It is useful to understand how the emergency assessment (triage) works, and this might help with your decision. Assessing the child starts with observation.
What health professionals look for – ABCD
ABCD stands for alertness, breathing, circulation and disability/dehydration. It’s aim is to ensure the seriously ill child is not missed. This is what the triage nurse or primary care doctor will be assessing as a first impression. Once this has occurred the child will be categorised depending on how sick he or she appears.
1. Alertness & Responsiveness – this is probably the most important observation. How is the child relating to the environment, his parents, and the health professionals. A child who does not move from the parent’s arms and is not particularly responsive will be triaged as requiring immediate assessment. However the child who appears alert, and interacting, will be triaged lower.
2. Breathing – Cough worries parents, but more important is breathing. Is the child comfortably breathing? This means able to walk and talk without difficulty. In the infant if he or she is feeding and alert and active then the breathing is acceptable. A good analogy is to think of a child’s chest movement when they are running or jogging. If they are struggling then clearly they will need assessment. Cough is very frustrating for parents particularly during the night. However if the breathing is fine cough rarely is going to be a serious with the exception of whooping cough in the infant.
3. Circulation – This involves assessing colour, heart rate, and strength of pulse. A child who is unwell will have a poor colour (mottled, pale), a too fast heart rate and weak pulse.
4. Dehydration & Disability. The child with dehydration will look lethargic, with dry mucous membranes, such as eyes, lips and tongue. They will usually have a history of multiple episodes of vomiting and diarrhoea over a short period. Disability means there is difficulty functioning, such as walking, talking, feeding.
So with this in mind here is a table that might help you to decide whether to attend an emergency department. It is also important to note that infants under 3 months are particularly vulnerable, and parents should have no hesitation in seeking advice in this age group for symptoms that are concerning.
- On the left hand side are common symptoms. Each has a link to a more detailed discussion on these symptoms.
- Along the top are the actions, whether to attend emergency or wait to see your GP or medical centre, or health nurse.
When to go to emergency
When it is ok to see GP
|Having difficulty breathing – ie the breathing looks and sound laboured,with difficulty talking and functioning due to the shortness of breath.||When not coughing there are no breathing concerns and the child appears well||The infant with recurrent coughing episodes – this maybe whooping cough|
|If the child is lethargic, unwell, listless & the cause of the fever is unclear.||The child appears well and the source of the fever is clear||
|The pain is continuous and associated with vomiting, lethargy, and the child appears unwell.||Intermittent pains, where the child appears well between the episodes||the infant or toddler with intermittent pain and vomiting³|
|The child appear listless, pale, and lethargic.||Between the episodes the child appears well.||the infant or toddler with intermittent pain and vomiting³|
|High fever, with bloody diarrhoea. Or if significant vomiting with dehydration concerns||The child appear healthy between the episodes||Infants under 3 months are more susceptible to dehydration|
|Severe, quick progression, unwell, drowsy.||Episodic headaches when well in-between||Persistent constant headache will need assessment|
¹Infants under 3 months are more susceptible t0 bacterial infections
²fever and limp needs urgent assessment as the causes can be quite serious, such as bone or joint infections.
³Pain and vomiting three to 4 times per hour, and slowly worsening may indicate intussusception, a bowel condition that requires urgent medical attention.
Note that some symptoms that worry parents are not considered serious by emergency staff. Fever and cough are examples of this.
- Fever – parents worry that a high fever is dangerous. This is not true, and in fact a fever is helping the body fight an illness, such as an infection. Finding the cause of the fever is more important that treating the temperature. See article on fever.
- Hacking cough– other than the infant a cough itself is distressing but does not cause any ‘damage’. This can be very frustrating for parents as coughs are usually caused by viruses for which there is little treatment.
For medico-legal reasons this post is a guide and does not replace the assessment of a qualified medical practitioner.