Children's A&E or Walk in Centre

[eyeczawikaivov]

9yo with a previous history of viral-induced-wheeze (needing hospital treatment, multiple incidents but all more than 5 years ago) clearly does have a bad cold & cough but might also be having asthma symptoms. breathing sounds dodgy and laboured but I honestly can't tell if it's just a ton of phlegm or if it's worse.

Have given 10 puffs of ventolin at 19:45, 01:30 and 05:15 - each time breathing calmed down enough to be able to sleep.

Now only 2 hours since last ventolin and cough is bad and breath loud and forced.

chances are it's just a bad cold so feels silly to worry but history when younger makes me more worried and I would rather be in the safe side and get him seen.

There's a walk-in NHS centre and there's a specialised Children's A&E - which would you go to in these circumstances?

A and E. If 10 puffs hasn’t resolved in 4 hours then it’s A and E

I would go to the walk in centre myself, they can make a decision on whether they should be seen at a&e or if it's just a case of needing some antibiotics. I would definitely get them seen today though!

I'd say the nhs walk in. But I think I'd call 111 first to see what they said.

A&E definitely. Dont mess about with breathing problems.

I'd go to A&E.sounds to me like he needs a steroid and saline nebuliser. If he is as bad and it sound like he is I would even be calling an ambulance to get the steroids quicker.

It maybe a cold but this is clearly asthma symptoms he is having and if the inhaler isn't working and he is having to have more his risk is very high which out weighs the wait you will have at walk in. If a child has an asthma attack in one day they need to be seen within 24 hours by a specialist nurse, GP. This is NHS guidlines.

My daughters asthmatic it's a nightmare. I hope you get him sorted x

A&E, my son was exactly the same at your age and the dr told me to bring him in every time he was unable to go less than 4 hrs between 10 doses of ventolin.

They get tired very quickly so please take him there.

The more I think about this the more I think you should be on your way to a&e.

The info below might help in the future. I count my son’s respiratory rate when he’s wheezy as that is a good indication of how good or bad he is.
We also have an oxygen finger monitor at home too. Like this:
www.medisave.co.uk/md300d-finger-pulse-oximeter-p-6895.html

Acute asthma may be classified as severe or moderate. Severe acute asthma is characterized by an oxygen saturation level less than 92%, a pulse of greater than 125 beats per minute (in children older than 5 years) or greater than 140 beats per minute (in children 2 to 5 years of age), a respiratory rate of greater than 30 breaths per minute (in children older than 5 years) or greater than 40 breaths per minute (in children 2 to 5 years of age), obvious use of accessory muscles (in children older than 5 years) or obvious chest wall recession (in children 2 to 5 years of age), inability to complete sentences in one breath (the child speaks 1 or 2 words), and being too breathless to feed. Moderate acute asthma is characterized by an oxygen saturation level of 92% to 95%, a pulse of 100 to 125 beats per minute (in children older than 5 years) or 120 to 140 beats per minute (in children 2 to 5 years of age), a respiratory rate of 20 to 30 breaths per minute (in children older than 5 years) or 30 to 40 breaths per minute (in children 2 to 5 years of age), some use of accessory muscles (in children older than 5 years) or some chest wall recession (in children 2 to 5 years of age), and talking in short phrases.

Definitely a&e. Even if it turns out to be a chesty cough no one would begrudge a child with breathing difficulties in A&E. Hope LO is ok.

Does he have an asthma diagnosis or not?
I'm not sure why you have ventolin at home if he last had an episode of VIW 5 yrs ago & no current diagnosis of asthma.

I'm normally the last to say A&E, but this time I think it'd be pretty reasonable to take him along. (Teenage) DS gets mild VIW but we don't have any ventolin at home for it.

I would see if your local area has the "wait less" app and see which department has the quickest wait time. What i wouldn't do is delay because as the day goes on the wait will increase.

You are right, probably just a bad cold but not worth the risk

A and e.

Always just go don't wait about. Asthma can go downhill so so fast and 10x ventolin is a huge dose equivalent to a nebulizer

10 puffs is no where near the equivalent of a neubiliser.

