After-hours Medical Care: A Feverish Search 

Murphy’s Law is an adage that states, in essence: if something can go wrong, it will. One corollary to that must be: if a child will get sick or need medical attention, it will be necessary as soon as her pediatrician’s office closes for the day. As a parent, you are wise to be proactive and think about what you will do if you need expert medical advice for your child at night, on a weekend, or on a holiday.

Call the doc first
Before your child is even born, you select a pediatrician. One important consideration when making your selection should be the hours when the doctor’s office is actually open. To accommodate working parents, many pediatricians have evening and limited weekend hours. One huge benefit to an office with non-traditional hours is that it might be open if an emergency arises. Based on the concern, the doctor may ask you to bring your child in for an evaluation.

When medical offices sign off to an answering service for the evening, some enlist the help of a service called telephone triage. This means your pediatrician’s telephone is answered by a nursing staff that has specific pediatric experience and instructions about how parents should respond in an emergency. For example, if your 5-year-old has a fever of 104°, you’ll be told to do X, Y, and Z. But if your 5-week-old has a fever of 104°, you’ll be told to do A, B, and C. The nurse usually will call back to check on your child’s progress within an hour or two of your initial call.

If at any time you don’t feel you’re getting sound advice, or there’s something you would prefer to talk to the doctor about, simply request that the service call her. Your doctor or the physician covering her practice is never more than a phone call away.

If you’re unsure whether a situation needs emergency medical attention, it’s best to call and talk things over with the doctor. If it’s a problem that can wait until the office is open, the doctor will say so. If not, he’ll tell you what to do next.

Urgent care centers
Many communities have freestanding urgent care centers for patients who need or want to see a doctor after hours. Most are open until around 8 or 9 p.m. during the week, and 4 or 5 p.m. on a weekend. They offer a host of services, ranging from diagnosis and treatment of fevers or skin disorders, to suturing and x-rays.

These centers are individually owned and operated, so you may want to ask questions before taking your children here for treatment. First, ask what type of doctor is available; rarely will it be a pediatrician. Rather, it probably will be someone trained in family practice or emergency medicine. These doctors are qualified to treat just about any type of patient—including children—but they do not specialize in treating children; they’re generalists. Also, before going to an urgent care center, find out if there’s a specific age requirement for care. In other words, will doctors there even agree to see a child under a certain age?

It’s always a good idea to check with your pediatrician before taking your child to an urgent care center. Ask whether he feels your child’s condition warrants it. If he says your child should be seen immediately, and it’s for a service an urgent care center can provide, there are some advantages to going here instead of to an emergency room. In most cases, for example, there will be a shorter wait time, closer proximity to home, and less exposure to contagious illnesses. Just be sure the center you choose is equipped to deal with your child’s age group and condition. If it’s not, your next step would be an emergency room.

One note: for after-hours medical care that is not urgent, you may also find a clinic at your local pharmacy, staffed by practitioners who are able to write prescriptions. If time permits, check with your insurance provider before a trip to a clinic or an urgent care center to find out about your coverage.

The emergency room
It’s a good idea to familiarize yourself with the hospitals in your area before you need them, and to know which services each offers. Likewise, know the hospital where your pediatrician has admitting privileges, so if given a choice, you can bring your child to the place where her own pediatrician would be able to see her.

In a life-threatening scenario, such as any time your child has difficulty breathing or has seizures, go wherever is closest; time is of the essence. For conditions like high fevers, lacerations, or possible broken bones, you have a little time to consider your options. Many hospitals have pediatric Emergency Rooms, which are separate areas for children to be treated—apart from the adult population. This can make the experience less scary, as there’s usually a specialized staff dedicated to caring for these little patients. They are more familiar with the physical and emotional needs of children and their families.  

No parent likes to see his child ill or suffering. Unfortunately, kids do get sick and have accidents, often at inconvenient times, so making those all-important decisions regarding their medical care is your job.

Being informed will help you make the best decision for your child, and lead to a quicker, happier (and healthier) resolution.

Linda Cassar is a registered nurse who works with high-risk new moms and infants in a major medical center in northern New Jersey.

November 2008