Benji has been an unusually healthy baby. He’s had one cold, about a month ago, and that’s it. So when he woke up from his nap at my mom’s house yesterday burning up with fever, we were surprised, to say the least. But he was clearly miserable: Very hot, moaning, wanting to be held constantly, and even fell asleep in Mom’s arms for a while. When he woke up, he was inconsolable and feverish, so we called the doctor. They couldn’t get us in that day, and Benji clearly needed some kind of treatment, so we went to a local urgent care clinic that I’d been to before.

At the clinic, they gave him a big dose of Motrin first thing — which he promptly vomited up. This unpleasantness necessitated a half-hour of inconsolable wailing, during which time the RN saw us, looked in his ears and eyes, and diagnosed an ear infection and conjunctivitis. She prescribed amoxicillin twice a day for the ear and antibiotic eye drops every three hours for the eyes, plus fever reducers every four hours around the clock, alternating Motrin and Tylenol to avoid overdosing on ibuprofen or acetaminophen. Before we left, they gave him another dose of Motrin that he kept down, and as that took effect and the fever dropped, he perked up substantially.

At the clinic, I told the RN that he’d had the weepy eye for a while and we’d just been leaving it because he had no other symptoms (“until now,” she said). She strongly recommended treating it with the antibiotic eye drops, so I acceded. I also later said to Mom that it seemed odd to get an ear infection with no other previous symptoms. I thought you usually got ear infections after having a cold or some kind of congestion, and he hasn’t been sniffly, runny-nosed, or exhibiting any other symptoms before this. So where’d the ear infection come from?

But what do we know? So we got the drugs and started dosing him up. He took the Tylenol fine, but when it was time for Motrin at 11:00 pm, he threw up again immediately. This meant changing his bedding, soothing him again, and trying to give him a little bit more Motrin so his fever didn’t get out of hand. But we decided not to wake him again, and instead let him sleep and give him Tylenol and the other drugs when he woke up in the morning.

This we did, and an hour after taking Tylenol and amoxicillin, Benji threw up again. Yet again he was inconsolable, but also exhausted. Eventually he went down for a nap, but woke up half an hour later wailing and hot again. Our late morning was all holding a moaning/wailing/crying/utterly miserable Benji (me, or Ian, or Mom, both of whom have been around to help for the day), and eventually Benji fell asleep in my arms — an extremely atypical activity that shows how exhausted he was. At one point, he was so hot and miserable, moaning and crying constantly, that I called his doctor and was able to get in at 1:50* to see him in person.

We gave Benji more Tylenol at 12:00, and by 1:50 he had perked up some. Not by any stretch his normal self, but he took interest in the freeway cars we could see from our exam room. The doctor looked at Benji, asked about his symptoms, and told us there was no ear infection and nothing wrong with his eyes, either. He said that urgent care clinics often diagnose ear infections as a catch-all and over-prescribe antibiotics. Based on the symptoms we described (no cold, cough, sore throat, or anything besides a high fever) and what he saw in Benji’s ears and eyes, the primary care doctor (PCP) thought Benji has a viral infection. We’re to stop all antibiotics and the Motrin, which can upset a baby’s tummy. Now we’re giving Tylenol every 3 – 4 hours while Benji’s awake and encouraging him to drink as much fluids as he’ll take. No waking him up if he’s asleep. No gut-wrenching antibiotics. No loathed eye drops. Most viral infections are done within 5 days, he said, so we should be pretty much better in 3 days or so.

Besides, he added, these days we’re not really prescribing antibiotics for ear infections. Mostly now they’re having parents wait a few days, treat the symptoms, and see if the baby can fight it off himself. Most of the time, babies with ear infections don’t need antibiotics, which just make them feel lousy and upset their stomachs.

These approaches could hardly be more opposite: One healthcare provider loads us down with antibiotics and a complicated treatment regimen that makes Benji miserable and even induces vomiting; the other recommends treating symptoms minimally and essentially says to let Benji’s immune system do its thing on its own, a regimen that leaves Benji feeling well enough to crawl around and toss sombreros a bit. That’s so much more to my liking — I really worry about over-prescription of antibiotics causing resistant bacterial strains, and see drugs as an absolute last resort; plus they make a body feel so icky — I can’t overstate how relieved I felt to stop almost all the drugs. It was like a huge weight was lifted.

At the same time, I feel terrible. It’s OUR FAULT poor Benji has been throwing up, giving him drugs that upset his stomach. On top of his fever, we’ve been forcing him to get these eye drops and antibiotics that make him feel even more miserable.

I also feel frustrated and confused. What do I do next time Benji’s sick and we can’t get in at our primary care doctor? I don’t feel at all confident going back to that urgent care clinic, with the diametrically opposed treatment recommendations we got there versus with our PCP. The fact is that, within 7 days, Benji should be better. If we hadn’t seen Benji’s PCP, we would have stuck with the antibiotics that entire time, and he’d be better, so how would we know if he didn’t need the drugs? I’m left feeling rather distrustful of the whole urgent care experience, which essentially resulted in 24 hours of extra misery for all of us. Yes, they were already going to be miserable hours, but adding in extra vomiting, drugs, and eye drops certainly didn’t help.

Not sure what to do about that, but for now we’re just going to offer Benji fluids, Tylenol, and rest — essentially how I’d treat myself if I got a fever. We’ll worry about next time next time.

* About this: This was actually our well-baby checkup time that I had to cancel yesterday when he was sick. So in the end we did see the doctor at 1:50 today, just not for his well-baby. Funny. We’re fortunate nobody else took our spot in that 24 hours.

One thought on “Urgent Care vs. Primary Care: Compare and Contrast

  1. your decision to wait when he feels ill is the way to go,just use commom sense,like you would do for yourself.
    Tylenol would be my first choice also. Glad all is getting better,it is a learning experience with a child,not easy but part of being a parent.

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