When a child needs medical attention, a parent has to decide where to go for treatment depending on when the child becomes ill, the degree of illness, and the proximity to one of our locations. Luckily, we have many options at Duke.

Duke Children’s Primary Care has an extensive primary care network that can see patients Monday to Friday during the day -- and Saturday morning at our Roxboro Street location.

When our primary care locations are closed, we have Duke Urgent Care clinics open 365 days a year at Brier Creek, Hillandale Road, Morrisville, Knightdale, and Fayetteville Road.

And we have the Duke Emergency Department (ED) and its dedicated Pediatric Center, which is open 24 hours a day, seven days a week.

In general, appointments for colds, chronic diseases, and an occasional ear infection can be scheduled easily within 24 hours at one of our primary care sites. Children with issues in need of immediate care outside of clinic hours can be seen at the urgent care sites. But some children have urgent or emergent issues at unusual hours and may need to be seen in the emergency department.

Dr. James Fox, a Duke pediatric emergency department physician, explains which symptoms indicate a visit to the ED is needed.

-- Dennis Clements MD, PhD, MPH

James W. Fox, MD

Unfortunately, every year millions of children in the United States will require emergent medical care for a wide variety of injuries and illnesses. Fortunately for the children living in the Triangle, Duke University Hospital has a specialized area in the emergency department that only treats children.

The multidisciplinary medical team takes great care in providing age and developmentally appropriate treatment to children in the ED. The pediatric ED at Duke cares for children 24 hours a day, every day of the year with direct and immediate access to experts in every pediatric subspecialty should the need arise.

Many children cared for in the pediatric ED do not have life-threatening conditions, and many of the children’s conditions may be cared for by the child’s primary care physician.

However, there are many illness which are best cared for in the pediatric ED. The following are a few examples of conditions that should be treated in the pediatric ED. (This list is not meant to be all-inclusive.)

Difficulty Breathing

There are many causes of labored breathing in children. However, if at any time you are concerned about your child’s breathing, he should be evaluated quickly by a physician. Signs of difficulty breathing include:

• Breathing rate faster than normal
• You can see your child’s ribs or collarbone outlined by skin when he breathes in
• Your child’s belly moves outward with every breath in
• Your child’s nostrils move outward when he breathes in
• Your child’s lips or tongue are blue

Here are a few specific considerations in children with trouble breathing:

Pneumonia

• If your child is currently on antibiotics for pneumonia and you notice signs of difficulty breathing, he should be evaluated in the ED.
• If your newborn or infant stops breathing, has blue lips or tongue, or has any other signs of difficulty breathing, he should be evaluated quickly in the ED.

Asthma

• If your child has asthma, immediately administer rescue medication (albuterol or Xopenex) as directed by his physician. If you do not notice an improvement in his breathing, bring him to the ED.
• If your child is currently receiving oral steroids (e.g. Orapred, prednisolone, prednisone) and signs of difficulty breathing appear, bring him to the ED.

Allergy

• If your child has a known severe allergy (e.g. nuts, shellfish, bee stings) and develops signs of difficulty breathing after an accidental exposure, administer his Epipen immediately and call 911.
• In children without known allergies who may be having an allergic reaction and display signs of difficulty breathing, call 911.

Infants

• If your newborn or infant stops breathings, has blue lips or tongue, or has any other signs of difficulty breathing, he should be evaluated quickly in the ED.

Fever

While the vast majority of children who have a fever do not have a dangerous illness, fever may be a marker of a serious infection (e.g. meningitis, pneumonia, urinary tract infection). Children with fever are often tired, much less active, and less interested in eating and drinking.

Giving your child weight-appropriate doses of acetaminophen (Tylenol) or ibuprofen (Motrin; do not use if your child is less than six months old) may make your child feel better and more interested in eating and drinking.

You should bring your child to the ED for evaluation if your child:

• Is three months old or younger and has a rectal temperature of 100.4^oF (38^oC) or higher
• Has a stiff neck
• Is dehydrated (mouth is dry, no wet diapers in 18 hours, eyes sunken, soft spot sunken)
• Has a condition which makes him more susceptible to infections (for example, receiving chemotherapy, sickle cell anemia, on daily oral steroids, or has a central line in place)

Call 911 immediately if your child has a fever and:

• Is difficult to arouse
• Has difficulty breathing
• Has a seizure

Poisoning

If your child has ingested a toxic chemical (fertilizer, household cleaners, insecticides, oils, etc.) or a medication that was not prescribed to him or taken in an excessive amount (this includes over-the-counter and herbal or “natural” products), he may require an ED evaluation.

If your child is acting normally or you are unsure if he swallowed a potentially poisonous substance, a call to the Poison Center will be helpful (800-222-1222).

Call 911 immediately if your poisoned child:

• Is having difficulty breathing
• Is difficult to arouse or becomes unconscious
• Has a seizure

Broken Bones

When children injure bones, parents often wonder when it is necessary to bring their child to the ED for evaluation. Here are some guidelines:

• The injured bone is obviously deformed. The bone may need to be “reset.”
• A bone is out of place (dislocated).
• There is an open wound in the area where the bone is thought to be broken. This may be an “open fracture.” Certainly if you can see the bone, bring your child to the ED.
• Your child reports numbness, tingling, or weakness in a body part beyond the injured bone. Also, if body parts beyond the injured bone are cold or pale, an ED evaluation is warranted.

If you believe your child’s injured bone needs to be evaluated in the ED, you may give your child a dose of Tylenol or Motrin but do not allow your child to have anything to eat or drink until he is evaluated by a physician.

-- James Fox, MD, is a physician in the Duke Department of Pediatrics' Division of Hospital and Emergency Medicine.

-- Dennis Clements, MD, PhD, MPH, is the chief of primary care pediatrics at Duke Children's Hospital.