Tips to Navigating a Kid's ER Visit

It can be SO scary and intense bringing your child into the Emergency Room. NUMBER 1, please remember that YOU are in charge of your child. Some staff in the ER can make you feel like they are the ones in charge, but ultimately YOU give consent.

So, when is it worth going to the ER vs urgent care or your doctor’s office?

🚨 If your gut instinct is telling you to take your child in, then PLEASE take your child in. YOU are the one that is with them, knows them best, has eyes and ears on them. No Instagram post is going to be able to ultimately decide this for you.

🚨 When it’s the middle of the night and nothing else around you is open. If your child is not breathing quite right, you think they will only get worse before your doctor’s office opens the next morning or you can’t get something under control (like vomiting) and you’re concerned about complications (like dehydration), it is usually best to go ahead and go. Make sure to look for a 24-hour urgent care, if you are on the fence about needing the ER.

🚨 If your child is struggling to breathe, please take them in ASAP! This could look like retractions (when the skin between the ribs is pulling or sucking in with each breath), breathing too fast, have nasal flaring (when their nostrils flare out or get bigger with each breath - usually seen in infants), or you hear odd sounds (wheezing or stridor, for example).

🚨 If your child has been vomiting excessively or excessive diarrhea and you’re seeing signs of dehydration like:

• Very dry mouth or lips
• No tears when crying
• Sunken eyes or sunken soft spot (in babies)
• Not urinating for 8+ hours or very dark urine
• Unusual sleepiness, fussiness, or lethargy
• Cool hands/feet or mottled skin

🚨 Head injury with loss of consciousness, repeated vomiting, confusion, or abnormal behavior

🚨 Seizure (especially a first-time seizure or one lasting >5 minutes) - this would be a reason to actually call 911 vs drive to the ER

🚨 Severe allergic reaction (swelling of lips/tongue/face, difficulty breathing, widespread hives) - call 911 if difficulty breathing is present or if it will take you longer than 10-15 minutes to get to the ER

🚨 High fever with concerning signs (stiff neck, trouble waking, purple rash, seizure)

🚨 Ingestion of poison, medication, or unknown substance. You can call Poison Control first to see if an ER visit is necessary, unless your child is exhibiting worrying symptoms after ingestion

🚨 Severe or uncontrolled pain that you don’t understand

🚨 Major cuts that won’t stop bleeding or may need stitches 

🚨 Broken bones with obvious deformity, discoloration, or broken skin

🚨 Severe abdominal pain (especially with vomiting, bloating, or inability to walk/move comfortably)

🚨 Any situation where your child is unresponsive, hard to wake, “not acting like themselves,” or you truly believe you need your child seen within the hour

Ok, so you decided to take your child to the ER, now what?

Many parents are concerned about the “Consent to Treat” forms that you sign when you first arrive. They believe they mean that they are giving doctors full permission to treat their child however they deem fit without any say from the parent.

This is definitely much more nuanced and a fear-driven argument of the medical freedom community (which I respect and agree with on a lot of stuff, but not everything). This creates so much unnecessary fear for parents whose kids likely do need medical intervention.

You can ALWAYS request the front desk to print the “Consent to Treat” contract out and amend it to suit your comfort level with initials next to your amendments.

If you are in a TRUE emergency where your child needs life-saving help right away, consent is assumed under EMTALA and you will sign forms later once your child is stabilized or things have calmed down. At that point, I wouldn’t worry too much about forms, I would worry about my child being alive.

If your child is not rushed back to a trauma room or acute care room, then breathe and be thankful!

There is an acuity system used to put patients in an order based on:

• their symptoms
• reason for coming in
• medical history
• the triage nurse’s quick assessment

This assigns a number to the patient, which tells the ER staff how quickly this patient needs to be seen based on how acutely ill or injured they are.

Patients get called back in order of their acuity, NOT time they arrived. If there are two or more patients of the same acuity, then they will go by time arrived.

So, if you go to the ER, please don’t be *THAT* person that gets annoyed that people who arrived after you are going back before you. Their child is likely sicker than yours and needs help sooner. If you notice your child is worsening while you’re waiting, then inform the triage nurse, so they can reassess your child’s acuity.

When your child gets called back to be triaged, you will usually go into a small room before your patient room and sometimes go back out to the waiting area. If the ER is slow, they might be able to do triage in your patient room.

Triage is when your child gets vital signs done (heart rate, breathing rate, pulse ox - measures oxygenation, temperature, etc), a full nurse assessment, and you get asked a slew of questions.

The one that gets parents very worked up, especially in the medical freedom community, is, “Is your child up to date on vaccines?” 

You will likely even be asked this question by the check-in nurse.

Many medical freedom influencers tell you to lie and just say, “Yes.”

I don’t agree with that, personally, but you can obviously do whatever you want to do.

Just know that if you do give any answer other than yes, you will likely encounter someone wanting to lecture you or challenge your choices, especially if you go to a teaching hospital where they have residents.

(hint: if you can avoid hospital visits in July, I highly recommend it 🫣 - the new residents start their rotations every July, so it’s a bunch of confused newbies!).

So, what would I do as a former Pediatric ER nurse and Medical Freedom Advocate? 

If I were in this situation, I would likely give an answer like this to protect my child without getting into a debate, but am remaining truthful, calm, and confident:

• “We’re working with our pediatrician on a personalized schedule.”
• “We make individualized decisions for our children’s health based on informed consent.”
• “Yes, for what we feel is appropriate for our child.
• “That’s a conversation we have privately with our doctor.”
• “We’re here for [today’s issue] — we’d prefer to stay focused on that.”
• “Yes, we’ve made informed decisions we’re comfortable with and my child is up to date based on their needs.”
• “We decline to answer at this time.” (if it’s on a form)
• “Not applicable to today’s visit.” (also good for forms)

Last thing I’ll say about the vaccine question is that anyone can lecture you, belittle you, or try to challenge your choice, but they ultimately can’t do anything about it without your consent.

