Doctors breakdown the differences between the care your kid will get in your hospital's ER vs. your local urgent care clinic and take the guesswork out of knowing where to go in an emergency.

By Janelle Randazza
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Kids get hurt. They run into walls, they eat rocks, they stick crayons in their ears, and they lose peas and pebbles up their noses. And because you can pretty much count on kids getting injured or sick after normal pediatrician hours, most parents find themselves looking at whether they should take their child to the ER or urgent care in emergency situations.

As a general rule, urgent care is for minor, non life-threatening situations and the ER is for crisis situations. If you think it's the type of situation that needs a follow up, like a sprained joint, go to urgent care. If you think your child needs major medical attention, like a major bone break, or might require continual observation, like trouble breathing, the emergency room is your best bet.

According to Oreste Joseph Bruni, M.D., ED Liaison at St. Joseph Hospital in Bethpage and full time attending physician at CityMD Urgent Care in Massapequa, NY, if you have a child under two months old, no matter what the situation: a bump, a bruise, a fever—go to the ER. Urgent care clinics are not equipped to evaluate or treat children that young. An emergency room will give you immediate access to a range of staff and specialists for a child that age.

"Children of that age present their illnesses differently and give very different signs to underlying problems," says Dr. Bruni. "You need to be in a place that has a full staff on hand for a child that age."

If you have an infant over two months of age, call the urgent care clinic ahead of time to ensure they treat infants. Some clinics have age limits and won't take patients under a certain age. Make sure the facility works with children and is comfortable treating them. 
When you call, be sure to speak with the attending physician and be specific about your child's symptoms. You don't want is to go to an urgent care with a sick kid only to be told you should head to the ER instead.

Basic rules aside, we went to the experts to take the guesswork out of how to handle the most common kid injuries. Here's how to be prepared and make an informed decision when you are weighing your choices to take your child to the urgent care vs. ER.

A Goose Egg on the Head

Minor bumps, bruises or cuts on the scalp are terrifying, but usually nothing to worry about. It can be hard to immediately tell if your child has a concussion or if there is an underlying injury that needs immediate attention. If the child is vomiting, seems disoriented, or complaining about ongoing pain, skip the urgent care and go directly to the ER.

"You need to be in a place where a child can be monitored over the course of 24-hours. It may not require that—they may send you home—but an urgent care can't provide that kind of monitoring," says Dr. Bruni. In short, if your child needs to be anywhere other than home for a head injury, it's going to be an emergency room or a hospital, so make that your first stop.

A Cough that Won't Go Away

An emergency room visit will cost you more than a trip to urgent care, it will expose your child to more illnesses, and the wait is typically longer. For something like a persistent cough, the urgent care is the way to go.

"You'll be waiting in the ER for a long time for something like this. A cough will not take precedence over a major injury," says Dr. Bruni.

Urgent care should be able to run all the necessary x-rays to determine the cause and treatment of a persistent cough and it will allow for follow up to see how things are progressing.

They Swallowed Something They Shouldn't

Mark S. Mannenbach, M.D. pediatric emergency medicine specialist at Mayo Clinic Children's Center in Rochester, Minnesota, says this is largely dependent on how the child is presenting at home, and what they swallowed. If choking is a real hazard or they swallowed something corrosive like a button battery or a detergent pack, call 911—your child may need to be air-lifted. If your child proudly announces from the back seat of the car that they ate a rock, the urgent care should be fine.

Your child will probably need x-rays and probably a 24-hour follow up with additional x-rays, which is easily done in urgent care, and you'll get out of there much faster.

"The x-rays are important and urgent care is great if you need a follow-up appointment, which you most-likely will," says Dr. Bruni.

They Stuck Something in Their Ear

Sad but true, this one is worth a trip to the ER. If left in there, or accidentally pushed in deeper by a frustrated child, it can cause pain, infection, or hearing loss. If you can't see the object, chances are it's far enough in there that you are going to need a professional that has worked with kids to get it out and an emergency room is your best bet. Because kids are very creative, it's always a good idea to have the doctor check both nostrils as well as the ear cavities, while they're at it.

A Split Lip, Eyebrow, Chin, etc.

This all depends on the severity of the cut and the placement. If the cut is very deep, both Dr. Bruni and Dr. Mannenbach recommend an emergency room.

An emergency room will give you access to a plastic surgeon, and Dr. Mannenbach says most ERs are equipped with topical anesthetics that can minimize a child's trauma when they've been injured.

If you are looking at a fairly minor cut, however, urgent care is fine.

"Honestly, derma bond works great, is simple, and doesn't require any needles. Urgent care will get you in and out and it'll be covered by your insurance. I've seen plastic surgery bills for $18,000; you really have to decide if you think your kid needs that before you make your choice," says Dr. Bruni.

A Deep Cut or Broken Bone

This is where you may start to worry about damaged tendons or even infection. Both Dr. Mannenbach and Dr. Bruni say, if it's a serious break or cut, go to the ER.

"If the bone is sticking out, or if there is a laceration where you think you may have cut a tendon, go to the ER," says Dr. Bruni.

While it's probably a no-brainer that, if a bone is sticking out you should go to an ER, if you can't move a joint or use it for strength like squeezing, you've likely severed a tendon and need a specialist to repair it and evaluate it for underlying abnormalities.

A Stomach Ache

Bruni says it requires a skilled physician to determine if you are dealing with a child who is suffering from appendicitis or a ruptured appendix and is in danger of going toxic. If your child has a fever and vomiting, accompanied by pain that starts around the belly button and seems to be migrating to the right side, go to the emergency room.

"You would not want to miss appendicitis. It could be deadly." Dr. Bruni says that most of the abdominal pain they see is attributed to constipation, however you never want to delay an appendicitis diagnosis. If you suspect appendicitis, the first stop should be the emergency room.

A High Fever

If it's over 104 degrees, Dr. Mannenbach and Dr. Bruni recommend you go to the emergency room.

A fever that high can lead to seizures or serious dehydration and both scenarios are best-treated in a hospital setting.

"An urgent care isn't for seizures and if your child is dehydrated and needs intravenous fluids, you are going to want someone that specializes in working with kids to be doing that," Dr. Mannenbach says.

In the end, your choice may depend on proximity of facility or gut feeling--something that both doctors say a parent should always go with. It's okay to assume the worst and be pleasantly surprised that your worries were worse than the actual diagnosis.

"I've never seen a parent regret going to the emergency room," says Dr. Mannenbach. "When your child is hurt or in pain you have to make the best choice for them."

Be Prepared Before Accidents Happen

Do Your Homework Find out which emergency facilities in your area work with children your child's age. Your pediatrician's office can give you tips, and can even recommend which facilities they are affiliated with.

Most urgent cares do not have pediatricians on staff, so research beforehand if yours does. 
"Pediatrics is a specialty and the emergency room pediatricians have training that takes care of the unique needs of children. There is extensive training and experience in handling and reading patients that needs to occur in an emergency setting," says Dr. Mannenbach. "Find out which facilities near you have an emergency pediatrician on staff."

Know the Hours One of the limits of urgent care is their hours. Urgent care isn't meant for prolonged observation or treatment. If you are seeking emergency care for something that might observation, like trouble breathing or a head trauma, bring your child to the emergency room.

"You definitely don't want to go to an urgent care only to be turned away because they close in an hour. Do your research ahead of time," says Dr. Bruni.

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