Why NOT To Take Your Child to the Emergency Room

Let me preface this post by saying that I have spent the last few weeks working in the pediatric emergency room–and I love it. It’s a well-equipped facility with a team of highly qualified people dedicated to providing excellent care to kids. But it’s not always the most appropriate place for your sick child–here’s why:

  1. The ER doctor doesn’t know your child. The trust that develops over time between a doctor and a patient (or family) is absent. It is also extremely helpful to have seen a sick child when they were healthy, to know how far from their baseline they are.
  2. Your child doesn’t know the ER doctor. Sick kids are not happy kids, and it’s hard to do a physical exam on a screaming 2-year-old. A familiar face causes less distress, and allows the doctor to do a better evaluation.
  3. “Emergency” does not mean that you’ll be seen soon. The ER team takes care of the sickest patients first. If your child has a minor illness and a severely ill or injured child rolls in, you’ll be waiting a while.
  4. It’s expensive. Really expensive. It costs about $500 more to evaluate a minor illness in the ER than it does in an office setting–and that’s without any tests.
  5. Your child will probably have tests. This means needle sticks, radiation exposure, and increased cost. Often, your pediatrician could do a thorough physical exam and schedule a follow-up the next day. But the ER gets one shot, and they can’t afford to miss something, so they tend to over-order imaging and labs. I’m guilty, too.
  6. The ER’s job is to figure out what your child doesn’t have. They are not tasked with figuring out exactly what is going on and solving every problem; the focus is on ruling out life-threatening conditions and deciding which patients need to be in the hospital. This often frustrates parents who come in wanting answers.
  7. There are sick kids there. This week, we have been seeing 20+ cases of vomiting/diarrhea per day. In the fall, it’s RSV. In the winter, it’s flu. We do our best to keep things from spreading, but viruses haven’t survived this long by being bad at what they do. If your kid wasn’t sick when she went in, she may be soon.
  8. If the beds are full, really sick kids can’t be seen. This is more altruistic, like vaccinating your child so nobody else gets polio–but it’s real. Every ER has a limited number of beds (we have 16), and when they’re full, they’re full. If they’re full of relatively healthy kids, the really sick ones sit in the waiting room until a bed opens up.

So What Should You Do?

Find a pediatrician that you trust. This is the most important step, and it’s one that you should take when your child is healthy. A good pediatrician can identify diseases early, track your child’s growth and development, provide reassurance when that’s all you need, and handle the vast majority of acute illnesses. If–or rather, when–your child gets sick, your pediatrician has access to her records and history, avoiding expensive and unnecessary repeat testing. He/she will understand your personality and perspectives, and your child will be less scared of a familiar face. Look for a doctor that has same-day sick visits, weekend hours, and phone availability even when the office if closed–a lot of ER visits can be avoided by talking through symptoms over the phone.

If your child has a minor illness (runny nose/congestion, cough without difficulty breathing, mild headache, fever without any alarming symptoms, vomiting and diarrhea without dehydration, etc.), stay at home. Use home care measures like saline drops and bulb suction for congestion, offering small amounts of fluids frequently to prevent dehydration, or controlling fevers with over-the-counter medicines (if you must). Call your doctor if you have any concerns, or schedule an appointment to be seen the next day.

If your child has an illness that has been progressing over several days or weeks, but is not in immediate danger, schedule another appointment with your doctor. There are many challenges in diagnosing childhood illnesses, many of which have similar symptoms at the onset, and it may take multiple visits to fully define the problem and best treatment. Many parents get frustrated by this and turn to the ER physician essentially for a second opinion. Because close follow-up and continuity is so important in these cases, this doesn’t tend to be very effective. If you don’t trust your pediatrician, find a new one.

Occasionally children have severe or even life-threatening conditions and need to be evaluated quickly. This is where the ER team shines–especially if you are fortunate enough to have a dedicated pediatric facility nearby. The doctors, nurses, and staff are trained to handle life-threatening situations efficiently. Many pediatric centers will even have a Child Life Specialist, whose job is to make the experience less stressful for your child. They have the equipment needed to handle respiratory problems, traumatic injuries, severe infections, and any other emergency that might roll through the door. They have access to the imaging, specialists, and interventions that are sometimes required to diagnose and treat these problems. If your child has a true emergency, it’s the place to be. And if my kids are really sick, I might beat you there.

