Should I Take My Child to the Pediatrician, Urgent Care or Emergency Department?

By Dr. Sarah Kay Herrera, a CHOC Children’s pediatrician

At CHOC Children’s, we know that parents want to be confident they’re giving their child the best care. In order to do that, you need to know where to bring them when they’re sick, but the problem is there are so many options: Do I bring them to the pediatrician’s office? Urgent care? Emergency department? This can make you feel overwhelmed and confused – especially with cold and flu season just around the corner.

We believe parents should have peace of mind they are getting their child the best care. We know it can be scary, stressful and sad to have a sick child. That’s why our Primary Care Network has 16 convenient locations throughout Orange County and beyond. CHOC Children’s Hospital in Orange offers the only emergency department in Orange County that’s just for kids. At the Mission Hospital Emergency Department, in partnership with CHOC Children’s at Mission Hospital, kids and families have access to pediatric-trained nurses, physicians and specialists.

To help you make decisions about where to go for care, consult this guide:

1. Pediatrician

Your pediatrician’s office is not only a place for check-ups, but your primary resource for sick visits as well. Your child’s pediatrician is the doctor who already knows your child’s medical history.

  • You will need to set an appointment for a sick visit, which could include symptoms like fever, runny nose, cough, ear pain, headaches, sore throat, rashes or abdominal pain.
  • If your child is experiencing a chronic lingering issue such as abdominal pain or headaches, it is best to see your pediatrician as they can provide ongoing care and find a pattern in the symptoms, which is important for more complex illnesses.

Here’s a helpful guide of what to bring to the pediatrician’s office.

2. Urgent care

  • Urgent care offices are usually open after business hours, which is typically after 5 p.m. and weekends.
  • Most are walk-in clinics and do not take appointments. This means you can usually expect long wait times. This is the best place to go for acute illness such as fevers, ear pain, runny nose, cough, sore throat, vomiting, diarrhea, minor falls, and stitches.
  • Sometimes your pediatrician or an urgent care provider may decide your child is too ill to go home and they may send you to the emergency department for further treatment or testing.

Emergency department

  • In some cases, it’s best to go straight to the emergency department for apparent life-threatening events, which could include rapid and fast breathing, head trauma, trauma with loss of consciousness or vomiting, motor vehicle accidents, severe abdominal pain or dehydration.
  • An infant less than 28 days old with a fever of 100.4 degrees or higher is considered an emergency and should be taken directly to the ED.
  • Here’s a helpful checklist of what to bring to the emergency department.
  • Not all urgent care clinics and emergency rooms take care of children on a regular basis. It is best to go somewhere that specializes in children’s health. Pediatric-focused facilities have specialized training and equipment to offer the best care for your child.
  • Most pediatrician offices have a phone triage line to help parents decide which place may be best for their child.
Looking for a pediatrician? Find one near you.

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Is it OK to Skip your Child’s Checkup if They’re Healthy?

The first few years of your child’s life are a major factor in their lifelong growth and development, which is why it’s not ok to skip your child’s checkup even if they’re healthy. Well child checks are an opportunity to track your child’s development, make sure they’re getting the care they need to stay healthy, and for parents to get answers to any parenting questions. Families are busier than ever these days, so it may be tempting to skip something called a “well child check” if your child is feeling healthy. Here are five reasons why it’s not ok to skip your child’s checkup, even if they’re feeling healthy.

Dr. Katherine Williamson
Dr. Katherine Williamson, a CHOC Children’s pediatrician

#1 Relationship building

It’s important for your child to develop a rapport with their pediatrician. We are positive role models for young kids and help lessen their fear of going to the doctor. When they’re a teenager, parents are often asked to leave the exam room, so the pediatrician can speak to them in private. Your child will feel more comfortable asking personal questions about their body and puberty later in life, if their pediatrician has been a constant figure and steady resource since childhood.

#2 Mental health check up

Well checks also serve as a mental and behavioral health check-in. Your pediatrician can help evaluate your child’s mental health and wellbeing over time.

#3 Screen time discussion

Do you ever struggle with the question, “How much screen time is too much?” or find yourself battling your children over screen time limits? Your pediatrician can be a resource for you in helping reinforce screen time limits with your child. We can help explain to your children why their bodies need less screen time and more play, and how too much screen time affects their body and brain.

