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There are many costs to using the emergency department for non-urgent care.


There’s the literal cost of care, given that emergency room visits generally have higher co-pays than clinic visits.

There are also plenty of figurative costs. Bringing your child to the emergency department when she does not have a serious illness or injury is likely to lead to a long wait, because she will be triaged behind the actual emergencies. After that long wait, you’re likely to receive an unsatisfying diagnosis and/or treatment: a Band-Aid for a cut, a directive to drink fluids for a run-of-the-mill cold, etc.

These experiences may erode your trust in the emergency department, especially when you receive the bill. It’s hard not to feel snubbed, like your child’s pain doesn’t matter, even when you are being told that your child is medically fine.

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If you and your not-so-sick child are in the emergency department all night, both of you might miss out on a good night’s sleep, and, as a result, school and work tomorrow. While logging all that time in the waiting room, you and your child are also susceptible to hospital-acquired infections from all of the other sick patients.

Visiting an emergency department for a non-emergency can also have longer-range consequences. Taking a child to the emergency room for common ailments like ear infections can harm continuity of care, argues a recent review article in the The Journal of Pediatric Health Care.

When parents seek treatment for such issues at the ED, their children’s primary care providers (PCPs) might not receive valuable information about different illnesses. Without knowing how many ear infections or cases of strep throat a child has had, a PCP will not know whether or not to recommend interventions, like tympanostomy tubes or tonsillectomies.

All of these consequences focus on your child, but there are consequences for other people, too – including the truly sick children whose care may be delayed by overcrowded emergency departments or by overstretched hospital staff.

Given all of the negative consequences of bringing children to the emergency department for non-urgent conditions, it’s surprising that so many parents are doing it. A study of 31,076 emergency department visits from 33 different pediatric practices found that nearly half of those visits (47 percent) were classified as non-urgent by hospital staff. In other words, roughly half of children being seen in the emergency department did not need to be there.

Why are so many parents bringing their children with non-urgent conditions to the emergency department? How can you avoid being one of those parents?

It’s rarely a matter of life and death

The ED is for acute medical problems that may kill or maim if left untreated, which is why many hospitals around the country use the Emergency Severity Index to triage patients. The ESI’s triage algorithm is easy to read and worth parents’ time, because it shows exactly what a triage nurse or other healthcare professional will be asking when evaluating your child’s case.

The ESI flow chart begins with one easy question: “requires immediate life-saving intervention?” A “yes” answer leads to an ESI score of 1, and hasty attention in the ED.

A “no” answer leads to another set of questions. If the situation is not high-risk, the triage score will be somewhere between 3 and 5, depending on how many resources will be required to help a patient. If a patient does not require any resources (say, for a cold or flu), then the patient will be scored a 5. Many parents who bring their children to the ER for non-urgent categories will get a 4 or 5.

Why parents head to the ED

If their children are not at serious risk, why are so many parents heading to the ED?

One recent study found that parents’ tended to rate their children’s conditions more severely than medical professionals did. The hospital staff determined that of 381 visits, 298 (78.2 percent) were non-urgent cases.

In other words, just over two in 10 patients actually needed emergency care. However, almost 40 percent of parents asked to rate their children’s conditions reported that their children needed emergency care.

One explanation for overuse of pediatric emergency services is that parents, who are, on the whole, less experienced medical providers than doctors and nurses, are simply not good at evaluating whether or not a medical condition constitutes an emergency.

That explanation, however, fails to account for the nearly 40 percent of parents in the study who brought their children into the ED knowing that they had a non-urgent condition.

One way to better understand why parents bring their children to the emergency room is to simply ask them. Two different interview studies have done just that, questioning parents who took their children to the ED for non-urgent conditions. Both studies took place on weekdays during normal work hours, in order to determine why parents chose the emergency room over a PCP.

In the first study, researchers identified three main reasons for choosing the ED over the PCP. Some parents indicated that they chose the ED because their PCP recommended it, either after an in-person visit or after a phone call.