As always, your comments are welcomed (even if you happen to disagree). I'll get back to you as soon as I can. Please try to keep it civil--I reserve the right to delete comments that are offensive or off-topic.

37 thoughts on “Why NOT To Take Your Child to the Emergency Room

  1. Great article, thanks! What is your opinion on urgent care clinics as an alternative? (obviously for non life-threatening conditions)

    • Alicia,

      I think urgent care facilities certainly have their place. Kids are different, though–we always say they’re “not just little adults.” If there’s a pediatric urgent care near you, that’s where I’d go for those after-hours but not ER-worthy events. They’re less expensive, for sure, and probably fully equipped to handle most of life’s minor complications.

      -Chad

  2. A list of what IS an emergency is helpful. As a former triage nurse for a large (30+ providers), I can tell you that there is a woeful lack of knowledge out there and because so many parents work, a quick solution to a minor (and usually quite self-limiting) illness is desired. Parents believe that the ER is the place to get that so that their work schedule is not interrupted.

    • Sandra–thanks for your comments. I agree completely, but listing every possible emergency is tricky. The big ones, like lethargy, severe respiratory distress, or significant dehydration are easy to list, but sometimes hard for parents to evaluate at home. Different physicians also have different thresholds for wanting to see a patient or send them to the emergency room. There are some things that could be either emergencies or relatively minor events (seizures, loss of consciousness, injuries, etc.), and it’s hard to advise what to do without the specifics of each situation. And then there’s the liability issue of leaving something off a list that was intended to be all-inclusive.

      Those are just some of the issues involved, but they highlight the importance of a relationship with a doctor who is available (or has a colleague/staff member who is) when parents have questions. If the only after-hours option is the ER, we end up with mostly unnecessary visits.

  3. I have only taken my daughter to the ER twice in her 6 years. Both times on a weekend when her fever could not be controlled.
    The first time, she had been to her pediatrician a week prior and was diagnosed with a cold. This eventually turned into pneumonia that was diagnosed by the ER pediatrician.
    The 2nd time really proves that #6 is true. Again, uncontrolled high fever. Back to the pediatric ER we go. On the way, she projectile vomits in the car. The ER gets her fever down, does no other tests and tells me it’s a stomach virus basing this on the fact that she vomited one time. Later that week I take her to urgent care and they do a flu test which turn out to be positive. Unfortunately, her fever was controlled in the interim so she was back in school sharing the flu virus with her friends.
    As a medical professional, I (and my family) don’t visit the doctor often because I realize that not much can be done in the instances of viruses and broken toes. If we can take care of it at home, we do. My daughter sees her pediatrician annually at her physical so he doesn’t know her very well. There’s just not much history. She is just started to remember him because he’s the doctor that gives her bubble gum.
    Thank you for this post as well as many others I have read here. This is great ininformation that all parents need.

  4. While I appreciate this article it also pisses me off. I never ever want to go to an ER. In 30 years I never went. Since my daughter was born, just 16 months ago, she’s been there 4 times. Everything could have been handled in office. However, I was advised to the ER everytime because it was a Friday afternoon or no appointments were available within the next 24 hours. If switch doctors is your suggestion, I’ll let you know we have no options. Unfortunately for us there was space at the base clinic and we have to be seen there. Before you dismiss someone for running into an ER with just a 104 fever on a Friday night, understand that there may have been no other option and the nurseline sent us there.

