SAFETY NETTING

It is likely you have been sign posted to information on spotting a sick child, as part of a process called “safety netting.” This is explained in detail under

• Serious Symptoms And Safety Netting

In summary:
“Safety-netting advice is information shared with a patient or their carer designed to help them identify the need to seek further medical help if their condition fails to improve, changes, or if they have concerns about their health.”
Peter Edwards et al. Published in British Journal of General Practice. November 2019.

A BOOKLET TO DOWNLOAD

From the NHS Vale of York CCG
An excellent booklet originally developed by PRIME Centre Wales, Division of Population Medicine, Cardiff University, which is worth downloading “when should I worry” NHS Vale of York Clinical Commissioning Group – When Should I Worry
Use for children over 3 months as explained in the booklet.

High temperatures (Fever)

As the NHS points out in most cases of high temperature
“you can usually look after your child or baby at home. The temperature should go down over 3 or 4 days.”
There are occasional situations when a high temperature is combined with other symptoms and signs and you should then attend A&E. The list below includes symptoms and signs of sepsis (including meningitis septicaemia)

Call 999 if your child:

• has a stiff neck
• has a rash that does not fade when you press a glass against it (use the “glass test” from Meningitis Now)
• is bothered by light
• has a fit (febrile seizure) for the first time (they cannot stop shaking)
• has unusually cold hands and feet
• has blue, pale or blotchy skin, lips or tongue
• has a weak, high-pitched cry that’s not like their normal cry
• is drowsy and hard to wake
• is extremely agitated (does not stop crying) or is confused
• finds it hard to breathe and sucks their stomach in under their ribs
• is not responding like they normally do, or is not interested in feeding or normal activities”

There is more information about controlling a temperature and also when you should call 111 or ask for an urgent GP appointment in the article “High temperature”

• High temperature (fever) in children High temperature (fever) in children – NHS
• Meningitis Meningitis – NHS

From the NHS 

• High temperature (fever) in children High temperature (fever) in children – NHS
• Symptoms of sepsis and what to do Symptoms of sepsis – NHS
• Sepsis Sepsis | NHS inform

From Patient info

• Fever in Children Fever in Children (High Temperature): Causes and Treatment | Patient
• Sepsis Sepsis (Septicaemia) | Symptoms and Treatment | Patient
• Sepsis warning signs you need to know The warning signs of sepsis | Sepsis symptoms | Patient
• Child sepsis safety net Child Sepsis Safety Net | Patient

From the Sepsis Trust

• How to spot sepsis in adults and children About sepsis – The UK Sepsis Trust
• Sepsis FAQs FAQs – The UK Sepsis Trust

From NICE

• Identifying people with suspected sepsis Recommendations | Sepsis: recognition, diagnosis and early management | Guidance | NICE
• Sepsis Sepsis | Health topics A to Z | CKS | NICE
• Scenario: Feverish children – risk assessment ( includes the NICE traffic light system : Red (high risk of serious illness)) Scenario: Feverish children – risk assessment | Management | Feverish children – risk assessment and management | CKS | NICE

SHORTNESS OF BREATH

There are some features of shortness of breath in babies and young children which are worth knowing about and may indicate a need to call 999 or go to A&E.

These features will be associated with fast breathing/struggling to breathe but are in addition and include

• Sternal/ Intercostal recession
• Stridor and abdominal movement
• Cyanosis

Though not common, each of these features can occur in many infections involving the chest and/or airways and are best understood by considering 3 childhood conditions with the feature highlighted. Note at the bottom of each condition there is more information on each feature (including in some cases a video of the feature).

The 3 conditions included are:

INTERCOSTAL RECESSION

Bronchiolitis (demonstrating the importance of intercostal recession)

As the NHS suggest
“Most cases are mild and clear up within 2 to 3 weeks without the need for treatment, although some children have severe symptoms and need hospital treatment.”
“While it’s unusual for children to need hospital treatment for bronchiolitis, the symptoms can get worse very quickly.”