#4 Enforcing healthy habits

Well child checks are a great opportunity to reinforce healthy habits. Often, kids will listen to their pediatrician more than their parents. We can remind children about the importance of eating healthy, doing their homework, brushing their teeth, wearing helmets—and listening to their parents!

#5 Getting answers to questions you didn’t know you had

During many appointments in my office, my conversation with parents takes a turn from why they originally came in to see me. They might have an appointment to get a rash checked out, but then I’ll notice a mole on the child I hadn’t seen before, and they’ll realize they too were wondering about that, but just forgot to ask. Pediatricians are resources for parents just as much as we are caretakers of your children. We’re here to help you get answers to your questions on acne, headaches, parenting skills, academic concerns, and anything in between.

Find a CHOC pediatrician near you

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Meet Dr. Charles Golden

CHOC Children’s wants its patients and families to get to know its physicians. Today, meet Dr. Charles Golden, a board-certified pediatrician who serves as executive medical director of the CHOC Children’s Primary Care Network.

dr-charles-golden-choc-childrens
Dr. Charles Golden, a board-certified pediatrician who serves as executive medical director of the CHOC Children’s Primary Care Network

Education and training

I earned a Bachelor of Science in Biology at University of California, Riverside. After completing my undergraduate studies, I attended Western University of Health Sciences College of Allied Health and earned a certificate as a physician assistant. I worked at Southern Orange County Pediatric Associates (SOCPA) as a physician assistant until I started medical school at Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, in Pomona. I completed my internship and residency, including a year as chief resident, at Children’s Hospital Los Angeles.

Special clinical interests

I love all aspects of clinical medicine, but get energized when I have the opportunity to teach. I believe that every encounter with a patient is an opportunity to teach them something about the body and explain why we make the decisions that we do in medicine. I’m also passionate about teaching medical students and residents, as they continually challenge me to stay up to date with new research. I love the feeling I get from contributing to the development of their careers as physicians.

New programs and developments within CHOC’s Primary Care Network

In the near future, we plan to open an after-hours clinic for the entire community. By the end of this summer, we’re planning on implementing a single electronic health record (EHR) for all of our primary care offices so that all of our providers chart on patients in the same record, and a patient’s medical information can securely be available to whoever they see in our group. This will continue to improve communications within the practices.

We’re also growing our comprehensive adolescent medicine services. We will be hiring another adolescent medicine specialist to address this unique, complex patient population

We’re also working on the use of digital vision screening devices to look for problems with vision in children younger than 4 years old, who are often too young to read a visual acuity chart.

As a component of CHOC’s mental health initiative, we’re working closely with CHOC’s chief psychologist, Dr. Heather Huszti and her team to provide a mental health professional in each of our primary care offices to help the medical team screen for and address mental health issues.

What I want patients and families to know about CHOC’s Primary Care Network

For many people, bringing your child to seek medical care can be a stressful event. There are many sources of information out there regarding children’s health, and in some cases those sources may contribute to more confusion and anxiety. I would like patients and families to know that when they choose a CHOC pediatric provider, they can trust that the care being delivered is state of the art, up to date and based on clinical and scientific evidence, combined with years of expertise. They will be greeted by empathic staff who are skilled in making children feel comfortable, and providers who are not only skilled at diagnostics, but bring a warm and compassionate touch to the visit. Further, our pediatricians are partners with our specialists, and through this partnership they share knowledge, collaborate in patient care, and help to create a sense of calm for patients and their families.

What inspires me about the care being delivered at CHOC

Every day pediatricians, pediatric specialists, nursing staff, technicians and so many other professionals come to CHOC to make a difference in the lives of children in need. It’s a calling, and they’re passionate about it. You can feel it when you walk through the door, whether it’s from the smiles and greetings from the folks at the information desk, or when you see a security guard assist a family. Perhaps it’s when you see an associate go out of their way to offer hospitality to a random person in an elevator, or the cutting edge surgical and medical treatments that are happening every day. To try to answer what inspires me most about the care being delivered by CHOC would do a disservice to every little thing that occurs on our campus that makes CHOC a special place. I’m incredibly proud to be a part of it!