    • Working in the ER for many years , we have children with fevers come in ALL the time!!
      our first response is, did you give them any medicine at home?
      Tylenol and Motrin work wonders– and save you a a $ 500 visit—
      Fever is an extremely natural way for the body to fight off germs— and is not an emergency…. If you come to the ER, you will wait, because it’s not an emergent event… It’s a fever…
      Something to think about ….if the child has neck pain, is vomiting uncontrollably AND. Is now dehydrated, we might give them an antiemetic to keep fluids down– otherwise, anti emetics, sleep and fluids— we will tell you the same thing after hours of waiting in the ER

  5. Your topic was very good, your explanation kept my attention. A personal doctor to me is not just convenient , but , for accuracy, a must.
    Sometimes a new mom just freaks out. They get scared, maybe some of your , very correct, home remedies, will comfort them. But what if certain areas are in pain, should the nurse keep her mind so on the flue season, she forgets other very serious body parts?–she does see the patients before you do.
    Just an old ex-nurse—–

  6. I disagree. What I thought was just a stupid GI virus, turned into Acute Disseminated Encephalomyelitis. I at first thought it would be OK to take my pediatrician’s advice, which was to just wait and see, and keep my daughter hydrated, as long as her fever doesn’t reach 105. The next day she couldn’t hold up her head, stand, and could barely speak. Thank God I went to the ER, and didn’t wait around until her fever got higher.

    Had I waited around and listened to our pediatrician (who btw, hasn’t made any effort in 9 weeks since my daughter being in PICU and now rehab,) who knows how much worse the situation would’ve become.

    • I am glad that you brought your daughter for treatment as clearly she was very ill. I need to say that children can have a fever of 105 and have a simple virus and children can have a fever of 101 and have a very severe illness. Illness is not a number for parents to watch for. It is how their child is acting/behaving/appearing. This is more indicative of their well being than a number on a thermometer. Glad you listened to your parenting instincts. I’m sure if they knew how she was acting/appearing they would have recommended the same thing. Always a balance. Great Job.

      This is a great article.

      • Bravo!!!! Excellent response. As a pediatric emergency/trauma nurse I see ALOT of abuse of the system and ALIT of people thinking that they should be in and out faster than they would be if they were at McDonalds. I’m a little irritated reading some of these responses. Parents, nobody is saying NEVER go to the ER. We’re saying don’t go unless you feel you really need to. Period. End of story. Your pediatrician can do a lot for you. If they’re always pushing you to “just go the ER”, then find a new one. If you don’t trust them, f8nd a new one. If you’re “stuck on a base and have no alternative”, welcome. Its not your fault the base physician doesn’t have the confidence to handle nonemergent issues. We’re here for you! Most of us do have an alternative. Use it.

  7. Great article, I’m trying to figure out how I can post this in the waiting room of the rural ED I work in. When I see minor issues in ED I ask if they had called the pediatrician and the usual answers are; they were closed, they said we should probably go to the ED, or they couldn’t see us for 2 weeks”. Whether all these excuses are true, I don’t know, but I feel that there is very little effort (or education) on the part of the PMD in our community to keep these kids out of the ED. And, I do believe the parents think it is free to come to the ED.

  8. It would be great if Doctors understood the limitations of healthcare insurance as mandated by law. I’ve been with the same family practitioner for over 20 years, this year they don’t take my insurance. I’ve run into this for the past few years with children in my care as well. A hospital takes all insurance, and even those with none. Sometimes it’s not a choice, to go to ER for care, it’s because there are no other options.

  9. This is great information except when:

    You have the Dr you can A) afford, B) takes your insurance (if you HAVE insurance). Due to deductibles and co pays repeated well checks may not be feasible.

    you live in a rural area and the nearest immediate care has a 3-4 hour wait. It could be an hour or more drive to get to one on a Sunday. AND it is a PA, not a Dr. and definitely DO NOT specialize in pediatrics.

    My pediatrician does have weekend hours until noon on Saturday, but never on Sunday. the kids get sick on weekends and I have one with asthma that degrades very rapidly. Waiting until Monday is NOT an option. The other gets sick very rarely, but when he does, loo out hospitalization is usually involved.

    I am also a paramedic. The folks taking the kids to the ER or calling us for fevers generally don’t have routine care. Some are newer parents.

    While I understand the meat of the article. There are many factors driving people to the ER with kids.