Hope he improves soon

10 puffs though the spacer is the equivalent of a nebuliser and our paediatric a&e will do that instead of a nebuliser. I also think it’s cheaper and easier for them and not as effective.

The moisture of a nebuliser works much better for my kids (both asthmatic in different ways so not a one approach fits all when it comes to asthma) so I now ask for one instead and explain why.

He needs to steroids by the sounds of things as in the last 24 hours he has had at least 3 attacks.. I would imagine that if he had a peak flow metre he would struggle to blow it

We got a taxi to A&E and were seen very quickly. He's having steroids and inhalers and the like so it seems this was the right call.

Thanks all for advice.

thanks for update.

@lljkk my son doesnt have an asthma diagnosis but has an inhaler for use when he has a viral wheeze. Not used often but occasionally. He was hospitalised twice but not for about 7 years. Wondering if we shouldnt have it?

I think it's great OP & Starry do have the ventolin (!)
I reckon DS has intermittant asthma, most typically triggered by mild viral infections, but we can't get it diagnosed because his underlying lung capacity is quite high; so when he is tested when well (always scheduled), he passes the puff test with flying colours.

I guess at some point DS could make a point of going to A&E every time he feels out of puff until he finally gets some kind of diagnosis, with regular prescription. We haven't been willing to do that.

Frustrating.

*mind you, even when DS says he's feeling breathlessness, he never stops talking about it, which suggests his puff isn't that badly depleted.

I find that bonkers @lljkk they won’t give you an inhaler. I think you should fight for one.
My eldest has diagnosed asthma and we have all the meds we need but my youngest has viral induced wheeze and although not diagnosed as asthmatic we still have inhalers on prescription for him. He gets wheezy here and there now he’s older and like your son functions well when he’s tested but we have also ended up in a&e when younger. He goes from doing ok to at his worst 89% oxygen. That was really scary. They just get tired.

My sister has chronic asthma and I watched her nearly die when we were kids so I know I am slightly paranoid when it comes to breathing stuff. So many times I watched her go from doing ok, holding her own and then suddenly going down hill really quickly. Now she’s an adult she’s likened her attacks to breathing through thicker and thicker fabric as she got worse and it being exhausting.

I’m not sure exactly what my point is here!! But OP I’m glad you were seen quickly. I hope all is well with you.

Hope you didn't end up being admitted.

We were in for 3 nights with DC1 and viral induced wheeze. Thankfully he's now a relatively healthy 6yo (he was 13m at admission) and has only ever had one other hospital stay severe dehydration after gastroenteritis

Just a little update to let you all know we are home safe now with a wheeze management plan, some further doses of steroids, a couple of inhalers and a new spacer.

I have no idea why any organisation would have a policy to only prescribe ventolin if asthma is officially diagnosed. We are able to have ventolin due to there having been occasions when ventolin was needed in the past. Ventolin saves lives as we all know.

Getting DS officially diagnosed may follow now. They wouldn't give him a diagnosis before because all previous incidence of any kind of serious symptoms was before the age of 5. That never stopped us being able to get repeat prescriptions of the meds for management of milder symptoms that have cropped up from time to time but are inconclusive for diagnostic purposes.

Yes @lljkk I think my son is similar. He has spent his whole life with a cold and runny nose! It wasnt until he was 7 that he ended up in hospital and then again just after that. He was diagnosed with viral induced wheeze and has had inhalers since then which he needs occasionally. He is very reluctant to use them and so you know that when he does he is really feeling like it. My mum says he has what was known in the old days as a "weak chest"!!

Glad you got him seen and treated op
I’ve had my son treated with saline/steroid neb together ventolin & atrovent yes.

Asthma uk do some really good wheeze plans my son uses for school and at home I regulate at home due to my job (paed nurse) and decide when I feel he should be seen but quite a low threshold due to what I see at work, I’d never leave him if I couldn’t get 4 hours between multidose it’s quite scary even for me to see how quickly he can become unwell and it’s been cold after cold this winter which sets him off and he’s well controlled otherwise which is a pest.

Usually after a hospital admission they will alert your gp and you should go and see the nurse or gp within a week of any wheeze/exacerbation to access why it happened if they need any meds tweaked and plans changed. It might be they’ll start him on a preventer