To take my DD to hospital

[Pandon]

Posting in here for traffic, just hoping someone might have insight or a similar experience. For the past year DD (4) has had episodes of low blood sugar which we’ve only caught because her dad has Type 1 Diabetes. We were referred to a paediatrician in hospital who did a fasting test but everything they tested came back okay, however, they told us these episodes weren’t normal and were discussing the next steps (this was about 6 months ago). We were supposed to be referred to an endocrinology specialist however the appointment was cancelled and we were re-referred back to the paediatrician over Christmas and haven’t heard anything yet. Now, in the past 2 months, DD has started complaining about “stomach” pain just by her belly button after she eats and every so often wakes up with severe stomach pain and throws up. We did take her to the GP for this thinking possible appendicitis but GP just told us to keep an eye on her. On Sunday, DD had another episode of low blood sugar, with a reading of 1.2mmol/L and tonight she has woken up with severe stomach pain and vomited twice. I feel completely helpless. I googled her symptoms because of where the pain is and have gone down the rabbit hole of insulinoma/pancreatitis/pancreatic cancer and now I have worried myself. We’ve been waiting and waiting for further tests and referrals but everything seems to take months of me chasing to even sort out. I think what I’m trying to say is, AIBU to take my DD to A&E tomorrow and ask for tests? Or should I just keep pushing with the GP and the paediatrician?

Thank you in advance for any advice

Go. Your instincts deserve proper consideration.

I'd ask for her cortisol to be tested

Low blood sugar goes hand in hand with low cortisol.

Low cortisol can also cause d&v

Take her to A&E. If it’s the only way to get her chef, then it’s the only way. She can’t be left to suffer, it must be so upsetting for you. You need to explain the history and explain you’ve taken her in as it’s getting worse. Constant bouts of pain and vomiting needs to be seen to. Have they tested her for any types of bacterial infections? My Mil was vomiting for 6 months with stomach pain until she finally found out what it was after they tested her in A&E (it was some kind of campylobacter!). Could the low blood sugar be related to the vomiting?

It’s neither an accident or an emergency. It’s a Gp referral situation.

AIBU to take my DD to A&E tomorrow and ask for tests?

That's not really how A&E works

A&E will treat the emergency then refer you on.

If type 1 diabetes was suspected, they would stabilise then admit to paeds straight away. Because type 1 diabetes appears to have been ruled out 6months ago, I expect they will discharge and tell you to follow up with GP or clinic.

The only thing that would change it is if your DD now has high blood sugar. She could be in honeymoon stage of early diabetes and the fasting test would show something different if repeated now.

Is her sugar high when she throws up?

Sorry you are experiencing this, the delays are horrible and you are not unreasonable to be extremely frustrated.

A&E As soon as you can.

It could have nothing to do with diabetes, insulin and what not. Could be as simple as an strangled umbilical* hernia. She needs to be urgently physically examined.

“Occasionally, an umbilical hernia can become trapped (incarcerated) and/or the blood supply cut off (strangulated). Symptoms of an incarcerated or strangulated umbilical hernia include:

Pain and tenderness around the hernia’s bulge
Nausea and vomiting
A change in the colour of your hernia

If you or your child has any of these symptoms, seek urgent medical assistance. Incarcerated hernias and strangulated hernias are serious complications which can cause severe pain and damage and require emergency treatment.”

*umbilical refers to the belly button. These hernias happen right behind the belly button.

I'd maybe see if the GP can refer for same day medical review at the hospital first. Ours admit straight to the children's after speaking with the paeds registrar. It's like a medical ambulatory care unit. It'll be tricky for the ED to 'do tests'... of course they can refer to the medics, but if the GP can do that it'll save you a ridiculous wait.

If you're really worried I'd take her now while she's symptomatic. I said YANBU but if you're not worried enough to take her now it's not really an emergency.

I think a strangulated hernia is a big jump! Especially given that you’ve not mentioned visible hernia!
You’re right, the episodes of hypos are very concerning and she should have a cortisol checked if not done already but a&e isn’t the right place. She needs to be seen by an endocrinologist.
It might be that the vomiting and abdo pain is related, it might not. I’m sorry you and your DD are going through this, I’d be so worried. Can you go back to your GP tomorrow?

To echo @Maryandherlamb there might be a rapid access paeds clinic she can be referred to for bloods and work up quickly.

Have you considered if her symptoms fit with ketogenic hypoglycemia? It sounds very similar to what you've described.

Have you not seen/read how completly swamped hospitals are? A+E wait times of up to 24 hours, some patients waiting almost a WEEK to then be admitted for tests/treatment due to lack of beds? Or how long the backlogs are for even "2 week wait" suspected cancer referrals, actually being months or longer due to how long lists of people needing the tests/scans etc are? My Mils husband needs an urgent surgery on his spine, he could literally drop dead any moment his condition is that serious, yet there's no apppintment in sight because of how understaffed and backlogged everything is.
Your daughter isn't going to be pushed to the front of the VERY long queue because you take her to A and E, they won't just do all the tests then and there. I'm sorry to hear she's ill, but you need to wait your turn, and go through the right channels e.g, your GP. By all means be a thorn in their side about it, but be aware they are massively over worked and understaffed too, with more patients than they can actually care for, and hundreds wanting the very few available appointments. The NHS is a shit show currently, could you afford a consult with a private GP.