  10. Unfortunately with a special needs kids we always get told to take them to the ER even when the Er is not even necessary. If it’s after hours and we have a vomiting child with a feeding tube and it isn’t being controlled on Pedialyte and slower rate they tell us to go to the ER. This has happened to us at major hospitals like Duke. We cannot go to urgent care without a referral so for us it’s either wait for the next day to see if there’s a same day appointment or go to the ER and hope they can help.

  11. We have raised our kids not to think. Everything has been handled for them or handed them. They are lazy. The quickest way for them to handle the situation is go to the ER.
    In return, our government realizes the entire situation is out of control and turns their heads to this mess they’ve made

  12. That’s all crap! If ur kid is sick and u can’t wait I don’t think u really care how much it’s gone cost and if a kid is sock they aren’t gonna like no one in their face I’m 29 and still hate 2 be touched when I’m sick! I live in Ashland Ohio and would choose 2 drive my child 2 Akron b4 I would step foot in any hospital around me they r all piss poor people! Ashland hospital almost killed my brother and Mansfield almost killed me and my unborn daughter! The pa that almost killed my brother got fired and sued for killing a old woman that had a heart attack make reasons for that

    • And your argument is flawed. You have no medical degree. You cannot say ” he killed blank ” you don’t know. You also have no idea why a medical professional leaves or is asked to leave unless you know the person personally and THEY told you. It’s part of the general professionalism in medicine to NOT divule that information. You think a PA isn’t as qualified as an MD or DO to treat pediatrics in the ED? Again your sorely miss informed and not educated. Your selfish logic is a large part of the reason we have cost and resource issues in the ED. Just because you can bring your child to the ED, or because “I don’t care how much it costs” or “it’s quicker” are NOT acceptable reasons. You go to medical professionals to treat your illnesses because you can not yourself and do not have the knowledge, resources and training to do it yourself. So LISTEN to US.

  13. In the big city…..
    When you pay nothing for an ER visit, the fact it costs thousands of dollars just doesn’t matter to you.
    ER is open all the time. Don’t have to get up early. Don’t even have to get dressed. And you can probably demand a ride home after you take the ambulance to the ED for a cold.
    Play your cards right and you’ll even get a meal or two or three out of it. This old bag is tired of parents who use the ED as a PCP because they are too lazy to set up a PCP near home BEFORE their kid is sick.
    I agree rural areas are far different. Makes me want to live in the country.

  14. To those getting super defensive over this article. Chill. I can tell you that after almost 15 years in nursing, 11 of which have been in the ER, most of this is spot on. The vast majority of what we see is NOT emergent in nature- meaning not life threatening. The ERs get jam packed with people that want to be seen for things that are not emergent, many aren’t even urgent care worthy. Earache for 2 hours, runny nose, cough, skinned knees, etc. 90+% of the things we see can wait for a primary care doctor to see. However, we have created an immediate gratification society. No one thinks they should have to wait to see their own doctor, and heaven forbid you ask them to wait to see the ER doctor. The point is, when your child NEEDS life saving treatment you run the risk of not having the full attention because of the volume of non emergencies. We all know some people don’t have a doctor or insurance and there is no other option. Generally those are the people that come in for literally every little minor issue. We are happy to see everyone, even the ones that list the ER doctor as the primary doctor on school forms. Just bear in mind it is not a restaurant, you don’t get seen based on who shows up first. And please use common sense. Give the kid the Tylenol, but remember many times a fever requires a couple of days usage, not one dose because viruses need to run their course. Be the parent and wash the skinned knee. Put a bandaid on it and kiss it. When you come in, don’t expect a miraculous recovery just because a doctor has laid eyes on your child. And for goodness sake, put your phone down, the Doritos and Pepsi away and listen to the care team. We tell you when you need to get seen again and what’s normal. We LOVE our jobs and want the best for the patient, but the best isn’t seeing us again in 2 days because you didn’t listen the first time.

  15. thank you for posting this valuable information. I not only raised my own, but did Day Care for 10 years with (including mine) 6 kids under 5 yrs. I’m a pediatric nurse so I pretty much knew
    the kids and what to expect. also if a child doesn’t want to eat something or do something, they
    will lie about being sick. you have to know when to believe them. thanks again for posting this info.

