My kid keeps going to the emergency room...

In My Humble Opinion
1

and he’s not even 2. I’m somewhat anti-doctor, if only because I have realistic expectations of what they can actually do. My wife, on the other hand, thinks that they can work magic and takes the kids every time they get sick. We disagree often on what necessitates an emergency room visit, and I’d say I’ve prevented at least half a dozen pointless trips to the hospital (I have 3 kids total) thanks to my calm demeanor and a little bit of first aid knowledge.

The first trip to the ER was when he hit his head on a table and had a nasty gash above his eye. I stopped the bleeding but the gash was pretty bad and I figured it would need some stitches. This happened on a Saturday morning, and our doctor is closed all weekend, so I allowed my wife to take him to the hospital. They called down some fancy face surgeon and they put in something like 15 adorable little stitches. Now he’s got a gnarly scar above his eye.

Second trip was when she slammed his hand in the minivan door. I was out of a town and there was an off-duty police officer who volunteered to babysit the other two kids (no joke) while ordering her to go to the ER. Based on the extent of the injury as described to me, I totally wouldn’t have gone, but I can’t help what police officers tell her :slight_smile: They did an x-ray, nothing was broken, so they sent him home.

Latest trip was the result of him falling off the top bunk; one of those regrettable moments of lapsed attention that could have ended up much worse but thankfully didn’t. His face broke the fall; by the time I got to him, his lips were both starting to swell badly, he was bleeding from his mouth and nose, and the bridge of his nose was starting to bruise. I started to clean him up and tried to stop the bleeding; I pulled some chunks of skin out of his mouth but he wouldn’t let me touch his teeth. Since he didn’t lose consciousness and was crying and otherwise acting normal, I was just going to clean him up and see how he looked after he calmed down, but my wife had already called a babysitter and was ready to go. Based on the height of the fall, I acquiesced, but I was pretty sure he was going to be fine. My wife, on the other hand, was convinced they were going to wheel him straight into reconstructive surgery. They checked him out, did a face x-ray, and sent us home. It’s been a couple days now and aside from some minor swelling and bruising, he looks perfectly normal.

Why is this in IMHO? Well, I guess I’m looking for doper validation – are we misusing the ER, or do all of these scenarios seem reasonable? Or if you just want to make jokes about calling child protective services, then have at it; lord know my family has.

2

I would have gone all three times - because it’s easy to say after the fact that he’s fine, but would you really have been able to detect small fractures or other indications of problems that are not obvious to a lay person? Better safe than sorry with my kid.

3

Don’t you have a private pediatrician? You’re misusing the emergency room in the sense that you should have your own doctor to go to. Your wife does sound a little over-reactionary, but in the first case stitches were probably a good idea, and the ER is the place to go for that, though it should have been on the advice of your own physician. I’ve never heard of the circumstances in the second incident before, so I’m not sure what to think about that, but it’s another case where you could have contacted your own doctor first. The third case doesn’t sound like any intervention was needed at all. Once more, guess who you should have called first?

Anyway, your kid sounds like me as an infant. Chin stitched up twice, xrays for a concussion, and later a badly broken jaw. All that following a lung infection at less than a year old that would have killed me if I wasn’t hospitalized. So better safe than sorry, just get a private pediatrician and your wife can follow his instructions.

4

Do people call their pediatricians at home? Honest question – I never have, and I’ve never thought to ask for an emergency contact number for him. The 1st and 3rd examples both happened on weekends. If you call the office, the automated recording tells you to leave a message or go to the ER.

5

Too late to edit – we have done the leave a message thing, and to their credit a nurse has always called us back within 4 hours or so, even on weekends (not sure about nighttime), but you know… 4 hours is a long time when there’s blood involved.

6

Our pediatrician has an answering service and whoever is on call will return calls after hours that day, and the practice also does a half day on Saturdays for sick kids only (no checkups).

Our kids haven’t had too may injuries of that type, but the one time our daughter tipped a chair backwards an cut her head, our pediatrician sent us to Urgent Care at the local children’s hospital. This is a service for things that aren’t life threatening, but do need to be looked at. Because it wasn’t really an emergency, she was able to make an appointment for us there, so we didn’t have to wait all afternoon in a room full of sick kids and real emergencies.

7

I once called our pediatrician at 4:45 on a Friday afternoon because I wasn’t sure what to do in response to my kid’s injury. She told me that we could wait until Monday to come in, but if she thought that there was any chance of a fracture, she would just send us to the hospital for x-rays. She thought we should just go ahead and go to the ER for x-rays that evening. (For the record, the kid had a broken collarbone.)