Another group of parents chose the ED because of problems with their PCPs, including impolite staff, confusing directions from the PCP, or even a PCP whose accent was confusing to parents. Parents also saw advantages to the ED, which was available for walk-ins and might be closer to home.

The second study found similar reasons for ED use, but went a step further in matching those reasons to parents’ health literacy. Researchers found that parents with lower health literacy tended to seek care for a diagnosis and treatment, while parents with average health literacy usually came to the ED with a diagnosis in mind but seeking reassurance from a trusted source.

Both groups feared “getting it right” when it came to their children’s diagnoses. In that sense, the ED operated as a space to reassure parents that they were providing good care to their children.

The most interesting finding of this second study was that all parents heard alarm bells over some symptoms. No matter how much health literacy they had, nearly all parents in the study panicked about fever. Parents feared ear damage, brain damage, and other consequences frequently misattributed to fever, and took their children to the ED even when it was not recommended by their children’s PCPs.

What’s the best way to keep your kids out of the ED?

Boost your own health literacy.

What’s clear from the interview studies is that parents with stronger health literacy are better assessors of risk, better able to distinguish between non-urgent, urgent, and life-threatening situations.

1 | Learn to identify true emergencies

You’ll probably know a true emergency in the unlucky case you see it, but if you need reminders, the American Academy of Pediatrics’ Healthy Children site for parents offers a useful list of situations that count as emergencies.

Although medical emergencies come from the whole alphabet, remembering just the Bs is a good start: behavior changes (like disorientation), bleeding, breathing problems, broken bones, burns, and button batteries (only if swallowed). All of those things will be considered high priority in an emergency department, because they are either life-threatening, high-risk, or causing severe pain.

When you’re on the fence about whether or not emergency care is right for the situation, your child might be better served by urgent care. Many lacerations, for example, are urgent but not life threatening, and therefore do not require a trip to the ER. In fact, they may be more quickly resolved at an urgent care center.

Some hospitals, like the Mayo Clinic, operate both emergency departments and urgent care centers, which makes it possible for parents who are unsure about the severity of a condition to be redirected by the hospital staff.

If you don’t have a combination ED and urgent care center near you, and aren’t sure which of the two to go to, check out Colorado Children’s Hospital’s helpful quiz to train you to distinguish between urgent and emergency situations. Actually, if you have time to take the quiz, you probably have an urgent care need and not an emergency.

Many other terrifying-looking medical issues, like a high fever in a child over three months old or even febrile seizure, do not require urgent care and can be handled through follow-up with your child’s PCP, which is why the next step is so crucial.

2 | Develop trust in your child’s primary care provider

Try to see the same PCP for all of your child’s well visits. Doing so can help you build trust in that person’s judgment, which you can lean on when making middle-of-the-night healthcare decisions.

Your child’s PCP is there to monitor your child’s health, but also to educate you about how best to care for him. Make sure you are receiving the resources you need, including, for example, information on urgent versus non-urgent situations.

Many PCPs operate phone services for health questions. These hotlines are different from the insurer hotlines you might call to find out about health coverage. Instead, these hotlines put you in touch with a healthcare professional, often a nurse, who will help you determine how serious your child’s health issue is. That person can also contact your PCP to get further advice about how to proceed.

If your pediatrician does not have a triage after-hours phone service, ask why not. If you don’t trust your primary care provider, get a new one.

3 | Ask what you’re buying with an emergency department visit…and where else you can buy that

The hardest part of deciding not to go to the emergency department with a sick or injured child is probably not a medical issue. It’s a philosophical one.

One possible explanation for the overuse of emergency departments for common childhood illnesses is that parents are seeking reassurance more than they are seeking medical care. Although training yourself to identify true emergencies, developing trust with your child’s PCP, and cultivating a list of after-hours resources will all help you make better decisions, what you need most is to develop trust in yourself as a parent.

If you review the above studies about the ages of children brought to the ED, you would notice a distinct drop-off after the first few years of life. That’s not because young children are necessarily any more vulnerable than preschoolers or kindergarteners. It’s because parents of one-year-olds don’t trust themselves to identify and resolve their children’s health problems.

