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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.

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.

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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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There are certain moments of parenthood that stay with us forever. The ones that feel a little extra special than the rest. The ones that we always remember, even as time moves forward.

The first day of school will always be one of the most powerful of these experiences.

I love thinking back to my own excitement going through it as a child—the smell of the changing seasons, how excited I was about the new trendy outfit I picked out. And now, I get the joy of watching my children go through the same right of passage.

Keep the memory of this time close with these 10 pictures that you must take on the first day of school so you can remember it forever, mama:

1. Getting on the school bus.

Is there anything more iconic than a school bus when it comes to the first day of school? If your little one is taking the bus, snap a photo of them posed in front of the school bus, walking onto it for the first time, or waving at you through the window as they head off to new adventure.

2. Their feet (and new shoes!)

Getting a new pair of shoes is the quintessential task to prepare for a new school year. These are the shoes that will support them as they learn, play and thrive. Capture the sentimental power of this milestone by taking photos of their shoes. You can get a closeup of your child's feet, or even show them standing next to their previous years of first-day-of-school shoes to show just how much they've grown. If you have multiple children, don't forget to get group shoe photos as well!

3. Posing with their backpack.

Backpacks are a matter of pride for kids so be sure to commemorate the one your child has chosen for the year. Want to get creative? Snap a picture of the backpack leaning against the front door, and then on your child's back as they head out the door.

4. Standing next to a tree or your front door.

Find a place where you can consistently take a photo year after year—a tree, your front door, the school signage—and showcase how much your child is growing by documenting the change each September.

5. Holding a 'first day of school' sign.

Add words to your photo by having your child pose with or next to a sign. Whether it's a creative DIY masterpiece or a simple printout you find online that details their favorites from that year, the beautiful sentiment will be remembered for a lifetime.

6. With their graduating class shirt.

When your child starts school, get a custom-designed shirt with the year your child will graduate high school, or design one yourself with fabric paint (in an 18-year-old size). Have them wear the shirt each year so you can watch them grow into it—and themselves!

Pro tip: Choose a simple color scheme and design that would be easy to recreate if necessary—if your child ends up skipping or repeating a year of school and their graduation date shifts, you can have a new shirt made that can be easily swapped for the original.

7. Post with sidewalk chalk.

Sidewalk chalk never goes out of style and has such a nostalgic quality to it. Let your child draw or write something that represents the start of school, like the date or their teacher, and then have them pose next to (or on top of) their work.

8. In their classroom.

From first letters learned to complicated math concepts mastered, your child's classroom is where the real magic of school happens. Take a few pictures of the space where they'll be spending their time. They will love remembering what everything looked like on the first day, from the decorations on the wall to your child's cubby, locker or desk.

9. With their teacher.

If classrooms are where the magic happens, teachers are the magicians. We wish we remembered every single teach we had, but the truth is that over time, memories fade. Be sure to snap a photo of your child posing with their teacher on the first day of school.

10. With you!

We spend so much time thinking about our children's experience on the first day of school, we forget about the people who have done so much to get them there—us! This is a really big day for you too, mama, so get in that photo! You and your child will treasure it forever.

This article is sponsored by Rack Room Shoes. Thank you for supporting the brands that support Motherly and mamas.

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I can still remember bringing my first newborn baby home, even though it has been over a year now. And let me be clear—I don't remember it because it was blissful and euphoric. I actually remember it so vividly because it was close to the most anxiety-ridden, stressful, emotional day of my life.

The two previous days spent in the hospital were everything I hoped they'd be. Sure, I was getting virtually no sleep, and my body ached from all it had just been through, but I had an abundant amount of help at my fingertips. I didn't yet feel overwhelmed or inadequate and I was fully confident that I could handle this whole mama thing. Excitement was my overarching emotion.

And then we got home.

It didn't take long for the crying to start. And once it started, there was no end in sight. My sweet baby boy just kept crying, and crying, and then crying some more, and I longed to have a "call nurse" button to press for a little relief.

My amateur mama skills seemed futile as I rocked, shushed, snuggled and nursed my baby. None of it helped; my sweet son wanted nothing to do with this world and was begging to be put back in the warm and comfortable surroundings he had just emerged from.

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And so those first couple of months were a fog of diaper changes, feedings, nap time, crying (so much crying for both of us) and an endless amount of pleading prayers.

I didn't love my new role of being a mom yet. Although I had been dreaming of this calling my whole life, I decided I clearly wasn't cut out for it and figured the rest of my days were surely going to be full of hardship.

My hope and excitement for the future were at an all-time low, which could partially be thanks to those pesky postpartum hormones. This period of life was hard. All-consuming and so hard.

So I'm here to tell you, brand new mama, if you don't love being a mom yet, that's okay. Because here's what's going to happen.

One day, after weeks and weeks of having a fussy baby, that little bundle of joy is going to crack their first smile, and your heart is going to absolutely burst with happiness as you quickly grab your phone to capture a picture.

And then your sweet little one is going to start cooing and oohing and aahing, and you will feel like they're telling you all about their day, which is going to simply melt your soul. It definitely melted mine.

