What are the most common ages and reasons for pediatric emergency room visits?

Most Common Ages and Reasons for Pediatric Emergency Room Visits

Children under 5 years of age, particularly those under 2 years, account for the highest proportion of pediatric emergency department visits, with fever and respiratory illnesses being the most common presenting complaints. 1

Age Distribution of Pediatric ED Visits

• Children aged 0-2 years represent the highest utilization group, accounting for approximately half of all pediatric emergency department visits 2
• Infants under 1 year have particularly high rates of emergency care utilization, with influenza-associated hospitalization rates of 91.5 per 100,000 1
• Children aged 3-5 years represent the next most common age group seeking emergency care 1
• Adolescents (13-18 years) account for approximately 12% of pediatric ED visits 2

Most Common Presenting Complaints by Age Group

Infants and Toddlers (0-2 years)

• Fever without a source is the most common chief complaint, accounting for 15-20% of all pediatric ED visits 1
• Respiratory illnesses, particularly bronchiolitis, pneumonia, and croup, are leading causes of ED visits in this age group 1, 3
• Acute otitis media is a frequent diagnosis, often associated with fever 1
• Dehydration from gastroenteritis represents another common reason for emergency care 1

Preschool and Early School Age (3-5 years)

• Respiratory complaints, particularly asthma exacerbations, remain common 1, 4
• Fever-associated illnesses continue to be frequent presenting complaints 1
• Injuries begin to increase in frequency compared to the younger age group 5
• Infectious diseases, including influenza, represent significant causes of ED visits 1

School Age and Adolescents (6-18 years)

• Trauma and injuries become increasingly common reasons for ED visits 2
• Behavioral health concerns have increased significantly, particularly during the COVID-19 pandemic 5
• Self-harm and drug poisonings show concerning trends in adolescent ED visits 5
• Asthma exacerbations continue to be a common medical complaint 4

Seasonal and Temporal Patterns

• Respiratory illnesses show strong seasonal patterns, with peaks during winter months 1
• More than half of pediatric ED visits occur during evening hours (4 PM to midnight) 2
• Infectious disease presentations follow predictable seasonal patterns, with influenza typically peaking in winter months 1
• The COVID-19 pandemic significantly disrupted typical ED utilization patterns, with overall pediatric visits declining by 51% in 2020 and 22-23% in 2021-2022 5

High-Risk Populations

• Children with chronic medical conditions are more likely to be frequent ED visitors, with complex chronic conditions associated with a 2-fold increased risk of return visits 6
• Certain racial and ethnic populations, including African-American, Alaska Native, and specific American Indian populations, have higher rates of emergency care utilization 1
• Children with high-risk medical conditions have hospitalization rates approximately 5 times higher than healthy children for conditions like influenza 1
• Infants under 3 months of age represent a particularly vulnerable population requiring special consideration in emergency settings 1, 7

Common Diagnostic and Management Challenges

• Distinguishing between viral and bacterial causes of fever remains a significant challenge, especially in infants and young children 1, 7
• Appropriate use of diagnostic testing varies widely, with evidence of both overuse and underuse of certain tests 4, 3
• Chest radiographs are frequently overutilized in bronchiolitis (72% of visits) despite limited clinical utility 4
• Appropriate corticosteroid use for conditions like asthma (69% of visits) and croup (31% of visits) remains suboptimal 4

Impact of the COVID-19 Pandemic

• Overall pediatric ED visits declined substantially during the pandemic, but certain conditions showed concerning increases 5
• Mental health-related visits increased significantly, particularly among older children and adolescents 5
• Injuries related to self-harm and drug poisonings showed concerning increases during the pandemic period 5
• Non-COVID respiratory illnesses initially declined but began increasing again in early 2022 5