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This is a really common question. No one wants to go to the ER for something that could have waited, but you also don’t want to miss something serious. A simple way to think about it is in levels of care. Ask yourself: Can this wait, does it need prompt care, or could it be serious or life-threatening?

For most everyday concerns, start with your child’s doctor. Things like earaches, coughs, runny noses, mild fevers, growth or development questions, and minor injuries are usually best handled there. Many practices have nurse triage lines or telehealth, which can help you decide the next step if you’re unsure and want guidance.

Urgent care sits in the middle. It’s a good option when something can’t wait until the next day but isn’t an emergency, like needing a strep or flu swab, small cuts that need stitches or medical glue, bacterial pink eye, a non-life-threatening allergic reaction, or an earache when your pediatrician is closed. If you have access to a pediatric urgent care, even better, since they see kids all day.

The ER is for situations that are serious, severe, or could worsen quickly. ERs have the tools and teams ready for true emergencies. Go to the ER for problems such as:

• Severe injuries or fractures

• Severe allergic reactions

• Loss of consciousness or seizures

• Behavioral changes like slurred speech

• Lethargy or confusion

• Large and deep wounds or severe burns

• Signs of severe dehydration

• Fever in a child under 2 months old

• Cough with stridor or signs of respiratory distress

• Unrelenting abdominal pain, especially with tenderness

This is not a full list. If something feels life-threatening, trust that instinct and go to the ER or call 911. If you’re concerned about your child, know that the ER is always available.

If you want a clearer breakdown, including specific symptoms such as fever, cough, vomiting, abdominal pain, head injuries, rashes, and wounds, this PedsDocTalk YouTube video covers it all.

At this age, intense meltdowns are very common. Around 20 months, feelings are huge and language is still catching up. She knows what she wants but can’t always say it, which makes frustration build fast. None of this makes it easy, and it can be draining when you are in the middle of it.

In those peak moments, calming the body has to come before learning or problem-solving. When she is screaming, thrashing, or rolling on the floor, her nervous system is overwhelmed. She literally cannot process your words yet. Sitting nearby like you are doing is exactly right. Think of yourself as the calm anchor in the storm.

You can use a short, steady phrase in a quiet voice such as, “I’m here. You’re safe.” You do not need to explain or correct in that moment. If she is too dysregulated for touch, it is okay to stay close without holding her until her body is ready. Your calm presence can help to calm her.

When you notice her calming down, that’s when connection and learning can happen. You can name what you think was going on: “That was really frustrating. You couldn’t reach it.” Then give the next step: “When you need help, you can say help me.” You can sign for help too. Even if she can’t say it yet, she’s taking it in.

Outside of meltdowns, practice those words and gestures when things are calm. You are not trying to end every tantrum fast. You are teaching her nervous system that big feelings are safe to feel and safe to share. That is co-regulation. Over time, your calm presence becomes the tool she uses later to calm herself.

This PedsDocTalk YouTube video walks through a helpful approach to tantrums. If you want simple tools you can use right away, the PedsDocTalk Toddlers and Tantrums course offers more step-by-step guidance.

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Dr. Mona will answer these questions in a future Sunday Morning Q&A email. Chances are if you have a parenting concern or question, another parent can relate. So let's figure this out together!