially at risk for either growing in the wrong way or not being there anymore, then that feels like a good emergency room situation.

Dr. Rudy Kink: I would completely agree. And think about some of your children who have food allergies. If they are allergic to peanuts, and they ingest peanuts, and they start to develop a rash, that's an emergency room. As spring is right around the corner, if you get bitten by a venomous snake, that's an emergency room visit, or by any type of a snake, and you're unclear of what it is. Those type of things. Asthma exacerbation, if your child has asthma, and has trouble breathing, those are the ones that we would love to see and treat in the emergency room.

Host: Okay. So, I believe that we've covered this difference between the emergency department and urgent care. I think it's pretty clear. But now, talk maybe a little bit about the separation between when you go to urgent care versus when you see your pediatrician.

Dr. Rudy Kink: You know, those are great questions. A lot of it would depend on what your pediatrician can do. Some can do your regular routine screening. If you feel your child has COVID, flu, or RSV, a lot of pediatricians offices can screen for that. If your child may have some pain with urination and you feel they may have a urinary tract infection, offices can check a urine, but a lot of offices cannot do x-rays. So if you feel your child has like a pneumonia or a sprained ankle or a broken bone, or maybe even need to have a cut repaired with some stitches, some offices do not perform lacerations. So, that's best to discuss with your pediatrician at the next visit what can they do for your child in the event that they're injured or sick.

Host: Yeah, I think that is an important point that you just made, just almost proactively talking to your pediatrician to say, "Look, things are going to happen with children. What can I expect you to service versus when should I go to something like an urgent care?" I think that's a really strong point there.

Dr. Rudy Kink: Yeah. Because urgent care can do a lot of those basic x-rays that you would need in laceration repairs that address any type of minor scrapes and bumps.

Host: Right. So, it seems like there's the well visits or the regular visits to keep up with your child's health. There is proactive questions that you should ask. That feels like a pediatrician will be able to guide you right around what they can and cannot do., Also when something happens, they 24/7 access to where they can pre-triage for you for urgent care. And then, urgent care is when it is more severe or it's something outside of the scope of the pediatrician. You should go there. And then, the loss of life and limb type of thing is the emergency department.

Dr. Rudy Kink: Correct. I completely agree. And, you know, the urgent care can also direct you, that if they feel something is a little more serious than what was initially thought, they'll direct you to the emergency room as well. So, there's a couple built in safeguards along the way.

Host: Okay. Now, there are parents who are on the other side of things where they're like, "That's probably fine. It'll probably heal itself," when something happens to their child. Talk to us about when parents have that type of disposition. Do you have any thoughts around, "Hey, You really should be taking them into urgent care or to see a doctor about this"?

Dr. Rudy Kink: So, I grew up in a large family. I have seven brothers and sisters, and I think my mom knew more medicine than I ever will by taking care of us. And usually, fevers, and you'll see like one person in the family develop a fever, and then everybody else, you pretty well can assume that the child has the same thing going around in the family. But if a fever persists for longer than 12 hours or they have really bad pain, like a headache or abdominal pain, they really need to be seen, mostly if their activity is decreased. The child laying around, doesn't want to eat or drink, their normal activity of running around and playing is impeded. Second, like cuts, if they're bleeding and you cannot stop the bleeding for more than about five or 10 minutes, it really needs to be evaluated to make sure it doesn't need stitches placed or something like that. Bones, if you fall and hurt a bone, if the pain impedes the kid's activity. He doesn't want to climb or play or use that arm, that really should be evaluated. It's more knowing your child and what your child is doing after the injury or the illness. And if you see that they're not really getting back to themselves after 30-40 minutes, they really should be evaluated.

Host: Okay, yeah. So, it's one of these things where it's again, this assessment. But if things are persisting and they are not going away, they really should be evaluated.

Dr. Rudy Kink: Correct. And again, your pediatrician should be on your speed dial, because they are going to be the first person that can tell you what you need to do and if you need to get some Tylenol for a fever for a hurt arm and watch and see.

Host: Another question that I had, and I guess this is back to evaluating whether you should go to the emergency department or not, are there ever things or are there common things that you see where parents bring their child to the emergency department and it really wasn't an emergency department type situation, it was like, "Hey, this should have been handled by urgent care." Do you see some common things that our listeners can kind of try to avoid and maybe go to the urgent care instead?

Dr. Rudy Kink: Yeah, and that's a tricky issue because you never want to discourage it. So, we do see a lot of children with chest pain and we always worry, parents worry, that it could be their heart, what's causing the pain. But overwhelmingly, the majority of cases are never cardiac. It's always just musculoskeletal. And we see children when they come in and they may have had a fever, but it has completely resolved without any medication, it probably could be evaluated at an urgent care or the primary care physician's office, because the fever resolved, which means the illness is actually getting better. You know, if the injury to an ankle and the kid's running around playing, it's less likely that he sprained or broken or fractured a bone or anything like that. So, we do see those common complaints in the emergency room.

Host: When there's an emergency with your child, I think it's just like you just want to make sure your child is taken care of and brought to the right facility. It sounds like the first step is always call your pediatrician for pre-triage and figure out what the right place to go is. But in the case it is an emergency and you're taken to the emergency department, you know, how can parents just be assured that their child is being taken care of and brought to the right facility, and frankly, that they're just making the right decision for their child?

Dr. Rudy Kink: When your child comes to the emergency room, our triage nurses will assess your child. They'll look at the vital signs, the injury or the complaint, and they'll assess them. And they put them on a level, a level 1 through 5, depending on it. And level 1 is something very serious, like a child is life-threatening. Level 5 is something to where they would need some stitches removed. So, they level them. And depending on their level will be the way we see that child. So, the most critical children we will see first. So even though you may wait, you should be assured that your child is not getting rushed back immediately, but your child will be seen and evaluated in a timely manner. And our nurses are always there in the triage and assessing and keeping an eye on those children while they wait to be seen.

Host: Before we close here, Dr. Kink, what is one thing throughout your career and your experience that you know to be true that you wish more parents knew? I imagine that you see a lot of parents at their most anxious that come in, they obviously care about the safety and health of their child. And I think that hearing from someone like you, given all the experience and all of the things that you've seen, it might be helpful just to know things that might make them feel better or just educated around when situations like this happen, what is something common that you see?

Dr. Rudy Kink: So, a lot of it, I'm just looking at the child. So whenever I first see your child, and this is something that parents know, if you see that your child is playful, interactive, there's less likely something is life-threatening. So when you, as a parent, know your child and you're concerned, listen to that inner voice. If you truly feel your child is sick or injured and their activity has decreased and they're not themselves, they truly need to be seen. But if they're really back to playing, but just not 100%, you should rest assure that your child most likely will be fine. And that's what I've seen. When I walk into a room and I see a child up and playing or watching TV, I feel a little more confident that this child will be fine compared to those that are just really struggling on breathing or vomiting and just their belly hurts so bad they can't sit up.

Host: Well, Dr. Kink, this has been a fascinating conversation. Very informative for me especially, given that I'm a parent of two. Any final thoughts before we close?

Dr. Rudy Kink: I work in the emergency department. I'm there. And we are always open and always ready to take care of you and I never want to discourage you all. But thank you for your time. I appreciate this. Take care.

Host: That was Dr. Rudy Kink, Pediatric Emergency Medicine Physician at Le Bonheur Children's Hospital. For more information about pediatric care, you can visit lebonheur.org. If you found this podcast to be helpful, consider sharing us on your socials and check out the full podcast library for more topics of interest to you.

I'm Prakash Chandran, and this has been The Peds Pod by Le Bonheur Children's Hospital. Thanks for listening.