And then feeding the baby is going to get easier, and their nighttime sleep stretches are going to get longer, and taking them out and about isn't going to feel so overwhelming.

And then, mama, one day you're going to look at yourself in the mirror when you get a spare second. You'll see spit-up on your shirt, dark circles below your eyes that not even the best concealer could cover, unwashed hair tucked under your favorite baseball cap, and you're going to say to yourself, "I love being a mom. This is me now."

And you might no longer grieve the old life you once had. You'll stop wishing you could go back to your carefree youthful days, and you'll instead start looking forward to all the many fun family memories that will soon be made.

One day, you're going to love being a mama. I did.

Hang on tight to any little joys you can find during this in-between time and give yourself grace. A lot of grace. You're doing the best you can, and that's all you need to do for now.

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The summer season is the perfect time to get creative and enjoy fun projects around the house with your little ones. Some of the most memorable family moments can start with a piece of construction paper or end with a table covered in shaving cream.

While you're having fun, just remember that being creative is about the process, not the result. Your kids' artwork may not be museum-worthy, but that's okay! Embrace the fun of the creation and not necessarily the end result.

First thing's first, get organized.

before you can begin any project, it's important to start on a clean surface. A fresh canvas sets the stage for family activities and DIY projects so I always put away clutter and clean the surfaces to prepare for new activities.

I always recommend creating or purchasing organization bins or spaces for each activity or categories of items. For example, a container specifically for crayons, markers and colored pencils. Then when it's time to clean up, everything has a specific place. Make sure to clearly label the bins so everyone can easily determine what each container contains. This is a great way to exercise good organizational habits from an early age. As soon as they are 2-years-old, they can play a part in cleaning up and putting things away. And, if you have systems set up for them from the start, it makes it much easier for them! Kids also love to help clean counters once you've put everything away. Whether it's after you've cooked a meal together or exhausted all of the glitter glue, they love wiping down counters with wipes. Set the expectation that kids who craft are responsible for cleaning up their supplies when they're done. It's crucial to start the healthy habit of tidying up after yourself early on.


Ask your kids for their input.

Imagination runs wild, so take advantage of their creativity. Ask them what type of art project or fun family activities they want to prioritize. If you have multiple kids, create a "suggestion jar" they can continually add and pull from when they are looking for an activity to do.

It's important to embrace collaboration. You know what they say: Teamwork makes the (crafts) work. Encourage your kids to work together and call out ideas for each other's artwork.

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Here are a few of my favorite craft projects:

  • Flipbooks: Have each kid create their own flipbook full of creative crafts, poetry, or other fun moments they want to capture.
  • DIY dollhouse: Make a custom dollhouse filled with handmade mini furniture to decorate it in their own way.
  • Out-of-the-crayon-box crafting: Challenge your kids to craft with creative elements around the house—whether it be clothespin snowmen or sponge sailboats, there are endless possibilities.
Garner even more excitement by making the prep part a project itself! Have your kids help create a fun workspace for food-making, craft-building, or DIY science-slime experimenting. They can pick a color scheme, help find the right organizing bins, or decorate the wall with art projects from this past school year for inspiration.

Try DIY projects.

Kids need to get out their creativity and energy so hands-on projects are a fun way to put their growing brains to work while they do it.

Be sure to practice safe crafting. Store all scissors and other sharp objects in protected, designated places, make sure to read all directions for new craft supplies or projects, and watch out for slippery messes!

Stock up on these essentials:

1. On-the-go park bag: Parents should be ready to go to the park at a moment's notice. Have a bag pre-packed with all the essentials: a mini kite, a picnic blanket, a ball to toss around, sunscreen and more.

2. Chalk: I love bringing crafts outside whenever possible, and something as simple as colorful sidewalk chalk is an easy way to make drawings larger than life!

3. Contact paper: You can use contact paper to add temporary color and character to flower vases, glass jars or really any decorative container with a hard, smooth surface. As a first step, wipe the vases or jars down with a disinfecting wipe to make sure the surface is clean so the paper will stick properly.

4. Felt: Felt is one of my favorite kid-friendly ways to incorporate color into crafts. You can make fun flowers, finger puppets, or whatever your heart desires.

5. Bubbles: They provide instant fun for any age!

6. Instant camera: Capture all of your moments —happy, sticky, and everything in between. Let your kids get in on the action of capturing their favorite family moments and compiling them into an end of the year scrapbook!
Learn + Play

Is it too soon? I ask myself as you toddle in and chat excitedly about the baby in mommy's belly. "Where is she?" you ask. "But I don't see her," you insist when I tell you she's in there.

Will you miss our special time as a trio? I wonder, as we snuggle on your rug at night, you, Daddy and me, under a blanket too small to cover us all. But you don't realize, pulling it up over us anyway, feet popping out, giggling all the while.

Were we selfish? I worry as I rush to comfort you during the night when a fever spikes and you call out our names. "Mama!" "Daddy!" And we're both there in a minute.

How can I possibly love another child as much as I love you? I question myself, as you run into my waiting hug and beg for just a million more.

But I tell myself that we'll learn these new steps together in stride, just as we did when you found your way into the world and became all of mine. Because it was you, my sweet boy, who taught me how to be a mama.

