Parents will often comment that their children "always" seem to develop an illness or injure themselves and need medical attention after pediatric office hours, weekends, or holidays. While the reality is certainly not always or even usually, it is often enough. Because of this situation as well as the high incidence of families with both parents working, the number of facilities offering acute care for kids has significantly increased in recent years, and they represent a wide range of quality of care, In general, it is usually best to start with a phone call to your pediatrician, as the conversation will help families determine whether seeking medical attention after hours is even necessary, what "red flags" to be watching for, and what care suggestions can be made just from a phone call. If that midnight or Thanksgiving Day visit does seem to be warranted, guidance can also be given regarding the level of facility most appropriate. It is important to realize that facilities that satisfy the criteria for emergency rooms are likely to suprise families with much higher co-pays and other charges depending on the insurance coverage.
A helpful and practical guide to selecting an urgent care center vs. emergency room has been provided by Texas Children's Hospital which operates both types of facilities. Below is a personally modified version of this publication:
CONDITIONS USUALLY SEEN IN AN URGEN CARE CLINIC:
- allergic reaction (unless serious, such as anaphylactic)
- asthma (unless child in distress)
- ear pain
- fever in infants older than 8-12 weeks (depending on temp)
- flu
- minor burn
- minor injury from fall or sport
- pink eye
- rash
- simple laceration
- skin infection
- sore throat
- sprain and strain
- suspected urinary tract infection
- vomiting and diarrhea (unless baby or child appears quite ill
CONDITIONS USUALLY SEEN IN AN EMERGENCY ROOM
- broken bones (serious or with deformity)
- bleeding that won't stop
- extensive or complicated cut or laceration
- procedure requiring a CT scan or sedation
- seizure without a previous diagnosis of epilepsy
- serious burn
- snake bite
- spinal injury
- sudden change in mental state
- sudden shortness of breath or difficulty breating
- voimiting or coughing up blood
The guidelines conclude with the appropriate disclaimer that this only a guide for general information, and is not intended to be a substite for professional medical advice, diagnosis or treatment. Also, if there is uncertainty regarding urgent care vs. ER, it is best to go to the closest emergency room or phone 9-1-1.
Two closing considerations. Other things being equal, a pediatric urgent care is preferable to a general one for small children, and stand-alone urgent care centers are likely going to provide more a higher level of care than a pharmacy situated one. Finally, if the illness is something that can wait until the office opens, there are distinct advantages to that: the history and exam are probably going to be more thorough, and the doctor has access to records and real familiarity with the patient and family, and the notes of this visit automatically become a part of that patient record.