Mumsnet Talk

Ds just seen nurse at surgery, he has had temp for 5 days, she heard crackles in his lung and has prescribed abs. She tooks his sats and hear rate which were 93/130 (his temp was normal when she took it).

Anyone who knows anything about chests! Does this sound ok?

sorry your ds isnt well, sounds like he has a chest infection, hope he is better soon

I'm surprised he wasn't sent to hospital with 93 sats tbh. I think I'd call NHS in your situation.

I agree those sats are slightly low. If you are at all concerned I would ensure a doctor sees him this evening - A&E is probably your sensible option as if a GP is worried from here that is where they would send you anyway. How does his breathing look - is his respiration rate increased or the effort to breathe? Are his lips pink or purplish?

What did the nurse do?

I would hope she sent you straight to A and E for monitoring!

A child with oxygen saturation of less than 97% should be seen by a paediatrician ASAP, I think he sounds very poorly.

He should be in hospital with 93%. With that breathing rate, he is obviously working extremely hard to get oxygen around his body. If he tires of this, his SATs will drop and he will need extra oxygen.

I'm a nurse and I think those sats are too low. Call NHS direct straight away, or the GP but only if you get to speak to them without waiting.

Can't believe any nurse wouldn't flag that up!

His symptoms indicate pneumonia. He may need IV antibiotics and possibly an oxygen mask.

I hope you have been able to see a doctor and your ds is getting the care he needs.

Sata are too low and with a temperature as well he should be seen by a doctor at least. Hopefully he has seen one by now. Hope he feels better soon.

Goodness, I have only just got back onto mumsnet.

We weren't sent to hospital, and we have been home, another night of sitting up with ds coughing, and his temp spiking in the middle of the night.

Ds has frequent chest infections and pneumonia, and he doesn't usually show the usual signs of low o2, as his low muscle tone disguises the fact that he is struggling. The usual sign is that he becomes very floppy, and obviously low sats, but looking back at my notes, we have been sent home from a+e before when his sats have been 93.

We have never seen this particular nurse at the surgery before, so I was worrying.

We have to take him to the hospital for a cardiology appointment this morning, so I will call children's ward before we go, and ask if we can wait and see a paed.

Thankyou for all your advice, and sorry I wasn't back sooner.

Good luck today hazeyjane.

Does ds have a heart defect? I would confirm with cardiology what his baselines are and what level you should worry at because they won't be the same for a 'normal' child. eg dd's resting heartrate is way higher than a normal child's so can be worrying for the uninititated and her normal temp is low (bordering on hypothermic!) so I get concerned when her temp hits 37. Some children with CHD are perfectly fine at 93% sats and no amount of oxygen will get them higher.

He doesn't sound well though - poor thing.

Just back from ds's appointment. The nurse took his sats whilst we were there and they were up to 97. He is pretty ill, so we are keeping an eye on him, and will get him back to hospital if he seems to be struggling.

The cardiologist did an ultrasound which showed that he has a duct in his heart which hasn't closed up, so he wants to review him regularly, and has ordered a 24 hour ECG. Ds has a possible diagnosis of a rare genetic condition, which can be related to heart problems, which is why he was referred to a cardiologist.

Thank you everyone for your thoughts, and advice.

I did a quick search after I posted this morning and realised I replied to you before on another thread. I'm assuming they've diagnosed a PFO or PDA which can be common in prem babies. Is the genetic condition 22q/Di George? [nosey]

Glad his Sats are a bit better

Yes, I found that thread! I think PDA was mentioned, but can't be sure as ds was screaming so much. I am going to email the consultant, and ask for a report.

He asked if ds was prem, he wasn't but he was in nicu when he was born with respiratory distress and jaundice.

The genetic condition that he is being tested for is Kleefstra syndrome (9q34.3 deletion). The initial test was negative, but his geneticist and the Kleefstra team in Holland felt he fits the syndrome so well that he is part of a study which is investigating novel candidate genes and the syndrome.

Right, people need to leave the nurse at your surgery alone as sats of 93% do not require admission or oxygen therapy. They are on the cusp but they are above the threshold and so no one would have done anything. The heart rate was a little high but could well have been anxiety related given it was recorded in the absence of fever. It's be something worth repeating at the time.

IV antibiotics should only be necessary in children who cannot tolerate oral antibiotics or are severely unwell.

There is a lot of misinformation and scare mongering being written here by people who clearly don't know what they are on about.