My personal policy: We go to the pediatrician for routine stuff. We go to urgent care for things like strep or UTIs where I’d prefer the convenience of going after hours. And we go to the ER for broken bones or things that might need stitches. I don’t think any of the ER trips in the OP are unreasonable. I might have waited a little longer to see how the kid was doing for 2 and 3, but it’s hard to say.

8

I love urgent care facilities, but not every place has them. The place i live now does not, and when I lived in Virginia Beach, the ones there only had pretty damn short hours. People may scoff at doc-in-the-boxes, but when they run 24 hours, they are a lifesafer both to patients’ sanity, and to the emergency rooms said patients would have ended up utilizing instead.

9

IANAD, but have worked with children quite a bit. The stitches were a good idea, and with a little hand in the door it’s pretty hard to tell so ER visit is a good call.

The ER was unnecessary on the last incident. Clean up, see how bad it is. The most important thing with any big falls on the head (as I am sure you know) to check that they remember everything, aren’t groggy and don’t feel sick or throw up. If that is all fine and there is just swelling then there is honestly nothing they’ll do at the hospital, IME.

Where I used to work in the jungle in Brazil, the hospital was pretty far away so we only ever went if it was a real honest-to-goodness emergency. All kids survived, and life there was pretty rough. Tell your wife that, might help chill her a little :wink:

One time Camilla got whacked so hard on the side of her head with a football she keeled over, smashed her little head into a rock and bounced up. She was confused for a minute, but as the hospital is so far we thought we’d see how she would do. Because I am just a hysterical as everyone else, I insisted on waking her up several times in the night. One time I woke her up she immediately ran to the loo to throw up. So: to the hospital it was. I got one of the guys out of bed to drive us, because we had to go to the further hospital because it was the middle of the night. To get there we had to take this big road that runs right past a not-so-safe favela (I don’t know anyone there). This would, of course, be the place to get a flat tyre. Picture me, trying to help change a tyre while forcing poor Camila to sing songs to keep her awake, all the while terrified she was going haemorrhage or that we were going to be held up. :stuck_out_tongue: She was fine, of course. Got a picture of her beautiful brain that clearly shows what a wonderful, intelligent person she is.

Point is, you worry, you go through the ordeal, and it was always nothing. Maybe it’s silly, but really, what can you do?

10

I would have gone to the doctor, urgent care, or the ER (listed in order of preference) in all three situations.

When my oldest was about 6, he fell down the stairs and complained that his hand hurt. I shrugged it off. A few days later he winced when I went to hold his hand to cross the street. “That still hurts?” I asked. He said yes. I took him in for an x-ray and he’d fractured a bone in his hand. I felt like a jerk.

The moral of the story being, kids often don’t have enough experience or self-awareness to be able to say “yo, this is broken” as opposed to just “ow” so if it’s at all questionable, I take them in. Anything looking like it needs stitches, I take them in. Etc. I’ve found through painful experience that the consequences of needing to go but not going are much much worse than the consequences of going but not needing to.

Also the way you talk about “allowing” your wife to do things makes me bristle. My husband doesn’t need my permission for anything, nor I his.

11

Pediatricians often have a “nurse line,” where you can call and tell them your issue and get advice about home treatment and whether the child needs to be seen. Many insurance companies require you to coordinate care through your (or your child’s) doctor.

I think parents take their kids to the doctor/ER nowadays way more than they used to. I only remember going to the doc for checkups. When I was six or seven in the early 70s, I dislocated my finger in a fall. My mom called the doctor and got instructions to make a popsicle-stick splint, and my finger went back in the socket on its own. If I had done that with my kids I’d have had CPS after me.

12

Cool. Same here.

13

That’s about how I see it, except we always called the pediatrician first. He had Saturday hours, and I can’t think of a time we couldn’t reach him. Luckily for my kids there was never anything bad enough that they had to be rushed to the ER.

ETA: Wait, there was the time one of them drank a bottle of Dimetap. We called poison control, they said just watch him, he’ll probably be up running around all night, but unless he had a seizure or something we didn’t need to do anything. But that’s not like an injury.

14

All three of those were appropriate medical visits by triage nursing guidelines. At least, the most recent ones I know, which were 2010 or 2011.

