Tonight: call, urgent care, or the ER?

When a child is sick at night, the first decision is the level of care, not the diagnosis. Use 911 for immediate danger, call the pediatrician for guidance, and choose urgent care or an emergency department based on how sick the child is.

Decide in this order

• First ask whether breathing or consciousness is threatened.
• Use 911 for an immediate emergency.
• For poison exposure, use Poison Control guidance.
• For a young infant with fever, call promptly.
• For uncertainty, use the pediatrician’s after-hours line.
• Use urgent care for same-day problems that are not dangerous.
• Use an emergency department for dangerous symptoms.
• Remember that a freestanding ER is still an ER.
• Know which facilities see children your child’s age.
• Write down fever readings and symptom timing.
• Bring the medicine list and coverage card.
• Choose the route before the bad night arrives.

The fuller answer

It's late, your child isn't right, and you're deciding. Here is how the people who write the guidelines sort it — so you can decide faster and with less fear. It isn't a diagnosis, and when in doubt, you call.

Call 911

For anything that looks like an emergency: a child who is hard to wake or can't be woken, is struggling to breathe or turning blue, has a seizure, is bleeding heavily, has been badly hurt, or has swallowed something dangerous and isn't breathing or is convulsing. Don't drive a child who is that sick — call.

Call these, any hour

• Poison Control: 1-800-222-1222 — free, expert, confidential, around the clock. If your child swallowed something, take away what's left and have them spit out what's in their mouth. Don't make them vomit. If it's on the skin, take off the clothes and rinse with lukewarm water for 15 minutes; in the eye, flush with room-temperature water for 15 minutes; if they breathed fumes, get them to fresh air.
• Your pediatrician's after-hours line. Most offices have one. Save it in your phone today. The nurses on those lines hear "I'm probably overreacting" all night long. You're allowed to call.
• Crisis line: 988, call or text, for a child or teen in emotional crisis.

Fever: when the American Academy of Pediatrics says to call

The AAP is plain about the youngest babies: a baby younger than 3 months (12 weeks) with a temperature of 100.4°F (38°C) or higher needs the pediatrician called right away, even if the baby seems otherwise fine. Don't wait until morning.

For older children, the AAP's list of reasons to call right away is not about the number alone. Call if your child with a fever looks very ill, is unusually drowsy or very fussy, or has been in a very hot place such as an overheated car. Call if there is a stiff neck, severe headache, severe sore throat, severe ear pain, trouble breathing, an unexplained rash, or repeated vomiting or diarrhea. Call if your child has an immune system problem or a heart problem, has had a seizure, or has a temperature above 104°F (40°C) more than once.

The AAP also says to call if a fever lasts more than 24 hours in a child under 2, or more than 3 days (72 hours) at age 2 or older, or if the child still acts sick after the fever comes down. If you reach a nurse line and they say come in, come in.

Urgent care or the ER?

Urgent care is for the things that need a doctor today but aren't dangerous: an earache, a sore throat, a sprain, a cut that may need stitches, a rash, a fever in an older child who is drinking and alert. The hospital emergency room is for the dangerous things.

A freestanding emergency room is an emergency room, not an urgent care — its insurance and billing rules can be different, so don't choose one because the building looks like a walk-in clinic. If you are not sure what your insurance treats as in network, that is a question for daytime, not for the parking lot, unless your child is in danger.

Which door in Baytown

For a true emergency in Baytown, the hospital emergency department is Houston Methodist Baytown Hospital Emergency Department, at 4401 Garth Road, open all night and every day. Tell the person at the desk your child's age and what happened first, and they will sort it from there.

Two other emergency rooms are listed. Neighbors Emergency Center, at 6051 Garth Road, and Family First ER, at 5410 East Freeway, both list 24 hours a day, every day. They are emergency rooms, so use them the way you would use a hospital ER, and ask about how your insurance treats them when things are calm.

For the middle band of problems, three urgent care clinics list evening hours. American Family Care Baytown, at 8831 TX-146, Suite 100, lists 8 a.m. to 8 p.m. on weekdays and 8 to 5 on Saturday and Sunday. UrgentcareMDs, at 1658 W. Baker Road, lists 9 a.m. to 9 p.m. on weekdays and 9 to 7 on weekends. Next Level Urgent Care, at 7710 Garth Road, Suite A, lists 9 a.m. to 9 p.m. every day. Hours are as we hold them, and it costs nothing to ask on the phone whether a clinic sees children as young as yours before you drive there.

• Urgent care open now — the clinics near you with their closing times.
• Urgent care in Baytown — each clinic, with hours from its own site.
• Which door — the same decision for the whole family, including why a freestanding ER is still an ER.

Do this before the bad night

Most of the fear in these nights is not knowing. Ten minutes on a calm evening helps: save the pediatrician's after-hours number in your phone, save Poison Control, write down your child's weight, allergies and medicines on a note on the fridge, and pick which urgent care and which ER you would drive to. Know the route. If your child has a regular doctor, the pediatricians in the Baytown area page lists the practices. If you don't have one, finding a doctor when you don't have one tells you where to begin.

Before you go

• Bring the medicine list, the insurance or Medicaid card and your own photo ID.
• Write down when the fever started, what the thermometer said and what the child has had to drink, so you can answer quickly when the nurse asks.
• Call ahead to an urgent care to ask if it sees children of your child's age, since we cannot tell that from the listing.
• Bring a phone charger, a snack for yourself and the stuffed animal.
• If you are unsure whether to leave the house at all, call the pediatrician's after-hours line first, because that is what it is for.

Sources

AAP HealthyChildren.org, "Fever and Your Baby," "When to Call the Pediatrician" and "Poison Prevention"; Poison Control (poison.org); 988 Suicide & Crisis Lifeline; Houston Methodist Baytown; hours for the other emergency rooms and urgent care clinics as listed in our place database.

En español

Llame al 911 si el niño no despierta, le cuesta respirar o se pone morado, tiene una convulsión, sangra mucho o tragó algo peligroso. Control de envenenamiento: 1-800-222-1222, gratis, a toda hora; no lo haga vomitar. Línea de crisis: 988. Un bebé menor de 3 meses con 100.4°F (38°C) o más necesita que llame al pediatra de inmediato. En niños mayores, llame si se ve muy enfermo, tiene cuello rígido, dificultad para respirar, sarpullido inexplicable, vómitos repetidos o más de 104°F (40°C), o si la fiebre dura más de 24 horas (menores de 2 años) o más de 3 días. En Baytown, la sala de emergencias de Houston Methodist está en 4401 Garth Road; Neighbors Emergency Center y Family First ER también abren las 24 horas.