Non Emergencies in the Emergency Department

I walk into the room, introduce myself, and ask my usual lead-in question: "When did things first start going wrong?"  The mom answers "She started with this rash last night, and this morning it has spread all over.  Just look at it!"  The mom yanks up the toddler's shirt and sweeps her hand to show me the extent of the child's scourge. And the child's skin looks....normal.  I put on my reading glasses and peer closer.  Still, I am hard-pressed to identify anything that could be remotely called a rash.  The mom offers: "Its those bumps that worry me."  Ah yes, I can see that the child's skin has tiny bumps that at first you don't notice, but alter the skin's texture a little bit.  I straighten up, complete the rest of my history and physical, and inform the mom that no, the child does not have measles or chicken pox or flesh-eating bacteria, but a dry, irritated skin condition called eczema.  A change of soap, more lotion, and it should be fixed up in a few days. Winter is a busy time in the Pediatric Emergency Department.  Bronchiolitis makes babies cough, influenza makes all ages feel and look miserable, and asthmatics wheeze.  Kids are kept indoors by the cold and cough on each other and spread the contagion.  Emergency Departments and doctor's offices are filled to the brim with sick children.  And then everybody waits longer to see the harried practitioners. The majority of theses illnesses involve coughs and fevers.  Fevers and coughs are not emergencies, and there are some simple things to know that can keep you from having to wait for hours in the Emergency Department or at your doctor's.  Fever itself is not an emergency.  Fevers do not harm your child- they do not cook kid's brains and they rarely cause seizures.  Fever is actually one of the body's natural mechanisms to fight illness- fever is a good thing!  When your body senses that you are sick, it sets your brain thermostat higher.  The higher body temperature makes it harder for infection to grow in you, and your immune system can get on top of the infection. What is more important with fever is how the kid is acting with the fever.  Certainly the child will be tired and miserable, but that is easily treated with medicines like ibuprofen (motrin, advil) or acetaminophen (tylenol, pediacare).  As long as your child is drinking some, breathing comfortably, and is mentally "with it," your child is doing okay. Most fevers are caused by viruses that will pass in a few days without need for a prescription. Likewise, most coughs are not emergencies.  Sure, coughs are irritating, particularly at night when everyone wants to go to sleep.  But as long as the child is breathing comfortably, then home remedies are as good (or better!) than any prescription.  Put your kid to bed with their his head elevated, get the vaporizer going next to the bed, put on some Vicks-Vaporub.  Give some ibuprofen or tylenol to ease that scratchy throat.  Don't waste your money on cough syrups- science has shown over and over that they don't work. There is no prescription that reliably helps coughs either.  Everyday I get parents who ask for a prescription for colds.  As I tell them, no one has invented any medicine that helps dry up runny noses or suppresses cough.  Doctors sometimes prescribe anti-histamines, codeine, or other things, but these medicines rarely help and often cause more trouble than they are worth.  They can make a child more awake and antsy and irritable, and the kid still coughs! So please don't be like the mom above and rush to the Emergency Department when your child has a rash or a fever or a cough.  We are busy enough with the children who are lethargic or working hard to breathe, with kids with broken arms and head injuries and lacerated faces.  Long lines of the non-emergent just makes everyone wait longer, only to be told the things that could have been done at home.  If you are not sure, call your doctor to see if you should come to the office or come to the ER.  Do your part to keep non-emergencies out of the Emergency Department.