Identification of sick children in acute care settings

Abstract

: At the heart of every paediatric consultation is the clinician’s responsibility to determine ‘is this child sick?’ In paediatrics illustrative language communicates a clinical picture of the child before us. When we define ‘sick’ we are thinking about a child, from the neonate to the adolescent up to eighteen years old, who will continue to decompensate without medical intervention. We are not concerned about a minor cold or cough, instead we think about the ex-premature infant with bronchiolitis who has the potential to rapidly deteriorate or the child who is ‘irritable’ whom we have to assume has meningitis until we can call them ‘miserable but consolable’. As health care professionals we rely on experience, evidence-based knowledge and clinical gestalt to determine whether we should be worried about our patients, and how we should approach the management of our patients whilst maintaining a holistic overview. This paper draws upon the global experience of our not-for-profit openly accessible ‘Don’t Forget the Bubbles’ (DFTB) website (https:// dontforgetthebubbles.com) to present a ‘meta-blog’ synthesis of approaches to recognition of the sick child. We explore how knowledge translation can guide our clinical skills in recognising which children are most at risk and address neonatal, cardiac, respiratory, head injury, metabolic and abdominal pain presentations.