I think a strangulated hernia is a big jump!

1 in 5 children under age 5 have an umbilical hernia. Complications are rare, but the symptoms match up and so best to be checked by an A&E doctor.

I think it is a bigger jump to connect low blood sugar on Sunday to her symptoms on a Wednesday morning. Especially since low blood sugar doesn’t cause the symptoms reported at all

As a reminder, the symptoms are “pain just by her belly button after she eats and every so often wakes up with severe stomach pain and throws up.” or pain so bad it wakes a child up: “tonight she has woken up with severe stomach pain and vomited twice.”

pain just by her belly button: exact location of an umbilical hernia…which 20% of 4yr olds have.

after she eats: yep, because an umbilical hernia involves a bit of small intestine protruding through the abdominal wall so you’d feel pain after eating.

severe stomach pain: if it’s strangulated the pain is quite severe, and the girl isn’t exaggerating as it’s pain bad enough to wake her up from sleeping.

vomiting: check. This also causes nausea and vomiting

only thing missing is the physical bulge of the hernia which can be as small as a pea or hiding behind an “outie” belly button.

I highly recommend child see an A&E doctor for a physical examination. This could be an emergency situation. Better to get checked out than not.

If you think it's an emergency go to a and e now. Prepare for a wait. Otherwise on the phone to GP first thing for a same day appt. Hope she's feeling better soon.

Thank you to everyone who has taken the time to reply and offer advice or kind words x

I did try to reply to everyone individually but I keep messing it up.

When we originally noticed the low blood sugar episodes the GP had a blood test done that showed low cortisol, which was why he referred us to the paediatrician. However, the paediatrician said the test wasn’t done under the right circumstances so the result didn’t count.

DD doesn’t have high blood sugars when she throws up and I’ve never recorded a high result from her so I don’t think she’s presenting as pre-diabetes or in a honeymoon period.

I was extremely worried before (hence the post) but since vomiting DD has said the pain is only a little now and has managed to go to sleep

I will be contacting the GP first thing and asking if we can get an urgent referral. I do understand how understaffed, backlogged and swamped the nhs is, but I will always do what’s best for my daughter. Unfortunately we cannot afford to go private.

I'm not sure about a strangulated hernia, as she doesn’t have pain if I press on her tummy and I can’t see any signs of a bulge, but I will definitely bring it up with the GP. I only linked the low blood sugar episode with the stomach pain as that is also where her pancreas would be.

Thank you all again, I’m going to try and sleep and ring the GP when they open.

@Onnabugeisha thank you. I didn’t actually connect her low blood glucose on Sunday to symptoms on a Wednesday.
as the OP said, these episodes of abdominal
pain have been intermittent over the last 2
months, further making a strangulated hernia unlikely.
If all episodes of fleeting abdominal pain and vomiting were thought to be incarcerated/strangulated hernias then A&E and the surgeons would be very busy indeed!
As I said before, a very big jump indeed to reach that conclusion!

FWIW, anyone I’ve ever seen with a strangulated hernia is sick sick sick!

@Pandon she should have a 9am cortisol test as cortisol level varies throughout the day but should be highest in the morning. If it’s a good level at 9am then you can exclude adrenal insufficiency. A random cortisol on its own is not particularly helpful.
Good luck today, there should be a way for her to be seen urgently by paeds within the next couple of days. Let us know how she gets on.

Check her blood sugar 2-3 hrs after eating. My daughter developed hyperinsulism at 4 yrs. her first symptoms were stomach pain, then she would vomit and then seizures. It would be at night, as she had not eaten and was having hypos. It could be she does have a hernia but a blood sugar challenge as well. Agreed cortisol test. Def seek advice for the hypos as urgent - these scores are damaging long term if continue.

Ds2 had a strangulated hernia when he was 4 (the health visitor and GP had repeatedly said his umbilical hernia would right itself even though it was getting slowly bigger but that's another story). He screamed the house down in pain.

how are you checking her blood sugar?
is it an adult tester?

No offence but this is a child that has been unwell for months. The OP shouldn't have to pay privately to have a child seen regardless of the wait times for everyone else!

OP have you kept a good diary? Type 1 diabetes is an autoimmune disorder it's not a massive reach to question if she has an intolerance causing the vomiting if autoimmune conditions are in the family.

I would ring for a same day GP appointment even if I had to lay it on thick about how unwell she has been overnight

No, it doesn’t make it unlikely. Episodes involving an umbilical hernia can be intermittent in young children because often the hernia moves back inside the abdominal wall and the pressure on the bowel is temporarily eased off. Then the bowel protrudes again, and the symptoms start up again.

It’s only a ‘very big jump’ to someone who doesn’t know the difference between presentation in a 4yr old vs a 40yr old.

Exactly. This is textbook.
Hernia bulges, the child has pain after eating and vomiting and then sometimes the hernia temporarily moves back inside and the symptoms ease off, until the next time it bulges through and the symptoms start up again. Then, eventually the hernia doesn’t go back and becomes strangulated.