Is It Safe to Take Your Child to the Pediatric Emergency Room?

The COVID-19 pandemic doesn’t stop kids from climbing trees, riding bikes, and doing other activities that may cause a tumble, create a few bruises, or require a trip to the local emergency department (ED).

And with parents trying to balance their own work—inside or outside of the home—while overseeing distance learning for their children, some kids may be less supervised than usual.

“We are all stressed as parents, and maybe we are not watching as carefully as we normally would,” says Marc Auerbach, MD, a Yale Medicine pediatric emergency specialist. “For example, with more household cleaners out, we are experiencing more accidental ingestions.”

Dr. Auerbach also says he is seeing more injuries typical of the summer vacation months and less of the usual spring ailments. With stay-at-home orders in effect, some of this is to be expected. For example, kids are not playing organized sports or riding in cars as much, both of which can cause injuries that lead to a good number of ED visits. But that doesn’t mean they aren’t still experiencing medical emergencies such as appendicitis—and parents should know that it’s safe to bring their kids to the ED when necessary, he says.

“Right now, many families may feel as though they are potentially putting their child’s health at risk by seeking care, but the appropriate use of the emergency department is vital to parents at this time,” Dr. Auerbach adds. “It’s important to call 911 and use the emergency department when your child has a significant injury or illness. We are still here and functioning, and doing our best to keep families safe in the ED.”

From a public health perspective, social distancing makes sense, Dr. Auerbach says, but for emergent health concerns, “we want to make sure there isn’t a delay in diagnosis and that people are using their emergency medical services and emergency departments when they need them,” he adds. “I know part of it is that people may think that coming to the hospital takes resources away from other people who need it, but we have ample resources to take care of those who are sick.”

Overall, the emergency department at Yale New Haven Children’s Hospital (YNHCH) is seeing fewer visits, says Beth Emerson, MD, medical director of the department.

“We are equipped and ready to see any pediatric patients who need to come. Families should feel confident in seeking care in the ED as needed; we have processes in place to help keep our patients safe,” says Dr. Emerson, adding that those with mild to moderate COVID-19 symptoms are seen in a tent outside of the pediatric ED.

The overall daily volume in the YNHCH Pediatric ED is down by 75%, says Erika Setzer, MSN, RN, patient service manager in the ED. “Our average daily census was typically 120 to 130, and we are currently seeing about 30 to 40 patients a day,” she says. “Our admission percentage is up—closer to 20%. Our admission rates prior to COVID-19 were at about 10%.”

That higher admission rate is likely because there are fewer visits for minor issues that parents typically used to bring their children to the ED for, explains Dr. Auerbach.

Plus, there have still been some significant injuries since the pandemic started, says Patricia Morrell, BSN, RN, coordinator of the Pediatric Trauma Program at YNHCH. “We have seen an increase in household injuries, including falls,” she says.

From talking to her pediatric trauma colleagues across the country, Morrell has heard of many scenarios where parents have delayed seeking care for their children because they worry about COVID-19.

“The most interesting piece of this will be when the quarantine ends. Three to six months from now, when people start to come back into the hospital more, we may see an increased number of ‘healed’ injuries that went untreated,” Morrell says.

Dr. Auerbach reports seeing broken limbs, laceration, and head injuries at numbers consistent with what he would see during the summer. “This may change as more parks and playgrounds have recently shut down, but I am not seeing as many very sick patients as I typically would at this time of year,” he says. “But we would also normally see more kids with problems related to diabetes, for example. As for COVID-19, we have been seeing about five to 20 patients a day, but we are only testing in the ED if they are being admitted to the hospital for respiratory issues, dehydration, and other more serious concerns.”

For suspected COVID-19 cases, parents should first call the Yale hotline (203-688-1700). “The hotline has pediatric experts who will answer any questions you have,” Dr. Auerbach says. “But if your child is in significant respiratory distress or a shock-like state, you should use your emergency medical services or go to the ED.”

For any other concerns, parents can also call their pediatrician for a telephone or video consultation in order to decide what level of care is needed.