First one: I’d have asked you if the sides of the wound stayed together on their own or if they were gaping. Considering they put in 15 stiches, I’m sure it was gaping. Gaping wounds or wounds that won’t stop bleeding after some minutes of direct pressure (number of minutes varies with age and other health conditions) need to be evaluated for sutures or other closure that should be done by a doctor. It needs to be done sooner rather than later, and it’s not something most pediatrician’s offices are equipped or insured to do*

Second one: This one could possibly have gone to an office visit, if they could get you in the same or the next day…if it was an adult. Kids just compensate for bad stuff so well that the kid could be suffering some actual nerve damage or internal bleeding that would be worsened by a delay in assessment. This is the most borderline one, IMHO, but I’d still suggest Urgent Care or an ER. X-rays are just so likely to be ordered.

The last one, absolutely, no question, completely cut and dry. Any fall over 3 feet for a child under 2 or over 5 feet for a child over 2 is an ER visit. Any. Doesn’t matter if he never lost consciousness, reacts appropriately, etc. The numbers are what is correlated with having a potential serious head injury. If you asked me what to do here and I didn’t tell you to go to the ER, I could lose my license over it. It’s clear as can be.

So rest assured that medically, these incidents were not overreacting parents. There’s something sad that I also have to point out: if you have accident prone kids, bring them in generously, rather than conservatively. You want every stitch, bad bruise and broken bone documented, even if it’s not a lifethreatening one. Otherwise one of these days you will need to take him in, and they’ll see signs of old trauma and ask you where he was treated. If you say, “Oh, we…uh…we didn’t think he needed to be treated. We took care of it at home. He’s…uh…real clumsy sometimes.” You’ve now just raised a red flag for potential child abuse. While every parent takes care of the kid at home sometimes, abusive parents do it a lot, to try to minimize their child’s medical record. We know this, and it’s now become a warning signal. Even if an investigation shows that you are parent of the year, you do not need the hassle and trauma of a child protective services investigation. So any time the kiddo hurts himself more than a band-aids’ worth, at least make an appointment with your doctor, so this stuff is written down in real time and doesn’t come back to bite you in the butt someday.
*this is why your pediatrician used to see you for owies and really bad colds and now they send your kids to the ER: equipment and insurance. If your kid is wheezing as well as coughing (and lots of parents can’t tell), she’s going to the ER anyhow, because the things she needs are there - medicines and medical equipment. If he needs x-rays or stitches, that’s mostly done in the ER now. Pediatrician offices more and more frequently are being set up for routine health maintenance, examination and pharmacology, rather than imaging and treatment. There are some exceptions, of course, but that’s largely what’s happening in my area. I’d rather save parents the time and aggravation of going to the doctor’s office only to be sent to the ER, so I just suggest the ER.

15

Pediatrician here. We are a 24/7 available business. FWIW our standard after hours is for the on-call doc to check for messages hourly until we are asleep and then have the service call with calls after that. We are also to be paged (yes the old fashioned pager) if the paient says it is an emergency. Nurses are available during office hours (often consulting with us) and we return calls that want to discuss with us at some point before we go home.

Odds are 1 and 3 would have been a Peds saying go the ED - gaping laceration, yup. Fall from top bunk? That’s enough force to be concerned about head trauma.

2 more of a judgement. Depends on how much pain the kid was in and how anxious the parent was honestly.

We handle wheezing just fine. And simple lacerations. And minor fractures.

Most Peds have evening hours.

16

OK, whatever.

17

I wish you could be my kid’s doc. Seriously. Every sniffle and I’m told to take her to the ER (she is prone to bronchiolitis, but still…). He’s got nothing in his office. (Of course, he’s a Medicaid provider…if you are and are taking new patients, PM me, please!)

18

Really? Every time we took kids in for that kind of stuff they would just stare at me blankly and say something along the lines of “well what do you want me to do about it?” They always said, every single time, only come back if they’re confused or throwing up. The nurse who trained me to take over her duties said the same thing. We just made “confused or throwing up” the rule.

I’ll revise my policy based on this ignorance fighting, I know that you know your stuff.

19

Fool of a Took. For all you know I’m a particularly linguisticly gifted cocker spaniel. :wink: But I’m a cocker spaniel who can link you to this neat little rubric for evaluating head trauma, so that helps. http://www.lvmsystems.com/bulletin/2010/12March%202010%20-%20Head%20Injuries%20in%20Children.pdf

It’s actually from the UK, but it references the foot-fall thing I’m talking about in the US, and it’s an easy link.

20

Ha, not so foolish then after all, knowing you could be trusted! :slight_smile:

Thanks for the link. I’m currently in the UK, so it’s far more relevant anyway. I think probably doctors in the jungle just aren’t that impressed with a little bash of the head…