“Call 999 and ask for an ambulance if:

• your child has difficulty breathing or exhaustion from trying to breathe (you may see the muscles under their ribs sucking in with each breath, they may be grunting with the effort of trying to breathe, or they may be pale and sweaty)
• they’re breathing very fast
• you’re unable to wake your child or, if woken up, they do not stay awake
• their breathing stops for a long time, or there are regular shorter pauses in their breathing
• their skin turns very pale or blue, or the inside of their lips and tongue are blue (cyanosis)”
  Bronchiolitis Bronchiolitis – NHS

The term given to “muscles under the ribs sucking in with each breath” is called intercostal recession and this can be clearly seen in the attached link which includes a number of the other common signs of serious respiratory distress  Signs of Respiratory Distress in Children – Physiopedia

STRIDOR AND ABDOMINAL MOVEMENT

Croup (demonstrating the importance of stridor and abdominal movement)

As the NHS suggests
“Croup is a common childhood condition that mainly affects babies’ and young children’s airways. It’s usually mild. “
However, on rare occasions when you might need to attend A&E it is worth understanding what to look for

Call 999 if:

• your child is struggling to breathe (you may see their tummy sucking inwards or their breathing sounds different)
• their skin or lips start to look very pale or blue
• they’re unusually quiet and still
• they suddenly get a very high temperature or become very ill
  Croup Croup – NHS

Stridor (“breathing sounds different”) and Intercostal recession and abdominal movement (“their tummy sucking inwards”) can clearly be seen in the attached link which includes a number of the other common signs of serious respiratory distress  Signs of Respiratory Distress in Children – Physiopedia

CYANOSIS

Pneumonia (demonstrating the importance of cyanosis (blue skin or lips))

As the NHS suggests
“Call 999 for an ambulance if someone you care for:

• are struggling to breathe
• have blue lips or a blue face
• feel cold and sweaty, with pale or blotchy skin
• have a rash that does not fade when you roll a glass over it
• collapse or faint
• become confused or very drowsy
• have stopped peeing or are peeing much less than usual”
  Pneumonia Pneumonia – NHS

Blue skin or lips (cyanosis) can mean there’s reduced oxygen in your child’s blood and as such indicates you should call 999 and attend A&E.
Blue skin or lips (cyanosis) Blue skin or lips (cyanosis) – NHS

DEHYDRATION

As the NHS suggests
“Dehydration means your body loses more fluids than you take in. If it’s not treated, it can get worse and become a serious problem.”
In the general population babies, and young children are more at risk of dehydration.
“Take your baby or child to the GP urgently or go to A&E if they:

• seem drowsy
• breathe fast
• have few or no tears when they cry
• have a soft spot on their head that sinks inwards (sunken fontanelle)
• have a dry mouth
• have dark yellow pee or have not had a pee in last 12 hours
• have cold and blotchy-looking hands and feet”

The article below also suggest how you can reduce the risk of dehydration in children

From the NHS
Dehydration  Dehydration – NHS

From Patient info
Dehydration (in particular Babies and young children with dehydration) Dehydration | | Patient

SEIZURES (INCLUDING FEBRILE SEIZURES)

As the NHS points out
“You should call 999 for an ambulance if you know it’s their first seizure or it’s lasting longer than 5 minutes.”

From the NHS 

• What to do if someone has a seizure (fit) What to do if someone has a seizure (fit) – NHS
• Febrile seizures Febrile seizures – NHS
• Epilepsy Epilepsy – NHS

A SERIOUS HEAD INJURY

Minor head injuries are common in children, and most are not serious but there are certain features which should be assessed in A&E, and these are included in the article from the NHS (if you are not sure you can always contact 111)

From the NHS, Patient info and NICE
Head injury and concussion

• Head injury and concussion – NHS
• Head Injury Advice | Patient
• Head injury | Health topics A to Z | CKS | NICE

specific conditions

A practice clinician may tell you that your child has a specific condition such as bronchiolitis. The NHS website has well organised articles where they include information on specific conditions, including when you should call 999 (or go to A&E) or call NHS 111(or ask for an urgent GP appointment).

Examples include

• Bronchiolitis – NHS
• Croup – NHS