One of my readers wrote to me with a request. She was never quite sure when she should go to urgent care vs an emergency room….could I write a post that reviews the guidelines?
We wish that we could give you a straight answer! Some urgent care facilities can suture up a wound, do an x-ray and/or start an IV. Others will send you to the emergency room for those same services depending on the age of the patient.
There doesn’t seem to be consistent standards out there. But a little preparation in advance can help you navigate through the confusion.
Seeing your primary doctor should be where you try to start.
Routine check ups are the opportunity to have your doc get to know your child.
Chronic issues (anything lasting longer than a month) should also be managed by your regular doctor unless there is an acute change and you need to be seen urgently. Those often require continuity. Labs and referrals can't be managed as effectively by someone who sees you only once.
Refills should be handled by the office of your primary care provider. Pay attention if you are running low on something and request a refill at least a week in advance. Please Don’t wait until Friday afternoon.
But Murphy's Law generally seems to make certain that the fever spikes, or the vomiting starts, right at 5:01 pm when the average doctor's office turns their phones off.
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Also, we get it that sometimes the hours and location of an urgent care feel much more convenient.
In any case, it is important to be familiar with your after hours/urgent care options.
Waiting until you or your child is ill is not the best time to start learning about what choices exist in your area.
Do some research
Start by asking your regular doctor’s office if there is an urgent care that they are associated with.
How late are they open?/Do they do walk-ins or schedule appointments?
Are there after hours advice nurses available?
Where is the closest emergency room? Is it staffed with pediatricians?
Does your insurance plan have a preferred option that won’t cost as much?
If you are traveling, plan ahead and figure out local options for care before the trip.
Once you have some Urgent care options give them a call and ask them a few questions. Most will deal with general illnesses, but you also want to know:
Do they do sutures?
Do they do IVs? This is exceedingly rare for pediatrics.
Do they do X-rays?
Can they remove a jelly bean from the nose or ear?
Will they help assess a head injury?
And here is the most important follow up… Is the answer still yes if you have an infant or toddler? Some places who don’t blink about treating a seven year old are very quick to show you the door and send you to the ER if your child is younger than that.
Things to keep in mind if you need to be seen at urgent care
Know the exact names and dosages of any medications the patient is on. If possible bring them with you or take a photo of the container.
Have an accurate timeline of the illness. It is a good habit to start a shared document when your kid gets sick. This way caregivers can track symptoms, timing of medications etc. That document will be a useful history for any medical professional who you end up seeing.
Request that the urgent care send a report to your primary doctor.
Here are some of the most common reasons that people go to urgent care.
When available, I’ve included blog post links that may be helpful in helping you figure out if you need to be seen.
Fever (read more)
✅ Urgent Care: Almost always ok, except for noted exceptions
🛑Emergency Room: If Temperature is over 106 or baby is under 2-3 months
Respiratory Illnesses (read more)
✅ Urgent Care: Good place to start unless there is severe respiratory distress
🛑Emergency Room: The post linked above describes what respiratory stress actually looks like.
Ear Pain (read more)
✅ Urgent Care: Can usually tend to the majority of ear issues.
🛑Emergency Room: Only if there is marked, severe swelling around the ear/skull (This won’t be subtle!)
Vomiting / Diarrhea (read more)
✅ Urgent Care: Unless you suspect dehydration. Although it never hurts to check, most urgent cares don’t do IVs.
🛑Emergency Room: If an IV is might be needed, the ER is the right choice.
Abdominal Pain
✅ Urgent Care: Check for constipation or gas which are the most common culprits
🛑Emergency Room: If unable to walk or jump due to the pain
Allergic Reaction/Hives (read more)
✅ Urgent Care: Hives without any of the signs below are OK
🛑Emergency Room: If hives are associated with trouble breathing, coughing, vomiting, diarrhea, or lip/tongue swelling, or if an Epi pen was needed. After the use of epinephrin, supervision is needed to make sure that symptoms don’t rebound
Rashes (read more)
✅ Urgent Care: Virtually all OK, with one rare exception listed below
🛑Emergency Room: If there is a fever along with a rash that is purplish and doesn’t get lighter when you press on it go to ER immediately. If patient is acting confused call 911
Injuries - Body (read more)
✅ Urgent Care: Call ahead to ask about x-ray availability and stitches if you suspect they may be needed. Dislocated Elbow (nursemaids) is usually an easy fix at urgent care. A mild sprain can possibly wait until the next day, Rest/Ice/Elevate and (arnica) if it it is still painful in the morning, get it checked out
🛑Emergency Room: Many gaping wounds and obvious fractures need the ER
Injuries - Head (read more)
✅ Urgent Care: If it was minor and none of the red flags are presented, Urgent care may be able to offer reassurance
🛑Emergency Room: If there was a fall from up high, or very fast and sudden impact (i.e. air bags went off in a car), loss of consciousness or vomiting, it is safest to get them thoroughly checked out in the ER
Urinary Tract Infections (read more)
✅ Urgent Care: Almost always OK, except ↓
🛑Emergency Room: If associated with a fever in a young infant under 3 months
Sore Throat (read more)
✅ Urgent Care: Almost always OK, except ↓
🛑Emergency Room: If unable to close the mouth or turn the head, with high fever and excessive drooling
Swallowing / Inhaling Foreign Bodies
(read more: swallowing, foreign bodies)
✅ Urgent Care: Good to call in advance to check. Many urgent cares will remove deep objects out of ears/nostrils but others will not. It may actually depend on who is working the shift. ( Dr. Ted is a superhero when it comes to getting things out and stitching things up, not everyone is so willing)
🛑Emergency Room: If any signs of distress. If the swallowed item was possibly magnets, button batteries or water beads those can be especially hazardous, but anything that could cause a blockage needs to be assessed and dealt with. If actively choking call 911
Pink Eye (read more)
✅ Urgent Care: Almost always OK, except ↓
🛑Emergency Room: If the skin around the eye is entirely red and swollen with pain and fever
Burns
✅ Urgent Care: If first or second degree.
🛑Emergency Room: Burns on the face, neck, hands, feet or genitals are generally more serious. Any potentially third degree or burn covering a large area of the body needs to be seen in ER and may be require being transferred to hospital that specializes in burns
Poisoning (read more)
🛑Urgent care not the right option.
✅Call poison control: 1-800-222-1222. They may direct you to the ER
Seizure
🛑Urgent care is Not the right choice
✅Go to ER. If this is the first time, it is appropriate to call 911
Behavior / Psych
🛑Urgent care not the right choice.
✅ You can call 988 but they will likely direct you to head to the ER. especially if you are dealing with a minor.
Bonus link
What should you have on hand in your medicine cabinet
Enormous thanks to amazing designer Nancy Elle who helped us try to make the text behave.
Thank you to Sawyer for being one of my favorite models.
And Bella, this one’s for you!
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