For the first three months or so, no new parents know what they’re doing. This is also the time period when some issues, like fever, are considered emergencies. So you might choose to follow an informal three-month rule, erring on the side of caution and making frequent calls to your child’s PCP until you can start to separate urgent from non-urgent.

As you begin to learn these distinctions, and develop your health literacy, start to trust as much in yourself as in your child’s medical staff.

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As the saying goes, "failing to prepare is preparing to fail," and that seriously applies to parenting. With no fewer than one dozen items to wrangle before walking out the door on an ordinary errand, mamas have plenty on their mind. That is why one of the very best gifts you can give the mamas in your life this year is to reduce her mental load with some gear she can depend on when she's out and about.

Although it may be impossible to guarantee completely smooth outings with kids in tow, here are the items we rely on for making getting out of the house less of a chore.

1. Bugaboo Bee 5 stroller

This stroller is a dream come true for any mama on the go. (Meaning: All of us!) Lightweight, compact and easy to maneuver with just one hand, this is made for navigating busy sidewalks with ease—or just fitting in the trunk without a major wrestling match. It's designed for little passengers to love just as much, too, with a bassinet option for newborn riders that can be easily swapped with a comfy, reclining seat that can face forward or backward for bigger kids.

$699

2. Bugaboo wheel board

This wheel board will let big brother or sister easily hitch a ride on the stroller if their little legs aren't quite up for a full walk. We love the smart details that went into the design, including a slightly offset position so Mom or Dad can walk without bumping their legs. And because toddlers have strong opinions of their own, it's brilliant that the wheel board allows them to sit or stand.

$125

3. Nuby Keepeez cup strap

If you know a little one gearing up for the major leagues with a killer throwing arm, this is a must-have so parents aren't buying new sippy cups on a weekly basis. Perfect for tethering to high chairs, strollers, car seats and shopping carts, it allows Mama to feel confident she'll return home with everything she left with in the first place.

$6.99

4. Bugaboo footmuff

For those mamas who live anywhere where the temps regularly dip below 40 degrees Fahrenheit in the winter, this ultra-soft, comfortable footmuff is a lifesaver. Made with water-repellant microfleece, it keeps little ones dry and cozy—whether there is melting snow, a good drizzle or simply a spilled sippy cup.

$129.95

5. Bugaboo stroller organizer

Because we know #mombrain is no joke, we are all for products that will help us stay organized—especially when out and about. With multiple zipper pockets, a sleek design and velcro straps that help it easily convert to a handbag when stepping away from the stroller, it helps keep essentials from spare diapers to the car keys within reach.

$39.95

6. Bugaboo Turtle car seat

It may be called a car seat, but we love that this one is specifically designed to securely click into a stroller frame, too. (Meaning there is no need to wake up a sleeping baby for a car-to-stroller transfer!) More reasons to love it are the lightweight design, UPF 50+ sun protection shade and Merino wool inlay, meaning it's baby and mama friendly.

$349

7. Chicco QuickSeat hook-on chair

This hook-on baby chair will almost certainly earn a spot on your most-used list. Perfect for dining out or simply giving your baby a space to sit, it's portable and beyond easy to install. (Plus, it's a great alternative to those questionably clean high chairs at many restaurants!)

$57.99

8. Bugaboo stroller cup holder

Chasing after kids when out and about can work up a thirst, just like neighborhood strolls in the chillier months can get, well, chilly. So we love that this cup holder will help mama keep something for herself to drink close at hand. Designed to accommodate bottles of all sizes and easy to click onto any compatible stroller, it's a perfect stocking stuffer.

$29.95

9. Bugaboo soft wool blanket

Fair warning with this luxe stroller blanket: It's so cozy that you might want to buy another one for yourself! Made with Merino wool that helps it stand up to any elements parents might encounter during an outing, it will help baby stay warm during the winter and cool enough as the temps start to pick up.

$109.95

10. Munchkin silicone placemats

Made to roll and stow in a diaper bag, these silicone placemats will make dining out a (relatively) less messy experience. With raised edges that will help contain spills and a grippy bottom, they will stay in place on tables so that parents might be able to enjoy their own meals, too.

