UF Health Pediatric Emergency Room Brings Expertise to Children 17 and Younger
Q/A with Medical Director Carolyn Holland, M.D.
About the author:
Carolyn Holland, M.D., is board-certified in pediatric emergency medicine and is the division chief for pediatric emergency medicine at the University of Florida College of Medicine and the medical director of the UF Health Pediatric E.R. Holland grew up in Florida and completed her bachelor’s and master’s degrees at UF. She then worked in secondary and higher education before attending Eastern Virginia Medical School in Norfolk, Virginia. After earning her medical degree, she completed a residency in emergency medicine at the University of Cincinnati and a fellowship in pediatric emergency medicine at Cincinnati Children's Hospital. After her training, she remained on the faculty at the University of Cincinnati for a few years before returning to UF to join the faculty here.
Q: What makes a pediatric E.R. different from an adult E.R.?
A: Pediatric emergency rooms are built for children and their families. With colorful rooms and murals, along with toys and games to keep children occupied, the atmosphere in pediatric emergency rooms is designed to be kid-friendly. In addition, ours has stretchers with narrow slats to help keep kids from falling out of the beds, cribs for infants, age appropriate snacks, formula and diapers. Waiting rooms are for pediatric patients and their families ONLY, so the space is not shared with adult patients with serious medical problems like heart attacks and strokes.
Q: When should a child go to the E.R. versus going to their pediatrician?
A: While we are open 24/7 and happy to care for all patients who come in the door, the first call in a non-emergency situation should be to the pediatrician’s office. There is generally someone on-call 24 hours a day to provide advice and help parents/guardians decide if an emergent trip to see a doctor is necessary. The pediatrician can often arrange to see a child first thing the following morning in the office and avoid the wait in an E.R.
That being said, there are some “must go to E.R.” conditions:
- Any child less than 2 months old with a fever greater than 100.4 degrees Fahrenheit
- Suspected broken bones — especially if there is any concern that the bones are not lined up and need to be put back in place
- Head injuries associated with passing out, seizing or recurrent vomiting
- Seizures in children who normally don’t have seizures
- Signs of dehydration, such as lack of urine for more than 12 hours, very dry lips and mouth, and sunken eyes
- Fast, heavy, gasping breathing and/or speaking only two to three words between taking breaths or turning blue
- Gaping cuts (especially on the face) that need repair; young children may need sedation or the help of child life specialists to offer support during procedures
- Concern that a button battery was ingested
- Concern for a neck or spine injury
- Uncontrolled bleeding
Q: What makes the UF Health Pediatric E.R. unique?
A: We are the ONLY pediatric emergency department in North Central Florida that is fully staffed by board-certified, fellowship-trained pediatric emergency medicine physicians. We are also the only hospital in North Central Florida that has all pediatric surgical subspecialties should your child need surgery, including pediatric anesthesia, surgery, orthopaedics, ENT, urology and neurosurgery. We also have 20+ pediatric medical subspecialties available 24/7, including but not limited to neurology, gastroenterology, cardiology, endocrinology, rheumatology, nephrology, hematology/oncology, pulmonology and infectious diseases. Finally, we are the only hospital in North Central Florida that has a pediatric intensive care unit and a neonatal intensive care unit. All of these services make it extremely unlikely that your child would ever have to be transferred out to another location to get definitive care.
Q: Has the COVID-19 pandemic changed the way the UF Health Pediatric E.R. cares for patients?
A: The biggest changes are related to the wearing of personal protective equipment with every patient encounter and the requirement that parents and older children also wear protective equipment. You will see the nurses and doctors in N95 masks and eye protection at all times, and sometimes even in protective gowns and gloves. We have also enhanced our room cleaning procedures in between each patient. Our visitor policy has been limited to one adult at the bedside while the patient is in the emergency room.
Q: How are pediatric E.R.s staffed?
A: They are staffed by physicians and nurses who have chosen to specialize in the care of children and their families. When it comes to emergencies, children are not just “little adults.” Doctors, nurses and the support staff in a pediatric emergency department are knowledgeable about illnesses and injuries that are specific to children. They are also experts at communicating with children and their families. At UF Health, all patients in our pediatric E.R. are cared for by board-certified, fellowship-trained pediatric emergency physicians and pediatric-trained emergency medicine registered nurses and support staff.
Q: What should parents/guardians know in advance before bringing a child to the E.R.?
- Don’t be afraid to give your child some pain medication and/or fever medication at home before coming to the E.R. It is the first thing we are going to do when the child arrives, and if it is already starting to work before you get here, it will make our examination much easier.
- Stay calm and let your child know what to expect. Children are little barometers for the stress going on around them. If you are freaking out, it is likely that your child will do the same. They are looking to you for reassurance, so let them know that everyone is there to help and be as honest as you can based on the child’s age.
- Bring a list of your child’s medications and medical history. While we have an electronic health record that keeps track of many items, it does not connect with all other health systems and can sometimes be outdated. We also recommend bringing a comfort object for your child (favorite blanket or stuffed animal) and something to distract him/her (book, phone, tablet, etc).
- If possible, please do not bring other children with you. This way you can concentrate on supporting your ill/injured child and not have your time and attention divided. The E.R. is unable to provide child care and some of our rooms are small, so additional people can make it feel crowded and uncomfortable.
- Don’t stop for food on the way to the E.R. If your child is ill and/or injured and requires a procedure with sedation or anesthesia, your child’s care may be delayed or be riskier on a full stomach. We will let the patient eat and drink as soon as possible after being evaluated by a doctor.
Q: Are there any common myths associated with the E.R.?
A: Some parents are afraid that we won’t believe a fever is real unless we actually measure it in the E.R. This is not true! If a parent/guardian tells us there was a measured fever, or even a fever that was felt by hand, we will believe the parent/guardian, which is why giving the child pain and/or fever-reducing medication prior to arrival is not a problem and is preferred.
Q: How long will an E.R. visit take?
A: There is no way to predict how long your visit will take in the emergency department. Severe medical problems are seen first, so if your child is there for a minor condition, you may have to wait a little longer. If your pediatrician calls the hospital prior to your arrival, it can help the emergency staff speed up the process, but labs, imaging and specialty care take time. Please be patient and know that we are going as fast as we can to provide the safest and highest-quality care possible.
Q: If a child is seen at the Pediatric E.R., will his/her pediatrician be notified?
A: If the primary pediatrician is listed in our electronic health record, he/she will get information about your child’s emergency department visit and any hospital admissions automatically. Additionally, many of the pediatricians in the local area and surrounding counties have access to our electronic health record. However, it is always good practice to call your pediatrician after an E.R. visit to arrange a follow-up appointment in his/her office.
Q: What if a child needs to be admitted to the hospital after being seen in the Pediatric E.R.?
A: We are really lucky that our Pediatric E.R. is part of UF Health Shands Children’s Hospital. Our pediatric emergency medicine staff and the inpatient physicians have a very close and collegial working relationship. There is always direct communication between the emergency room team and the admitting team so that all are on the same page when it comes to the care plan. If your child needs to be admitted, the transition will be seamless.
Q: Do you have any additional advice for families?
A: Yes, advocate for your child and ask questions. You are the person who knows your child the best. If you don’t feel comfortable with your child being discharged, let the medical team know. Ask questions so you understand what the plan is at home, when to return to the emergency room and when to follow up with a doctor. While you’re here, you may see multiple health care providers — from nurses and paramedics to resident physicians to surgeons to the attending emergency physician. They may all ask you the same questions, and it can sometimes feel redundant. But each set of people have different tasks and pieces of information they need in order to provide the best care, so repeat questions are sometimes essential.