Hope your little one gets better soon.

They do require monitoring though!

Wouldn't fully commit to this without seeing the child, but you would not routinely admit a child for sats of 93%. Beds are scarce, if you don't need oxygen you don't come in. Admitting for what might happen is decadent.

which is why I said that I would want monitoring in A and E. I agree that some peoples reactions were over the top but at the same time I would expect at least a couple of hours in A and E with regular SATS checks just to ensure the situation isn't worsening.

How is he now, Hazy?

Erm...he did have a fever though. The OP said he has had a temp for 5 days.

A temp, sats of 93%, an elevated pulse, we don't know what his resps are but likely to be elevated. He is two and a half. Most importantly his mum feels uncomfortable and so has posted in the Internet.

Should really be seen by someone really, even if its just for reassurance.

Sounds like he's quite 'interesting' hazyjane (from a medical POV). I have one of those.

Hope he's feeling better.

Well,very briefly - we are in hospital,ds has pneumonia. We took him to a+e yesterday morning,and he was given a chest xray,put on oxygen and is having iv antibiotics. Hopefully we'll go home tomorrow,but they are a bit concerned about his o2 levels and think there is an underlying problem so want to do a sleep study.
Thankyou for all your advice, it was really useful. Ds has got a complicated medical history,and sometimes it is hard to know when to gear up and get into action,and when it is ok.

hope he is better soon x

Sorry to hear that, poor thing. Pleased you got him seen. My DS is a bit complicated too, so understand how you feel. These things always seem to happen at the weekend.

Hope he makes a speedy recovery.

"Right, people need to leave the nurse at your surgery alone as sats of 93% do not require admission or oxygen therapy. They are on the cusp but they are above the threshold and so no one would have done anything. The heart rate was a little high but could well have been anxiety related given it was recorded in the absence of fever. It's be something worth repeating at the time.

IV antibiotics should only be necessary in children who cannot tolerate oral antibiotics or are severely unwell.

There is a lot of misinformation and scare mongering being written here by people who clearly don't know what they are on about.

Hope your little one gets better soon."

Umm, well, when our child was 15 months, we took him to A&E with very similar sats (93%, tachycardic). He was given oxygen and an aerosol bronchodilator and then observed for a couple of hours. His sats were then 97/98% and they were still keen to admit him and only let us take him home after a period of observation to see that he was stable.

Although a child can have 93% for a while, it is very tiring and could easily dip to a dangerous level overnight. Where is it that they discharge a child with these sats?

Hope your ds is feeling better soon. I also have a 'interesting one'

Its really hard to know what's 'normal' for your dc that other children without said complications would obviously require urgent medical attention. Dd also has a funny heart rate, which presents with tacycardia & a murmer when she's even the slightest bit poorly. Some drs know this is normal for her. Others panic & rush us to ctu for no good cause. Other times when I've known something isn't right they've sent us home only to be rushed back in via a&e later.

Dd's temp is always stupidly low, anything above 37 & we start having fits. To top it all off she's allurgic to paracetamol!!!!

"Although a child can have 93% for a while, it is very tiring and could easily dip to a dangerous level overnight. Where is it that they discharge a child with these sats?"

All of several london Paeds Emergency Departments I've worked in.

Lots of children will desaturate at night without anyone being any the wiser - most children who snore will have this to a lesser or greater extent, a sleep study would let you know how low and how often. The sats are more useful as an indicator what is going on in the lungs and underlying changes as opposed to be directly "dangerous".

Sorry to hear that the child from the original post has now been admitted but I still maintain that the original management of this child by the nurse was appropriate.

But it wasn't right was it? The child has pneumonia.

You also had the wrong information...

'The heart rate was a little high but could well have been anxiety related given it was recorded in the absence of fever.'

The mum had said he had a fever for five days. The ob's suggested something was going on and there was. All the London hospitals I've worked in would not have sent them home without ruling out an underlying cause, which in this case was pneumonia.

Luckily the mum knew he wasn't right.

Thankfully there is a campaign to support parents in peads A&E at the moment after a too many parents have been sent home, despite their concerns, some with tragic consequences. The Royal London springs to mind.

Well done OP for going with your instinct, you know your child best

And also (just while I'm having a bit of a rant) part of a being a HCP is to provide reassurance, which this nurse obviously didn't do.

To leave the surgery & be worried enough to post on a forum suggests the OP didn't feel listened to or taken seriously. A failed consultation IMO.