$8.99

11. Bugaboo Breezy seat liner

Designed to keep baby warm when it's cool and cool when it's warm, this seat liner will minimize fusses during all seasons—which is one of the very best gifts you can give a mama. Because accidents of all types can happen on the go, we also love that this seat liner is reversible! With a number of colors, it's also a fun way to help a stroller to stand out at the playground.

$79.95

12. OXO Tot Handy stroller hook

If you ever catch yourself thinking it would be nice to have another hand, these stroller clips are the next-best solution for when you are out and about. Perfect for lugging a bag or anchoring a cup, you'll want a set for every stroller you own.

$14.99

This article was sponsored by Bugaboo. Thank you for supporting the brands that support Motherly and mamas.

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Vogue cover star Ashley Graham has received a lot of advice about pregnancy from some pretty famous friends. Since the moment she announced her pregnancy in August, Ashley Graham has been sharing gorgeous pictures of her body's evolution. But as we all know pregnancy is just the teeniest sliver of the iceberg that is motherhood, and there have been a whole lot of mothers eager to tell her so.

In the new issue of Vogue, the supermodel and some of her famous friends share the advice they've been giving the mom-to-be.

"Now all anyone wants to talk to me about is being pregnant," said Graham, who is due to have her baby boy with husband Justin Ervin in January. "There's just this camaraderie. It's a secret society that I didn't know about."


While most of us don't take too kindly to unsolicited parenting advice, we might feel a little differently if Serena Williams was texting it to us.

Here are some of the choice bits of motherhood wisdom Graham has received:

Kim Kardashian: Pregnancy is harder than giving birth (but every mama has her own journey)

"Ashley, the pregnancy may be the hardest part, but the birth is the easiest," Kim Kardashian told Graham at Williams' fashion show this September.

Kim has had famously hard, complicated pregnancies, so that was her experience, but not every mother feels this way. For some pregnancy would rank as easier, while some would say that birth wasn't even as hard as the postpartum recovery.

Every mama's journey is different.

Jordan Foster: Friends make pregnancy and motherhood easier

Graham said she had a hard time during the first four months when she was keeping her pregnancy a secret and her body was going through all its crazy hormonal changes. "I felt like I didn't have anyone to talk to. I was gaining weight rapidly. And I felt alone. And the one piece of advice that my stylist, Jordan Foster, gave me was: Make pregnant friends. None of my friends were in relationships, let alone pregnant. And now I have nine pregnant friends."

We're so happy that Ashley found nine fellow mamas to connect with. Jordan gives good advice!

Serena Williams: It's okay to be scared

Serena Williams told Graham that it's okay to be afraid, there's a lot happening when your body transforms during pregnancy. It's okay to have moments when you admit that there is a lot going on.

"I was one of those people who wanted to know every ugly detail of what happens . . . down there . . . what happens everywhere," Serena Williams told Vogue of her conversations with Graham. "Like, why are my nipples so big a week into being pregnant? This makes no sense; the baby doesn't need to eat yet. I wanted to know every single thing, and I still love talking about it. Because I feel like it's important to kind of change the narrative and be like, it's normal to feel scared, and not be one of those women who are like, 'Oh, it's so great!' Just be scared out of your mind. That's normal."

Serena Williams: Don't compare yourself to other postpartum mamas 

Not that Graham, of all people, is prone to thinking her body should look like everyone else's, but Williams wanted to reiterate this. "I had a little problem with the lies of girls on Instagram—like, coming out of the hospital holding the baby and . . . you know . . . looking thinner than before," Williams said. "That's not happening to me! That's one thing I've learned, and the thing I tell Ashley: Everybody—literally every body—is different. You might jump back in an hour. I didn't."

Amy Schumer: You'll get why parents are so excited to give advice.

Amy Schumer understands a thing or two about the unsolicited advice people offer to pregnant mamas and new parents, but now that she's got a few months of parenthood under her belt she also understands why parents offer it. It often comes from a good place, even if the timing isn't great.

