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What to do when your child is sick after hours

New virtual visit option lets doctor exam patients via internet By Jennifer Meadows

Novant Health

When your child isn’t feeling well and your pediatrician’s office has closed, you’re left with a decision: Can this wait until the morning, or does my child need to be seen right away?

Dr. Kym Selden, a pediatrician with Novant Health Pediatrics says the answer isn’t always clear-cut. However, there are some general tips to help you make your decision.

A new option: Virtual care with a medical exam kit
At Novant Health, you can now see a doctor and get an examination without leaving your home. The option comes via TytoHome, a lightweight and portable medical exam kit.

Using TytoHome, patients can connect to a Novant Health provider who can virtually examine the heart, lungs, skin, ears, throat and abdomen from wherever they are — potentially eliminating a rush to the emergency room or the doctor’s office.
This could be especially handy for parents of young children prone to ear infections and other common childhood afflictions, said Dr. Pam Oliver, an ob-gyn and executive vice president of Novant Health and president of the Novant Health Physician Network.

“For years we’ve had the ability to do video visits where we could actually see a patient on video. But there are limitations in the assessment that we could do, and that makes a lot of physicians uncomfortable when we’re used to being able to actually touch our patients, to do an exam, to listen to the heart, look in the ears. So TytoHome is actually really innovative,” Oliver said.

“It has an attachment that allows physicians to look in the ears, look in the throat and actually acts as a stethoscope. So patients will put it on their chest and we can actually hear the heart rate and the breath sounds. This is a game changer because it adds a whole other level to the evaluation and what we can treat … from a patient’s home.” Not only can doctors make the diagnosis, they’ll be able to prescribe medication when appropriate, Oliver noted.

TytoHome is FSA eligible and available at NovantHealth.org/TytoHome, where you can also see demonstration videos. The cost is $299 and covered by flexible spending and health savings accounts.

Urgent care may suffice
Fortunately, most cases don’t warrant a trip to the emergency room. “If your child is not experiencing severe or life-threatening symptoms, an urgent care is likely your best option,” Selden said. “A good rule of thumb is that if it’s something you’d take your child to their pediatrician for during normal daytime hours, and you can’t wait until the next day, a pediatric urgent care is the appropriate place to seek care.”

Urgent care centers offer a cost-saving alternative to the emergency room for injuries and illnesses that do not require 911. Novant Health has two pediatric after hour clinics: Novant Health Pediatrics Highland Creek in Charlotte and Novant Health Forsyth Pediatrics After Hours in Kernersville.

“During sick visits, I give parents red flags to look for so they know what to do if ‘X’, ‘Y’, or ‘Z’ happens later on,” Selden added. “It helps to have a road map if the child’s symptoms change or worsen.”

Expanding access to convenient care
In 2018, Novant Health partnered with GoHealth Urgent Care, one of the country’s largest and fastest growing urgent care companies, to create a large network of urgent care centers across North Carolina. Phase one of the partnership will include at least 15 clinics in greater Charlotte and Winston-Salem. Novant Health-GoHealth Urgent Care will open its first urgent care centers in Winston-Salem in early 2019, followed by a number of new and renovated clinics in the greater Charlotte area over the next 12 to 18 months. The urgent cares will be equipped to care for everyday illnesses and non-life threatening injuries and include on-site laboratory and X-Ray services.

When the ‘ER’ is the right call
“If your child is not breathing, is in severe pain or is nonresponsive, call 911 right away,” Selden said.
There are other warning signs to watch for, Selden said, that would require emergency
medical attention. These signs include one or more of the following:
• Breathing that is labored or fast, or if the child has trouble breathing.
• Severe or persistent vomiting, or vomiting blood (red or brown) or bile (green).
• Bleeding that will not stop after 10 minutes of direct pressure.
• Pain that is not relieved with over the counter pain medications.
• Fainting, loss of consciousness or a seizure.
• Confusion or vomiting after a head injury.

When it comes to fevers, the answer isn’t the same for everyone. A fever 100.4 degrees and above in an infant less than three months of age is considered an emergency, but it’s less of a concern for older babies and children. Anytime you are concerned that the fever could be part of a more serious illnesses (e.g., associated with headache, 
rash, significant coughing, sore throat, vomiting, etc.), you should seek medical care. 
“Trust your gut,” Selden adds. “If you think your child needs to be seen immediately, don’t hesitate.” 
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