Why I decided to become a doctor

I fell in love with science as a teenager. Around the same time, my father had a heart attack. I remember going to the hospital and learning about his heart and how the medicine was working to provide care for him. I was fascinated by it all and never looked back.  If I wasn’t a doctor, I would probably be a general contractor. I’ve always enjoyed working with my hands.

Learn more about CHOC’s Primary Care Network

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Is Your Child’s Headache Cause for Concern?

When your child complains of a headache, it can be anything from a plea to stay home from school in hopes of avoiding a test, to a sign of something more serious. But how can you tell the difference? And when is it time to see the pediatrician? Dr. Sharief Taraman, a pediatric neurologist at CHOC Children’s, offers advice on what parents can do to keep headaches at bay, the importance of identifying a pattern in your child’s headaches, options for treatment, and what types of headache warrant a trip to the emergency department.

sharief-taraman-choc-childrens-pediatric-neurologist-offers-advice-childs-headaches
Dr. Sharief Taraman, a pediatric neurologist at CHOC Children’s, offers advice for parents concerned about their child’s headaches.

First, it’s important to be able to identify what type of headache your child may be suffering from.

What type of headache does my child have?

Migraine symptoms in kids

At least 5 attacks that meet the following criteria:

  • Headache lasting 1 – 72 hours
  • Headache has at least two of the following features:
    • Pain on both sides or only one side of the head
    • Pain is pulsating
    • Moderate to severe intensity
    • Aggravated by routine physical activities
  • At least one of the following:
    • Nausea and/or vomiting
    • Sensitivity to light or noise

If your child has more than 15 headache days per month over a three-month period, and at least half of those are migraines, they may be suffering from chronic migraines.

It’s a common misconception to assume that only adults suffer from migraines, which isn’t true, says Dr. Taraman. If your child has migraines, they are not alone. About 1 out of every 20 kids, or about 8 million children in the United States, gets migraines. Before age 10, an equal number of boys and girls get migraines. But after age 12, during and after puberty, migraines affect girls three times more often than boys.

Tension headache symptoms in kids

  • Headache lasting from 30 minutes to seven days
  • Headache has at least two of the following characteristics:
    • Pain in two locations
    • Pressing or tightening feeling (not a pulsing pain)
    • Mild to moderate intensity
    • Not aggravated by routine physical activity such as walking or climbing stairs
  • No nausea or vomiting – many children experience a loss of appetite
  • Either sensitivity to light or sensitivity to sound
  • Tension headaches occur most often in children ages 9-12

Cluster headache symptoms in kids

  • At least five headaches that meet the following criteria:
    • Severe pain in one location: within the eye, above the eyebrow, or on the forehead, that lasts from 15 minutes to three hours when left untreated
  • Headache is accompanied by at least one of the following symptoms on the same side of the body as their pain:
    • Conjunctival injection and/or lacrimation
    • Nasal congestion and/or excess mucus in the nose
    • Eyelid swelling
    • Forehead and facial swelling
    • Droopy eyelid and/or small pupil
    • A restlessness or agitation
  • Cluster headaches usually start in children at around 10 years old

Post traumatic headache symptoms in kids

  • Acute post traumatic headache: lasts less than three months and caused by a traumatic injury to the head
  • Persistent post traumatic headache: lasts more than three months and caused by a traumatic injury to the head
  • Both acute and persistent headaches develop within one week of: the injury to the head, regaining of consciousness following injury to the head, or discontinuing medicine that impairs the ability to sense a headache following a head injury
  • Extended recovery risk factors:
    • Prolonged loss of consciousness or amnesia
    • Females
    • Initial symptom severity
    • Premorbid history of ADHD, mood disorders, and migraines

Sleep apnea headache symptoms in kids

  • Typically occurs in the morning
  • Pain is present on both sides of the head
  • Lasts more than four hours
  • Not accompanied by nausea, nor sensitivity to light or sound

Medication overuse headache symptoms in kids

  • Headaches on 15 or more days per month
  • Takes over-the-counter medication for headaches more than three times per week over a three-month period
  • Headache has developed or gotten worse during medication overuse
  • Pattern of headaches resolves or improves within two months after discontinuing the overused medication

What to do when your child has a headache

A variety of non-medical interventions can be helpful for children who are suffering from headaches. These non-medical interventions for headaches include: ice packs; warm baths; taking a nap in a cool, dark room; neck and back massage; and taking a walk.