"People are so in your face when you're pregnant because they're so f---ing excited for you. And you don't get it. You can't possibly get it. And then after you've had a baby you're like, 'Oh, I get it!'," Amy Schumer said she told Graham.

But Schumer also told Graham she's gonna hold herself back from offering unsolicited advice, but reminded Graham that she's only a phone call away if the new mama does ever want to hear Schumer's suggestions.

Graham is taking all this advice in, while "not putting too much pressure on myself" she said.

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There's nothing Beyoncé can't do, at least as far as we can see. From dropping record-breaking albums to starring in movies to dominating stadium tours, the woman seems almost superhuman. But even Beyoncé can admit that working motherhood is really, really hard. She recently opened up about her struggles—and we never thought we'd say this—but we kind of feel like we can relate to Beyoncé.

The superstar recently opened up about everything from body image to hitting up Target in a brand new interview. But here's what we're taking away form the conversation: Beyoncé's raw, confessional comments about juggling motherhood and career.

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"I think the most stressful thing for me is balancing work and life," Beyoncé tells Elle when asked what stresses her out. "Making sure I am present for my kids—dropping Blue off at school, taking Rumi and Sir to their activities, making time for date nights with my husband, and being home in time to have dinner with my family—all while running a company can be challenging."

Say it louder, Beyoncé! It's crazy to hear that even the most iconic celebrity of all worries about things like school drop off. Admittedly, we don't know exactly what Bey's juggle looks like. We have no idea what it feels like to be trailed by the paparazzi or sell out stadiums or have access to absolutely everything money can buy. But here's what we do understand: The incredible pressure that comes with trying to fit too many things into too few hours, and the feeling that we wish we could be multiple places at once.

Something else we can relate to? Beyoncé's feelings about her body and its evolution over the years. "If someone told me 15 years ago that my body would go through so many changes and fluctuations, and that I would feel more womanly and secure with my curves, I would not have believed them," she says. "But children and maturity have taught me to value myself beyond my physical appearance and really understand that I am more than enough no matter what stage I'm at in life."

Amen to that, Mama!

And most relatable of all is this answer she provided. When a fan asked, "With all the hats you wear (chairwoman, global entertainer) and all the titles we give you (Queen, Yoncé), which brings you the greatest joy?" via email, here's what Queen B had to say: "Being Blue, Rumi, and Sir's mom."

We feel this so hard. And it's so gratifying to see that even Beyoncé—with all the massive, unprecedented things she's accomplished—knows that when it comes right down to it, nothing compares to being a mama.

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Every winter, without fail, my skin gets very dry. It's like clockwork. As soon as November hits its as if the dry skin Gods band together to give me dry, patchy skin. Some winters are better than others, but this winter it's especially bad. Maybe it's age-related skin changes, or perhaps it's because I moved into a new home with radiator heating and every morning I wake up in what seems to be the Saraha desert. Either way, I'm over it and needed answers.

I caught up with celebrity esthetician Elina Fedotova and her findings are making a big difference on my skin.

"Sometimes in the cold months, we feel achy so many people love to take long hot showers in the morning or take a bath and that is very understandable," she says. "However, remember that long hot showers can lead to over-drying your skin, especially in the winter. Instead of soap, use an oil-based sugar or sea salt scrub. Also, you can use butter-based polishing masks preferably with probiotics because it will help your skin's microbiome, which is essentially important for protective functions on your skin."

Here is my favorite body scrub, plus a few others for you to consider for this winter, mama:

Herbivore Coco Rose Coconut Oil Body Polish

Herbivore Coco Rose Coconut Oil Body Polish

A sweet-smelling body scrub that's uber gentle and in millennial pink? Yes, please! I also love that the sugar, virgin coconut and Moroccan rose oils not only provide major hydration, but they increase hydration and reduce redness. It also looks pretty cute alone on my vanity when I'm going through my decluttering phase and need to purge.

