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What Problem, Which Solution?

By Scott Hamilton, MD
November 10, 2022
Hamilton Blog Headshot Updated 12.21.21

This week's guest columnist is Chioma Ekwueme, MD, a family practice resident at Ochsner University Hospital & Clinics.

My son recently had a swollen ear. The parent in me began to panic as the worst possible diagnoses flashed in my mind: severe allergic reaction, flesh-eating bacteria? Before grabbing my car keys to rush to the emergency department, I stopped and asked: should we go to the ER and risk him getting a nasty bug or try over-the-counter medication until his doctor opens? We gave him Benadryl, and the next morning the swelling was better.

Winter is upon us. Temperatures drop, driving children inside to mingle. Noses run, coughs begin and germs get happy, on the prowl for new hosts. This is their time to thrive! Walk into any home, daycare, or school and you'll see runny noses and hear a variety of melodic coughs and sneezes.

Even with generations of “letting sickness pass naturally,” some of us go into panic mode when kids experience rattled breathing or a hacking cough. What do the search engines of our glorious information age tell us? Search “headache” and brain tumor information pops up. “Runny nose” shows pictures of nasal cancer. Search “cough” and be ready to schedule your lung resection! People come to the ER for things that previous generations shrugged off.

This winter is already busier than usual with early and rampant influenza, more RSV and strep throat. It’s best not to come into the ER and catch one of these things in the waiting room. If your child is breathing comfortably (not laboring), drinking adequately and recovering with medication, you can wait to see your doctor. Noses and eyes will run, coughs will hack and fevers will smolder. Don't make your solution cause more problems!

Dr. Hamilton's adult daughter recently visited an emergency department in another state for a throat abscess. Walking in, she immediately wanted to turn and run back out. Pandemonium: people crying, bloody bandages, and hordes of children coughing and sneezing. Fortunately, she avoided the waiting room when the triage nurse looked in her throat and sent her straight to an exam room.

About 27% of ER visits per year in the US could be managed in physician offices or clinics. Like we noted above, parents often bring children in for non-emergencies. For example, fever is NOT an emergency. Several times a day we hear: “He's coughing, but when his temperature was 102, we rushed in.”

Children get sick. It's inevitable. If they're drinking, making wet diapers and breathing comfortably (not wheezing or struggling to pull in air), then an ER visit is probably unnecessary. Babies with wet coughs don't choke to death on mucus. The rattling sound they are making doesn't mean pneumonia; it's only mucus in their throats that they'll eventually hack out.

For congestion, suction noses and have kids sleep in humidified air. Ibuprofen and acetaminophen (Tylenol) reduce fever and pain, so children feel and sleep better. If children are drinking, don't stress if they're not eating. Coming to the ER for RSV, Flu or COVID-19 testing doesn't change basic management. Even for those viruses, you do the same things.

To go or not to go. For colds and fevers, Emergency visits usually aren't necessary. Still worried? Call your PCP before hanging out in a germ-filled ER waiting room. Again, don't let your solution cause more problems!