  16. What we should do when is 2 or 4 in the morning? What we should do when is weekend? What we should do when we do call the pedestrian and he doesn’t have time to squeeze our child in his schedule?
    And why when is an emergency the recorded message of our insurance says “if it’s an emergency go to the ER?
    You know that doctors offices are not emergency facilities.

  17. I absolutely find this article spot on and very helpful. I have 2 boys, 18 yrs old and 15 months old. My oldest has only seen ER 3x over the last 18 yrs. My youngest has never been to ER (knock on the wood) since he was born. My husband and I have always opted for seeing their pediatricians, pediatric. urgent care or home remedy for simple cough, colds, flu & etc. If unsure or really worried, I would rather go multiple times to their pediatrician as their pediatrician knows them better than ER doctor. I just do not want to expose my children to unnecessary tests that ER will have to do to eliminate possible sickness or expose them to more bacteria or viruses that you can typically get in ER due the “really sick” people there. Tylenol, warm bath, saline drops, suction bulbs, a little bit of vicks on their feet when they have fever, cough or cold and lots of h20 and rest were my saving grace when my children are sick. We are blessed that we have healthy children. Most times, healthy living and keeping your children’s area and environment always clean helps in keeping ER doctors away from them. #toeachtheirown #myopinion

  18. As a physician who will be retiring after 43 years (the last 30 in full time ER) I agree with the points made . We complain about unnecessary ER visits but if it is your child with abdominal pain or fever you need to have some reassurance that it is not something that is serious. A Strep throat is nothing till it turns to Rheumatic fever and endocarditis. The “stomach flu” is not serious unless it is appendicitis. Return visits are not necessary until the vomiting is a strangulated hernia that was overlooked the first time. Yes we fuss among ourselves but are truly glad when a patient returns with the opportunity to fix something that was not obvious the first visit. We are all human and can miss a diagnosis and it can be corrected, if our ego doesn’t get in the way or a second pair of eyes and hands help too

  19. Totally true. I was a ER MD. Now only work at ambulatory practice and I try to teach my patients what an emergency really is

  20. I’m with the American College of Emergency Physicians. Many of the comments in this article are not only untrue, but they are harmful. Emergency care of children in the United States is the best in the world. Emergency physicians and nurses care for nearly 25 million sick and injured children under age 15 each year and the vast majority of them have good outcomes. Emergency physicians are experts in managing childhood emergencies and receive more training in pediatric emergencies than other physicians, including pediatricians. Telling parents “NOT to take your child to the emergency room” sends a dangerous message, especially when they may be experiencing a medical emergency. According to the CDC, the vast majority (96 percent) of all patients need to be seen within 2 hours – so the myth that all of these emergency rooms are filled with “nonurgent” patients is simply not true and the reliable stats don’t back it up.

    Dr. Hayes – you say that parents should “find a pediatrician that you trust.” Of course we agree with that. Every person should have a primary care physician that they trust as well and see on a regular basis. The problem is – two-thirds of emergencies happen after hours, on weekends and holidays when doctors’ offices and/or urgent care facilities are closed. What are parents supposed to do at 2am when their child is in agony, suffering from a fever and dealing with severe illness and need medical attention? They need to go to the only place where that child can be seen and cared for at that hour….the nearest emergency department.

    • Michael,

      I posted this article nearly 2 years ago and have had an overwhelming amount of support from physicians (including emergency medicine, pediatrics, and pediatric emergency medicine), as well as other ER providers and staff. I totally agree with you that emergency care in the US is excellent–it’s one of the things we do best in medicine.

      However, after having worked in two pediatric emergency rooms and talked to a number of ER physicians, I have trouble believing that 96% of the pediatric patients seen in US emergency rooms are true emergencies (using the definition you provided of needing to be seen within 2 hours). If you have a link to that data, I’d be interested to see it.

      While I have great respect for the breadth of knowledge, skills, and dedication of emergency physicians, I would argue that the 18 months or so spent by pediatric residents caring for children in inpatient, ICU, or emergency settings is more training than the average emergency medicine resident receives for pediatric-specific problems. For the handful of traumas or truly critical illnesses that roll in, you may be correct. But for the vast majority of pediatric ER visits (upper respiratory infections, fevers, pneumonia, ear infections, UTIs, rashes, etc.) I think pediatric training is more than sufficient.