Caring for a sick child, especially a complicated one, is daunting enough without dismissive or crappy attitudes thrown in.

Rant over.

To breakdown the original post:
"Ds just seen nurse at surgery, he has had temp for 5 days, she heard crackles in his lung and has prescribed abs. She tooks his sats and hear rate which were 93/130 (his temp was normal when she took it)."

Crackles in the lungs - indicative of infection, ie he has a chest infection or pneumonia
Fever was present for 5 days but the child was afebrile at the time of review.

The nurse made a diagnosis before discharging this child, and instigated treatment. The argument for IV vs oral antibiotics is a complex one but in theory the bioavailability of antibiotics should be good if taken orally in a child who isn't vomiting. Her diagnosis and management were appropriate, unfortunately the child's condition deteriorated further and they had to be admitted.

Who to admit and who to discharge is a complex process and won't always be right. If you admit too many "well" children you fill your ward and have to start treating and transferring from your A+E - this is inconvenient for parents and very time consuming, delaying patient care for all those in the department. Some children are discharged early in an illness and may well re-attend if they get sicker (bronchiolitis springs to mind) and some are inappropriately sent home.

Lots of parents are worried in A+E and it is important to tease out what exactly they are worried about and TRY to reassure them. Some parents are not easy to fully reassure and it can be time consuming and disruptive to spend an age with them trying to achieve this. I don't doubt that most patients who are admitted at a second attendance were worried about being discharged initially but the vast majority of those worried parents never need to re-attend.

Sorry to side track the thread but there seems to be a presumption that medical teams don't want the best for the children. Far from it, but we are equally aware that if we admit children who don't require hospital care we diminish our ability to care for the next child or the one after that.

We are home from hospital.

It is interesting how my op sparked off such a discussion!

I think the nurse at the surgery should probably have sent us to hospital, not so much because of his sats being at the level they were, but because of ds's history. tbh we saw a dr on Fri, who listened to ds's chest and did his sats - he said his chest was clear, and his sats were ok at 93. The next morning a chest x-ray showed that infection in both lungs, and a very thick white patch on his lung. And he needed oxygen, and IV antibiotics ( because he had had a course of amoxicillin, which hadn't worked, and he has swallowing/aspirating issues - something that I had mentioned to the nurse).

Usually with ds i have an instinct for when he needs to go in, but for some reason the nurse made me unsure of my instincts, hence my original post. We are well known at the surgery, and usually see the same nurse or dr, who know ds very well, and know what to look out for and always go along the lines, of if in doubt, call children's ward and get in, because he can go down very quickly.

My only gripe with the nurse (and the dr the next day) is that this is probably what she should have done, which would have saved us a night of sitting up listening to ds's breathing get steadily worse, and a 4 hour wait in A+E to get up to the children's ward.

sorry, just to add - re Fever was present for 5 days but the child was afebrile at the time of review.

The nurse knew that he had had ibuprofen an hour before we saw her, so that would be why his temp was down.

Glad you're home hazeyjane. As regards your wait in A&E;ask if the children's ward have a 'green card scheme' or 'open access'. This means that you can call ahead and go straight to the ward rather than having to wait in A&E. With ds's issues it may be useful. His paed should be able to sort it out.

Thankyou, we had open access last year, after we were sent home after a 6 hour wait in A+E with ds (again low sats, temp, chest crackles) on Christmas Eve, only to be admitted on boxing day with pneumonia. On that occasion the ward sister complained to a+e about ds having been sent home. But they only did open access for a sort time, ds has it again now, but again for a limited period.

I spoke to his gp today, and she agreed that everyone in the surgery needs to be made more aware (he is already red flagged) of how to deal with ds - ie - listen to me, do not rely only on his sats and what can be heard in his chest, and if in any doubt - get ds seen in children's ward straight away.

Hazy - although my DS is different from yours I have found that for anything to do with his chest (he has severe asthma) the GP is a waste of space and to go straight to peads A and E instead perhaps that would be an easy approach and just cut out the GP altogether?

OP I am relieved to hear that your dc in the end did receive the care he needed.

Inmyopinion1 Parents shouldn't have to fight and fight with the NHS to get decent care for their children. Parents who are less assertive, more obedient to doctors, may damage their child as it may not get the care it needs. This is why I have given up on the NHS for my children and only go private. Very expensive, but at least they get the care they need.