$36

Babe and Body’s Shower Yoga

Babe and Body\u2019s Shower Yoga

Sometimes you have to skip the downward dog and bring the namaste straight to your warm shower. This zen-inspired muscle and joint relief scrub combine the powers of dead sea salt and magnesium while infusing scents of lemon and lavender. The lemon oil is also great for tightening the skin, preventing wrinkles and removing excess oil. And, using it makes me feel like I'm kind of working out—even when I haven't seen the inside of a gym in days (okay, fine, months).

$29

OUAI Scalp & Body Scrub

OUAI Scalp & Body Scrub

This scrub really allows me to put Fedotova's suggestion to practice. This exfoliating sugar crystals cleanses and softens my skin and even adds a dose of probiotics that she mentioned to help my skin's defense. It also smells so good I use it during my at-home spa moments (read: mandatory self-care time) when my toddler is having a tantrum.

$38

Fresh Brown Sugar Body Polish Exfoliator

Fresh Brown Sugar Body Polish Exfoliator

This no-frills cult-favorite body scrub has stood the test of time. The brown sugar crystals in it serve as natural humectants that prevent moisture loss, while the oils add instant hydration. And, yes, the rumors are true: you can expect a complete skin refresh that lasts for days.

$39
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Gift-giving is always well-intentioned: It's rooted in the joy of seeing the kids open something new and showing their excitement. It's rooted in a language of love that lavishes gifts decadently like extra butter on a roll. It's rooted in an attempt to connect.

It's an immense privilege to have a family who loves my kids and showers us with gifts—I don't take that lightly. But what my kids need is a present mom, and the overflow of presents makes that harder than ever.

When birthdays and holidays are approaching, I find myself looking around every corner of my house. I see the Lego pieces that once created an incredible train track now scattered in every crevice. I see the pieces just waiting for me to step on them in the middle of the night.

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I see the discarded toys that I try to bring back to life because, after all, they were purchased not that long ago.

I see the tubs of "rotate in and out" toys that we use to try to keep things fresh because, after all, kids can only play with so many things at one time.

I see the pile of things we have yet to open. Things we reserved for later because the pile of "new" grew too large.

These piles of plastic make me feel out of control. They make me feel like I'm the manager of "things" instead of a safe place for my little humans. The toys call out to me to be picked up and organized during times that I need to rest, connect with my family or do anything else.

As a stay-at-home-mom, one thing I never anticipated was how many days can pass that I feel disconnected from my kids because the anxiety of "stuff" takes the front seat. Days when I feel like all I do is pick up "stuff" and try to keep my kids engaged in something for more than a few minutes. Days when it feels like the toys are literally mocking me out loud—reminding me of the control I've lost and the ongoing task list of keeping "stuff" from taking over the entire house.

This feeling of no control is a huge trigger for my anxiety. Anxiety has been a part of my life for years but as a mom, it has had bigger implications.

When anxiety takes over, I can't see the small moments and opportunities.

When anxiety takes over, I can't sit and laugh and tell stories like I want to.

When anxiety takes over, I can't get lost in hours of imaginative play.

When anxiety takes over, I can't sit and snuggle my little one without a constant flood of frustrated thoughts.

I want my kids to have an anxiety-free mom. I want them to have a mom who is connected and purposeful. A mom who gets lost in play and laughter. I want them to have a mom who encourages them to use their imagination and gets on their level. I want a mom who feels less pressure to "busy the kids" with something so that the "stuff" can be picked up.

You see, having all the stuff actually results in my kids spending less time enjoying what they have. It results in less time for play and more time for clean up. It results in more screen time because I need more "mommy needs to get this cleaned up so she doesn't lose her mind" time.

In a world that is so fast-paced and always screaming for "more!" I am constantly trying to help my kids slow down and savor what they have. I don't want my kids to not be able to focus on one activity because their brain is darting to the next thing. I want them to have intentional values—values of creativity and connection. The abundance of stuff feels like a roadblock to instilling these values.

So as the holidays and birthdays continue to come and go, I'll do my part to take care of my anxiety and ask my family and friends to do their part in helping us focus more on the values of our family and less on filling our home with toys that are sure to be deserted in just a few weeks. After all, is there anything better than love and connection?

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