Our Doc or the ER (or neither)?

Hi Mamas,

A few days ago my 17-month-old did a total face plant as she was running across the tile kitchen floor. She screamed bloody murder and a giant egg-sized bump appeared on her forehead a minute later. I was terrified and called my pediatrician’s office immediately to tell them we were on our way.

Was I ever shocked when her nurse suggested I either watch and wait to see if she was really injured, or head straight to the ER if I had serious concerns. Isn’t that what they’re there for? To take care of children who are sick or hurt? Was the office just too busy to fit us in, or were they blowing us off?

Either way, I’m pretty disappointed. Should I be looking for a new doctor for my daughter?

Dinah

Dear Dinah,

They don’t call ’em toddlers for nothing, right?

Mother Nature knew what she was doing when she made the skull of the forehead (known as the frontal bone) thick and hard. It takes tons of abuse in those early years. The vast majority of kids with head bonks are fine, and the size of the bump rarely has anything to do with the extent of the injury. The head and face are loaded with blood supply, so the swelling can be dramatic.

The fact that your little runner screamed fast and hard is actually a good sign. It means she wasn’t knocked out by her date with Mr. Floor, which is one of the things we look for when evaluating a head injury.

In cases like this it’s OK to take a watch-and-wait approach. If your child is crying but can get up on her own and move all her body parts, she’s probably just fine.

Next time it happens (and it will), keep an eye out for the next few hours to make sure she doesn’t vomit or become sleepy (and it’s not naptime), or especially irritable. If you see any of these signs, call the doctor. It goes without saying if your child is motionless or unconscious, or refuses to move after the fall, you should call an ambulance right away.

That said, let’s talk about the response of your pediatrician’s office. Chances are if the nurse had taken a few minutes to clearly explain all of the above, you would have been more comfortable with a watch-and-wait approach.

On the other hand, if there was reason to be seriously worried, the emergency room is the place you want to be, not your doctor’s office. They have the equipment and staff to properly evaluate and care for a head injury — the office doesn’t, unless your doc has invested in her own CT scanner.

The problem is you can’t be expected to know any of this, and it’s your doctor’s (or her staff’s) job to tell you. Communication IS part of taking care of your daughter’s health; possibly the most important part.

Consider having a conversation with the pediatrician about this episode, especially if you’ve been happy with her care up until now. She’ll probably be surprised to hear it, and it’s important information. She is the one ultimately responsible for the quality of care provided and will likely want to address it with the staff.

If you’re still not satisfied that the office is responsive and concerned about you and your child, by all means find someone new. It’s important to have a member of the team who you’re comfortable with.

Good luck!

~ The Mamas

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?


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