It was you who, in those first weeks, rested your head contently on my chest, just when I thought nursing might be too hard to handle. And it was you who flashed your first smile as the washer broke, amid mounds of spit-up stained laundry.

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You were the one who settled my breathing, as it quickened and tightened during my first panic attack. And it was rocking you at night that saved me when my maternity leave came to an end.

When you brought your very first stomach virus home and we all got sick at the same time, it was the sound of your first laugh that saved us during the eleventh hour, when we were questioning what made us think we were strong enough to care for a family.

We learned together how to navigate pediatrician visits and shots, what rocks and rhythms made nighttime smoother, how to introduce foods and when to wean. After six months, it was you who gave me the signal it was okay to stop nursing. When endless pumping sessions at work had me in tears, you assured me you'd love me just as much if I picked up a bottle of formula, gulping it down with a smile, your hands resting on mine.

When I worried at work each day that you were bonding more with your daycare teachers in those long hours than we ever could at home, you shared your first word, reminding me how special our bond is in that sweet, jumbled "mama."

We did it all, together.

And even now, as I worry about transitioning you into a big boy bed, you excitedly accept the challenge and graciously tell us we can give your crib to your new baby sister–just not your blanket.

At daycare, you rock the baby dolls, and you tell everyone you pass what your baby sister's name will be. You ask to read about Daniel Tiger and Baby Margaret, making sure I know how to navigate what's on your horizon.

Because, baby boy, you've always been quicker to adapt than me. Sometimes I think it's you who is teaching us.

You see, baby boy, it was your encouragement and love all along that guided me into motherhood. And it was your hugs and kisses and "good job mama's" that told me I could do this again.

Life will change as our family grows, but we'll keep learning together.

It'll be you who marches into that Kindergarten class, head held high as you proudly wear the backpack you picked out yourself, reminding us that time stops for no one.

It'll be you who introduces us to practices and clubs, field trips and permission slips–I'm sorry in advance for the ones I'll forget to sign!

It'll be you who turns my grip white, as you tuck your permit into the glovebox and pull onto the street for the first time.

It'll be you we wait up for first, worried that you haven't called. And it'll be you who heads off to college, leaving the house that seems too small feeling much too big.

But before your baby sister comes, and time continues to carry us in its unforgiving pace, I'll soak up every undivided second of attention I can give you. I'll snuggle you close and savor our chats. And we'll follow each other's leads, continuing to figure out this whole thing called life together.

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A recent trip to the movie theater had me brimming with excitement to reunite with Woody, Buzz, and the crew of Andy's (er, Bonnie's?) toys in the Toy Story franchise's new installment. Sure enough, my family laughed at the adventures of the cast, but it was a newcomer to the gang that really stole the show: a plastic spork named Forky.

While his reluctance to accept his place was charming and sweet, Bonnie's creation of Forky, and her subsequent attachment to him as her new favorite toy, points at a bigger picture—what constitutes a toy? Likewise, what does a child really need to be entertained?

The film's inclusion of such a common, utilitarian object as a chosen plaything serves as a reminder that children's imaginations are a powerful thing, and—when left to their own devices—kids are quite capable of having fun with far less than our society typically deems necessary.

Forky is a throwback to a time when less was more, and when families' homes weren't miniature toy stores.

I remember recently being spellbound as I watched my daughter engrossed in play with a handful of rocks. Each pebble had its role—mommy rock, daddy rock, baby rock, etc—and she carried on with a captivating scene encompassing equal parts comedy and tragedy. It was a rock family saga, and frankly, I was mesmerized.

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Despite a house full of flashy, modern, (and sometimes expensive) toys, I've found that some of the most creative play comes from the most unexpected "things" that most adults would consider non-toys. Kids have a unique way of looking at things, and often the items they gravitate toward as their preferred toy may leave parents not only scratching their heads, but also howling in laughter.

Kitchen accessories seem to be a favorite for many little ones, as I remember my own niece insisting on carrying a serving spoon everywhere with her. These inanimate objects function as the perfect plaything for children, as their minds are free to create whatever story or fantasy they desire. The make-believe is endless.

Other favorites for my kiddos include shoelaces, ropes, or yarn, which have infinite aliases—stuffed animal leashes and zip-lines being their go-tos. And who can forget the magic of cardboard boxes and of course bubble wrap. We're talking hours of fun and play.

After watching the film, I looked around my house at the abundant number of toys that my own children possess. Then I turned around and watched as they chose to stack Tupperware containers and throw foam koozies at them in a competitive game of kitchen bowling.

So yeah, we're all probably a little guilty of overindulgence with it comes to our kids. To be honest, it's fun to watch their eyes light up upon receiving a new toy at their birthday or other holiday. And I'm not arguing that those practices need to change completely. Rather, let's not forget the power of minimalism and its place in our lives. Let's encourage resourcefulness and creativity.

Behind the fun and nostalgia of the Toy Story series are important lessons and messages. In today's culture where more is more, Forky is a reminder that parents don't necessarily have to break the bank in purchasing toys for the little ones in our lives. In many cases, a "spork" will do.

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