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Introduction

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We can say with some assurance that, although children may be the victims of fate, they will not be the victims of our neglect.

John F Kennedy (1917–63)

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Important serious emergencies in children include:

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  • trauma, especially head injuries and intra-abdominal injuries

  • painful conditions

  • swallowed foreign bodies (FB)

  • respiratory problems:

    • bronchial asthma

    • epiglottitis

    • croup

    • inhaled FB

    • acute bronchiolitis

  • severe gastroenteritis

  • septicaemia (e.g. meningococcal septicaemia)

  • myocarditis

  • immersion

  • poisoning

  • bites and stings

  • seizures

  • febrile convulsions

  • sudden infant death syndrome (SIDS) and apparent life-threatening episode (ALTE)

  • child abuse:

    • emotional

    • physical

    • sexual

    • neglect

    • potential

  • psychogenic disturbances

  • anxiety/hyperventilation

  • suicide/parasuicide

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Survey by age group

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The author’s study analysed emergencies into three groups:1 preschool (0–5 years), primary school (6–12), adolescence (13–17).

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The commonest emergency calls in the 0–5 years group were poisoning, accidents and violence, dyspnoea, fever/rigors, convulsions, abdominal pain, earache, vomiting.

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In the 6–12 years age group: accidents and violence, dyspnoea, abdominal pain, vomiting, acute allergy, bites and stings, earache.

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In the 13–17 years age group: accidents and violence, abdominal pain, psychogenic disorders, acute allergy, bites and stings, epistaxis.

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The signs and symptoms of a serious illness

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Babies who are febrile, drowsy and pale are at very high risk and require hospital admission.

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The busy GP will see many sick children in a day’s work, especially in the winter months with the epidemic of URTIs. It is vital to be able to recognise the very sick child who requires special attention, including admission to hospital. It is unlikely that the commonplace robust, lustily crying, hot, red-faced child is seriously ill but the pale, quiet, whimpering child spells danger. These rules are particularly helpful in the assessment of babies under six months of age.2,3 The presence of a fever in itself is not necessarily an indication of serious illness but rather that the baby has an infection.2

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The features of a very sick infant include:

  • inactive, lying quietly, uninterested

  • increased respiratory rate

  • increased work of breathing

  • noisy breathing:

    • chest wall or sternal retraction

    • wheezes, grunting, stridor

  • tachycardia

  • sunken eyes

  • cold, pale skin

  • cold extremities

  • drowsiness

  • poor perfusion (reduced capillary refill time)

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A Melbourne study4 of the sensitivity of clinical signs in detecting serious illness in infants identified five key signs or markers:

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Table Graphic Jump Location
Favorite Table | Download (.pdf) | Print
Marker Risk to baby
Drowsiness 58%
Pallor 49%
Chest wall retraction 41%
Temperature >38.9°C or <36.4°C 42%
Lump >2 cm 42%

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If sepsis suspected, investigate with:

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  • blood culture

  • FBE/ESR/CRP

  • lumbar puncture

  • urine culture

  • chest X-ray

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Serious infectious illnesses to consider include:

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  • Haemophilus influenza type B (Hib) infection:

    • acute epiglottitis

    • meningitis

    (now uncommon since Hib immunisation)

  • acute bacterial ...

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