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Just for Kids | By Cindy Hawkins

When Cape Fear Valley Medical Center began to map out what a new emergency room for children might look like, H1N1 was just a series of letters and numbers. Fast forward to fall 2009.

The children’s emergency department celebrated its first anniversary last September with its busiest month ever, not just in the year since the new ED opened but in the past 10-plus years, from the time the hospital first separated sick children from sick adults in the emergency room. That September, the children’s ED saw 4,500 arrivals, an average of 150 patients a day. “If I had my crystal ball,” says Dr. David Smith, a pediatric emergency medicine physician and medical director of the children’s ED. Instead of 17 beds, he said, Cumberland County’s growth could have easily accommodated an even larger unit. Now, the hospital is talking about the ED’s future again. Cape Fear keeps growing, here and in Hoke County. It recently opened Hoke County’s only urgent care clinic and broke ground near the front of the hospital for a new facility that will house the CyberKnife, a piece of equipment used to treat cancers that cannot be surgically removed or treated with traditional radiation. But on the other side of the hospital, at the children’s emergency department, kids come first, and that priority is reflected in everything from the decor to the specially-trained staff. It begins with a separate entrance and waiting area. Having a separate entrance from the main emergency room, one of the busiest in the state, is important. It shields children from the traumas they might otherwise see in the main ED. Instead, families come in beside a bubbling koi pond, a nice distraction from the mission at hand, and can wait undisturbed away from the hustle and bustle in the main ED. A hospital visit can be a scary experience for little ones, but the new children’s ED was created with the child in mind. The bright and friendly jungle theme seems to minimize a lot of the fear. No ferocious jungle beasts here – they are all cuddly and smiling. On the floor, colorful animal tracks – ducks’ webbed feet, bear paw prints and deer hoof prints – mark the way. Cheery nurses in playful print scrubs greet families at the registration desk and direct them to the waiting area or one of the treatment rooms, each sealed off with glass doors, looking like something out of “Grey’s Anatomy.” Here, the jungle theme continues with jungle-print privacy curtains and paw prints embedded in the ceiling tiles. A few rooms are sports-themed, geared toward older children or teens. (The children’s ED sees patients up to age 17.) Each room has a soothing mural on the wall, reminiscent of a Thomas Kinkade painting, perhaps to soothe the nerves of harried parents. Of course, no room would be truly child-friendly without a flat-screen television showing the Cartoon Network, Nick, Nick, Jr., and other popular kid channels. On this particular Wednesday, the waiting room is nearly deserted. The children and teens who have come in are already receiving treatment. Compared to the longer waits in the adult ED, the average visit in the children’s ED is two and a half hours. Smith says most children receive routine care from their pediatrician. “We are available 24 hours a day for whatever needs a child has,” he says. “But a solid relationship with a primary care pediatrician is always invaluable to the healthcare of a child, and that physician should always be the first resource accessed with any problem. If the primary care pediatrician feels the child would be best served being seen in the PED (Pediatric Emergency Department) or if parents feel the child may be in danger, that’s the best time to come visit us.” Another positive aspect of the children’s ED is continuity of care. If a child is admitted to the Pediatric Intensive Care Unit, the same physicians who provide care in the children’s ED also serve in the PICU. More important, the physicians and nurses have specialized training to care for children. Dr. Smith says that everyone in the department is “very aware” of the special needs and fears of children in an emergency setting. “Distraction is always important, as is play therapy in terms of calming children and alleviating fears,” he says. “We also understand the needs and fears of parents, as education is a big part of what we do. Most children are going to be fine, but we have to make sure the parents understand that and feel comfortable with what is going on.” The practice of general emergency medicine and pediatric emergency medicine differ in many ways. Smith says that general emergency practitioners are like family practitioners in that they receive pediatric training and can competently care for and assess children. “The specific focus of the pediatric emergency medicine physician tends to lead to less pain and distress, fewer tests run and a better family focus,” Smith says. “Pediatric-trained physicians are more comfortable with child and family interactions and that leads to an improved quality of experience for everyone.”