When to take your child to hospital

This article is designed to help you decide if you feel you need to attend hospital if your child is unwell with symptoms such as fever, cough, vomiting, abdominal pain, diarrhoea, and headache. These are symptoms that everyone experiences at some stage. But how do you know when to take your child to the emergency department? On the one hand you are worried something serious might be occurring but on the other hand you do not want to over react.  The following is a guide that helps decide whether to get emergency help

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 airways,  breathing, circulation and disability.  However in this instance A is often used for Alertness.  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. A = 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. B = 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. C = 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. D = Dehydration, Drowsiness or 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. Drowsiness means difficult to wake. 

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.

Symptom	When to go to emergency	When it is ok to see GP	Exceptions
Cough	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
Fever	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	Infant under 3 months must be assessed if fever is >38.¹ Child with a limp and fever²
Abdominal pain	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
Vomiting	The child appear listless, pale, and lethargic.	Between the episodes the child appears well.	the infant or toddler with intermittent pain and vomiting³
Diarrhoea	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
headache	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.