…And why the medical home is almost always best
It never fails, of course. Your child doesn’t complain about their sore throat until 5:01 pm, the baby doesn’t run a fever until the weekend, your asthmatic child starts wheezing worse on Sunday. Those of us who have children in our lives learned long ago that they operate on their own schedule and it rarely coincides with ours. So, as a busy parent, what should you do? Should you wait until our office is open? Head to the closest emergency room? Or just hit the urgent care clinic down the street?
If you answered, “wait until you can take your child to their pediatrician”, you would be right the vast majority of the time. Now, I’m not talking about emergencies. If your otherwise healthy child has any of the following (or your parental instinct is telling you that your child is very ill), your child should certainly be seen in the emergency department right away:
- Difficulty breathing (not just noisy or congested)
- Lethargy or difficulty staying awake
- Extreme irritability
- Dehydration
- Injury
- Severe pain that is not controlled by over-the-counter pain meds
- Temperature >100.4 rectally in an infant less than 3 months old
You’ll notice this is a pretty short list. You may also notice what is not on this list – fever of any degree in an older child, sore throat, vomiting, cough and congestion without difficulty breathing, earache, and a whole host of other complaints. Now, this doesn’t mean your child is not sick and possibly miserable, it just means it’s not an emergency and does not require the very expensive and time-consuming evaluation and treatment they will receive in an ER. I promise you, diagnosing your child with an ear infection in the middle of the night as opposed to at 10 in the morning will not make them feel any better any faster.
Okay, so we’ve determined your child’s illness is not a true emergency. Why shouldn’t you take him to the local Urgent Care or pharmacy-based clinic? The simplest answer is that it’s not the best thing for your child. It may be the most convenient, it may get your child back to school faster and you back to work faster, it may even end up being the exact same treatment they would have received at the pediatrician’s office, but it’s still not the best thing for your child.
So, What’s so Special About Your Child’s Pediatrician?
First off, they are a pediatrician. That means they have extensive, specialized training and experience in treating infants, children, and adolescents and that cannot be emphasized enough. Children are not little adults. They have their own range of potential illnesses and often present a considerable challenge in obtaining a good physical exam. The vast majority of the free-standing urgent care or immediate care facilities in Cobb, Paulding, and the surrounding counties are not staffed by pediatricians (a significant exception is the Children’s Healthcare of Atlanta Urgent Care in Town Center). Instead, they are staffed with Emergency Care doctors, Internal Medicine doctors, Physicians Assistants, or Family Nurse Practitioners. None of these providers have extensive training in pediatrics.
Over the past few years, I have seen an alarming increase in the number of my patients who have been treated inappropriately by non-pediatricians. This week alone, I saw:
- A 12-year-old patient who received 2 antibiotic shots and 2 steroid shots for a viral illness. Antibiotics do not treat viruses and antibiotic shots should be saved for when a person is seriously ill.
- A 2-year-old patient who was given a prescription for a codeine cough syrup that the mother wisely decided not to give her. Codeine can suppress breathing and is completely inappropriate for an infant.
- A 3-year-old who was given a steroid shot for a cold. Not croup, a cold. Steroids are very potent anti-inflammatory drugs with significant potential side effects. I have no idea what this was supposed to do for this child.
- A 3-year-old child with asthma who was seen 3 times in the past 6 months at an Urgent Care and prescribed steroids but was never once told to follow up with their pediatrician. This indicates uncontrolled asthma and is potentially very serious.
These kids were all seen at different facilities by non-pediatricians and I did not receive any communication from any of these doctors about the care they had given my patients.
Parents often use urgent care facilities because of convenience. However, each one of these children had to be seen in my office anyway because they were not treated properly the first time. I have no doubt that each of these medical providers thought they were doing the right thing for the child, but their lack of experience and knowledge of pediatrics resulted in the unnecessary use of antibiotics and steroids, wasted time and money, and in a delay in proper care.
Why It’s Smart to Choose a Medical Home
Children deserve a medical home. We know your children. We know their history. We know their allergies and what medications they have been on recently. How are we going to know if your child has had an unacceptable number of ear infections or Strep throat or asthma attacks if we didn’t see them? If the urgent care diagnoses your child with multiple cases of Strep throat but never actually does a Strep test, your child may end up undergoing completely unnecessary and potentially risky surgery and general anesthesia for nothing. Is a little convenience worth that?
We keep a number of same-day sick slots open every day for patients with acute illnesses and we are open for sick visits every Saturday morning. If your child becomes ill at night and doesn’t require emergency room level care, they really can wait until the following day. Consult the Is Your Child Sick function on our website to help you determine what is an emergency. Call us if you are not sure. If you are in one of those rare situations where your child comes down with a sore throat Saturday afternoon and is leaving the country on Sunday, an urgent care may be your only option. However, the Cobb Pediatric providers strongly recommend the following guidelines:
- We strongly recommend the CHOA Emergency Department and Urgent Care Center if you feel after-hours care is needed (unless you feel your child is so ill that they need to be seen in the closest emergency department)
- Do not allow anyone to prescribe medication to your child if you do not understand what it is intended to treat (how will you know if it is working?)
- Do not allow anyone to treat your child for “Strep throat” if they didn’t even do a Strep test! Most sore throats are caused by viruses – always insist on a Strep test.
- Do not allow anyone to give your child an antibiotic if they had a negative Strep test (this means it is a viral infection and they will not get better any faster on antibiotics)
- Do not allow anyone to give your child an antibiotic for a “blood infection” or a “kidney infection” unless they have obtained blood/urine cultures to go to a lab for further testing (this is common practice in adult medicine but it potentially very dangerous in children)
- If your child is under the age of 2 years, they should only be seen by us or at CHOA Urgent Care or Emergency Department
- If your child has significant chronic medical problems, they should only be seen by us or at a CHOA Emergency Department
- Always insist that the emergency department/urgent care/immediate care send us information about your visit as well as giving you a copy
Pediatric Clinic in Marietta, GA
The pediatricians and pediatric nurse practitioners at Cobb Pediatrics take great pride in providing superior, evidence-based pediatric care for your children. We love seeing your children grow and helping families through typical childhood illnesses as well as more serious conditions. Preserving your child’s medical home and working as a parent-provider-patient team is essential to ensuring your child’s health. We look forward to working with you! Call (770) 425-5331 to schedule an appointment at our office in Marietta, GA today!
