How can you prepare for a child's ER visit

Taking your children to the emergency room can be a stressful experience. In a two part series this week, Hazel Guinto-Ocampo, M.D., chief of pediatric emergency services at Bryn Mawr Hospital, offers tips on how to prepare for a visit to the ER. Tomorrow, she’ll go over what to expect in the ER and how to get best care for your child.

Having been involved in a recent fender-bender accident, it made me think that parents taking their child to the ER can be like an accident in some ways. Although you are mindful of preventing one and would want to avoid it at all cost - sometimes it happens anyway. This is especially true now that we're in the middle of another flu epidemic.

Here’s how you can prepare for that unforeseen trip to the ER:

  1. Pack for a potential wait. Although most ERs are streamlining processes to minimize waiting times, patients do wait especially in the fall and winter. Therefore, bring items to keep your child occupied and comfortable. Bring books, electronic games, and comforting items such as a blankie or favorite toy. Pack drinks and snacks, but always check with your nurse or doctor first before feeding your child.
  2. Make arrangements for your other children if needed. Call relatives or friends to take care of your other children who may need to get picked up from school, or cared for at home. If at all possible, tag team with your spouse or older child, or make arrangements so you don't have to bring young siblings to the ER with you. This way, you can focus on the needs of your sick child, and your other children do not have to endure the waiting time, or watch their sibling undergo uncomfortable procedures.
  3. Be ready to provide relevant information. These include: health insurance;  your primary doctor and other doctors' names and contact information;  allergy, immunization, past medical and surgical history; list of medications; and a chronological sequence of events leading to your child's ER visit.  You may be asked this information by multiple providers.
  4. Pack for a longer stay. Be prepared for the possibility that your child will get hospitalized.  Pack items necessary for you and your child's hospital stay.
  5. Understand that some of your expectations may not be met. Remember that emergency departments are set up so the ER physician can diagnose and start treatment mostly for life threatening conditions, and to provide comfort and pain relief.  Even the most astute ER physician often cannot make an exact diagnosis for common complaints.  

For example, a 10 year-old girl comes in with a sudden onset of right lower belly pain. Examination and tests are done, conditions such as acute appendicitis, twisting of the ovary, kidney stone, or urine infection are ruled out, and her pain is manageable at home. At this point, she may be ready to get discharged although an exact reason for her pain was not found.

Arriving at an exact diagnosis during the ER visit is especially difficult for long standing conditions. These are best evaluated and managed by the appropriate specialist during an office visit.

A good number of patients are referred to the ER because of a concerning complaint heard or finding seen by the primary physician during a phone call or office visit.  The same finding may be gone once the patient is seen in the ER either because conditions change with time, or treatment recommended or started by the primary physician has taken effect.  Therefore, your child might not always get the tests or treatments suggested by your primary physician.

A good ER physician's primary responsibility is to first, do no harm.  Some tests and treatments may be unnecessary, can be uncomfortable, or can be potentially harmful or risky.