Let them lecture.

Let them get on their high horse.

Let them bully.

Just nod, say okay, and ask how they are planning to treat the issue at hand.

Focus on your child, what they need you to do, and know that you are still in control no matter what the staff says to you. 

After your child is triaged and taken back to a room, you should meet your nurse, the doctor taking care of your child, and treatment should start pretty quickly, depending on what information is needed.

Quick definitions:

Charge Nurse: the nurse managing the shift and the one who handles problems if something needs to be escalated.

Resident: Technically a doctor, but someone who graduated medical school and is now in the training part called “residency” where they are allowed to practice as a doctor under supervision.

Attending: a fully licensed and board-certified physician who has completed all residency training and is responsible for overseeing patient care.

Physician Assistant: a licensed medical professional who works under the supervision of an attending physician to evaluate, diagnose, and treat patients. PAs can perform procedures, order tests, and prescribe medications, often managing less critical cases independently within their scope of practice.

Nurse Practitioner: an advanced practice registered nurse (APRN) with specialized training in emergency care. NPs can assess patients, diagnose conditions, prescribe medications, and perform procedures. They often work independently or alongside physicians, depending on state laws and hospital policies.

Medical Assistant: someone who assists nurses and medical professionals in tasks like taking vital signs, assisting with procedures, and other patient care.

Something that may seem a bit out of nowhere, but is a concern many parents have... 

So many parents are concerned about doctors taking their child from them during an ER visit.

But is this a concern based on facts or fear?

While I totally understand the concern for medical kidnapping because there are TRUE cases in this country of it happening, I do believe that this fear has been completely exaggerated and has caused people to avoid the ER when it could, in fact, be just the help their child needs at that time.

Many cases that the medical freedom community has reported as medical kidnapping have actually not been that at all. As a former Pediatric ER Nurse and the wife of an SVU Detective who has been the one to remove many children from their parents’ custody, I can tell you that people on the internet spreading these stories simply do NOT have all the facts. And when parents are interviewed, they aren’t always sharing the full story.

Now that I’m off my soap box, let me share a few facts to help…

First things first, who can remove your child from your custody?

When a child is removed, the state takes temporary custody of your child to protect them from imminent danger - either from their home environment or from inflicted abuse by one or both parents. Who actually has the authority to remove your child is different depending on your state.

For example, in the state of Idaho, only a law enforcement officer can remove a child in an emergency - doctors can’t. State social workers can also remove children, but only with a petition signed by a judge.

Doctors do NOT have the legal authority to remove a child from their parents in ANY state across the country.

Each state’s process is a little different, but it always involves law enforcement, Child Protective Services or Health and Welfare, a judge, and depending on the state, there could be even more moving parts when it comes to temporarily removing a child from the custody of their parents.

I just want people to understand that there are a lot of steps that have to be taken before someone can take your child. For example, in the state of Idaho...

If ER staff suspects that the injury is due to child abuse, the hospital social worker will report these suspicions to the Department of Health & Welfare (they are mandatory reporters, meaning they legally have to report any suspicions of abuse)

The H&W social worker will report to law enforcement (LE) on any report that indicates a child has been victimized

LE will investigate - depending on the circumstances, this could be an officer or it could be an entire team of detectives who confer with child abuse expert physicians

If during the investigation, LE assesses that the child is in imminent danger, LE will remove the child either by their authority or with a court order

Parents have the right to have custody returned within the week.

The remainder of the process moves toward reunifying the child with their parents as soon as safely possible

Many ER personnel have seen horrible abuse situations, so try to take a moment to understand from their perspective. They are just trying to make sure the child is safe because they don’t want to be THAT person that doesn’t investigate for fear of push back or whatever else, and that child truly wasn’t safe and they let them go right back to their unsafe situation.

Know your rights, but also work with the healthcare team because you did come to them for help, right?

Don’t get me wrong, some healthcare professionals can be real arrogant pieces of work. I’ve seen the God-complex doctors who think everyone needs to listen to every word coming out of their mouth, the jaded nurse that should probably stop working because she has little to no compassion left in her soul, and even the nursing assistants who have the worst attitude and are not even remotely helpful.

But that is not everyone who works in healthcare. I recommend not automatically assuming that everyone that comes to help you and your child has ulterior motives and is out to get your child.

Remember when I said I, personally, wouldn’t choose to lie about my child’s vaccine status?

If you get into one of those situations where they need to do their due diligence in double-checking the facts of how the child got that particular fracture or bruising and they find out that you lied to them about vaccine status, why wouldn’t they wonder what else you’re lying about?

How could they possibly find out?

If you go to a pediatrician within the same healthcare system as the hospital, then it is possible for them to see all medical records. Therefore, they could see vaccine records.

Now, if you go to a pediatrician that is completely separate from the overarching healthcare system in your area, then they can’t just automatically have access to your child’s records at your pediatrician’s office and would have to send a formal request. That’s usually not something they worry about unless some kind of serious investigation needs to take place.

If you need to bring your child to the ER, then PLEASE bring your child to the ER.

Don’t even think twice about fear-based propaganda telling you that your child will be taken from you if you normally operate outside of conventional medicine.

Is it possible you’ll get a lecture or two?

Totally.

Is it possible you might get talked about at the Nurse’s station?

I’ve heard the comments and conversations. Trust me - you don’t need to care about those people’s opinions.

But is it also possible that you will go in, get your child the help they need, then go home thankful your child is safe and on the mend?

YES!

All in all, trust your instincts! You know your child, you care for your child, and most people working in the ER do what they do because they care too.