Parents shouldn’t be tempted to immediately turn to medication such as ibuprofen or naproxen, says Taraman.  Over-the-counter pain medications (such as Tylenol or Motrin) should be limited to no more than three days per week with no more than two doses per day, in order to avoid medication overuse headaches. Follow the dosing instructions on the label and ask your child’s pediatrician or pharmacist any questions before beginning a treatment regimen. Follow dosage instructions given by your physician or pharmacist, or download a guide to ibuprofen and naproxen.

dosing-instructions-ibuprofen-naproxen

How to avoid headaches

There are a number of things parents can do to prevent headaches, says Dr. Taraman. These include:

How to talk to your pediatrician about your child’s headaches:

Keep a journal of your child’s headaches so you can identify a pattern, and show your child’s primary care physician. If you don’t have a primary care provider, find one near you. In your headache journal, keep track of:

  • Headache start date and time
  • What happened just before the headache?
  • How much did your head hurt, on a 0-10 pain scale?
  • Where did your head hurt?
  • What did you feel just before and during the headache?
  • What did you do to make yourself feel better?
  • Did you feel better, on a 0-10 pain scale?
  • Headache end date and time

Your child’s pediatrician may adjust your child’s diet, headache hygiene routine, or their NSAID regime. In some cases, your primary care provider may refer you to a pediatric neurologist, who have specialized training in the nervous system (brain, spinal cord, muscles and nerves), who work in tandem with imaging and other specialists and pediatricians as necessary.

Patients should immediately be taken to the emergency department for some headaches including:

  • Thunderclap headache: severe, sudden onset of pain that occurs anywhere in the head, and grabs your attention like a clap of thunder. Pain usually peaks within 60 seconds to a few minutes.
  • Any headache that comes with weakness or numbness on one side of the body, or changes in consciousness or awareness.
  • Blurred, double or loss of vision that persists after the headache resolves.

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Kids and Throwing Up: Should You Worry?

Throwing up is no fun, for kids and parents alike. It can also be alarming. A CHOC Children’s pediatrician explains what causes children to vomit and when to be concerned.

The most common cause of throwing up is a stomach virus, otherwise known as the stomach flu or acute gastroenteritis, according to Dr. Reshmi Basu. It is often accompanied by diarrhea. Vomiting could also be caused by reflux in babies, a toddler’s aversion to certain smells or foods, motion sickness, food allergies, food poisoning, urinary tract infection, appendicitis or other less common conditions.

“It’s also really common for a child to cough so hard that they throw up,” Dr. Basu says. “This can be scary, but should go away once the underlying cause of the cough is resolved.”

Treatment for vomiting varies depending on the cause. In some cases, anti-nausea medication may be prescribed to give your child some relief. A stomach virus should clear up on its own after a few days. When vomiting is caused by reflux, food allergies or motion sickness, the underlying issue can be treated.

A child who vomits one time and has no other symptoms should be fine, Dr. Basu says. They may just have an upset stomach or strong gag reflex.

When to Call the Doctor

Call the doctor if your child:

· Is throwing up for more than two days but has no other symptoms

· Has severe abdominal pain with vomiting

· Has severe headaches with vomiting

· Has a high-grade fever with vomiting

· Has unexplained weight loss with vomiting, or

· Has any signs of dehydration (see below)

“Also, if your child or teen is throwing up periodically over a prolonged period of time, without any obvious reason, I would want to investigate that,” Dr. Basu says.

Watch Out for Dehydration

Kids who have thrown up multiple times are at risk for dehydration, and that risk goes up the younger they are or if they also have diarrhea. Signs of dehydration include extreme fatigue, tired-looking sunken eyes, going several hours without urinating, dark urine, dry lips, dry mouth, dizziness, and, in babies, crying without tears or a sunken soft spot. Your child should see a doctor immediately if they have any of these symptoms.

To prevent dehydration, encourage your child to drink lots of fluids. Pedialyte is best, but if they refuse that then offer what they will take such as water or diluted juice, although it is better to avoid milk. Your child’s stomach may only be able to handle small amounts at first. Dr. Basu recommends starting with 1 tablespoon of fluid; wait 10 minutes, then try 2 tablespoons, and gradually increase as tolerated.

Your child should see a doctor if they cannot tolerate any liquids.

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