      But the issue isn’t with emergency medicine at all–a huge part of the problem is that many primary care doctors (pediatric and adult alike) have drifted away from being available after hours or on the weekend. Parents’ concerns are often shifted to a phone triage nurse not associated with the practice, and these services tend to err on the side of “go to the ER.” While that’s understandable given the liability concerns, it’s often not the best choice for the patient.

      I would encourage you to look past the title and consider the points I made. The emergency room is not the right place for minor illnesses or management of chronic diseases (in the absence of an acute exacerbation). But for children with significant illnesses that need urgent attention–or whose parents have significant concerns that can’t be addressed elsewhere–the ER doors are always open. As I stated above in the last paragraph, that’s where the emergency medicine team shines.

      Thanks to your organization and all those who provide care when and where it’s needed. It’s a vital service, and one for which I’ve been personally grateful one more than one occasion.

      -Chad

      • Well said. These posts are about misuse of the emergency room by parents who don’t know, or in my experience it seems they just don’t care that the ED is not the best place for…diaper rash, sniffles w/out fever or other factors, school/sports physical, vaginal itching…and on. Each of those cases came in last night during my shift. Really? But when we had the traumas come in, the baby in triage struggling to breath, broken bones, autistic children who are overwhelmed and their families desperately want help….we are there to do what we do best….THEN we have to withstand trash talk from parents who have been waiting…were here first!..for a school physical? and my favorite….the teen with vaginal itching who called an ambulance and was hacked when after triage she was placed in the waiting room instead of being directly placed in a room as she wanted. But she eventually took up a bed asked for a meal since she had to wait so long, all to learn poor hygiene was the issue. And let’s not forget their cab ride home. After all she came in an ambulance ..with her mother. So it would be unreasonable to expect the family to TRY getting a ride from family/friends, or heaven forbid mother to have followed the ambulance in her car…oh, that’s right…then she would have to pay to park. My bad. If this ambulance ride/ED visit cost the family any amount of $$$….I wonder if it would have happened. I know what I think.

    • I didn’t hear him dismiss you at all. If you are truly worried about your child, bring them to an ER. Just because it’s a weekend doesn’t mean an ER visit is appropriate. I work at an MTF and I experienced this week not having beds for ill patients because they were full of people with colds that could easily treat themselves over the counter. It’s very frustrating for ED staff. There is nothing wrong with educating the public. I just wish more people would listen to advice like this without getting defensive.

  21. If you think it is an emergency then go to the emergency department !!! There are costs associated with the emergency care but it only makes up 2% of the total health care. ED’s are open 24/7, 365 holidays and all !!!. Sure go to the primary care, that is encouraged but if certain tests are needed guess where you will go? To the ED !!! The ED sees everyone, no is turned away due to religion, no religion, finances no finances it is there for everyone at the time when medical care is needed the most 24/7 365 ! All emergency personnel are there away from family to take care of the sick during the time help is needed most the time I need to know my child does no have appendicitis and I can take them home who gives me care when I most need it when no one else is around to help me.

  22. You miss a simple fact of emergency Medicine. ER Docs know “sick”. That is what we do. All your other points are irrelevant except cost. You don’t think a sick kid is going to scream in your office? A good ER doc does not rely on tests, he depends on a good history and knowing “sick”. He/she only does them when necessary. We read the Peds research and especially the Peds ER work. True, our job is to “look for the worst first”. That is the nature of ER medicine. since most pediatric illness is self limited, it is not important to know what it is, but which ones actually need treatment beyond fever control, etc. Your point about sick kids in the ER is true, to some extent. But your solution…”find a Pediatrician you trust”? Get real. Try to get seen during the day when your child is ill. No appointments. When will pediatricians realize that they need to leave openings for acute illness? Is it because you know most of it is self limited and therefore not worth changing your schedules. After all, you can just send them to the ER.

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