To be upset at A&E fobbing off my toddler?

[IWineAndDontDine]

I hate to be that person. I acknowledge they are overstretched and understaffed but I'm concerned about my daughter. Shes had diarrhoea for 3-4 weeks since covid. Lost her appetite around then, its got to the point she is probably eating 150 calories a day if that. Just a couple of mouthfuls of food. She's not herself, she looks gaunt, her eyes look sunken, she's gagging constantly as if she's going to throw up and occasionally does throw up. She's been warm for over a week. We haven't tested her temp with an actual thermometer but she's been clearly warm to touch and sweating. Just gradually getting worse since covid.

We have been told by everyone covid symptoms drag and drag so we kept thinking she would improve, but I just looked at her this morning and thought, this has gone on too long, you look super poorly and malnourished, so I called gp (my husband gets a private gp line through work). He said he wouldn't wait and get her seen before the day is up.

We took her to a&e as per drs orders and they checked her temp which was, 39.6. Checked to see if her tummy was tender, checked her lungs with stethoscope, and that was it. Said they weren't worried so long as she was drinking. Said the temp was worrying but only if it goes on for 5 days and as we havent tested properly they werent going to count it, despite it being over a week since we could feel she was clearly warm. No tests, no bloods, no advice. Am I being a paranoid mother? Have we been fobbed off or is this all I should expect from an a&e visit?

Are you giving any meds?

Why didn't you check her temp?

Has she had calpol and nurofen alternated?

If she felt a bit better with some calpol she might eat.

This is basics really, have you done any treatment yourselves or seen a pharmacist?

Well what they’re saying is she’s not in imminent danger. They can’t take your ‘she’s feeling a bit hot and sweaty’ as a confined fever. A&E is not the proper place for this. I appreciate sometimes we need support on a Saturday but out of hours GP (as in NHS) would’ve been more useful and if you don’t have an accident or an emergency then call 111 and get triaged. Out of hours GP can do blood tests if she needs them. You haven’t been fobbed off, but they can’t just admit you to a paediatric bed if she doesn’t meet admission criteria.

I trust they also checked her throat? Gagging and poor appetite can go along with tonsillitis, and there's a lot of that about. Also worth considering going dairy free for a couple of weeks, as secondary lactose intolerance is common after a bug, and tends to show as diarrhoea dragging on. Doesn't really sound like bloods are indicated, though personally I'd have done a urine test.

Hi, I had a phone consultation with an out of hours gp. They told me to go to a&e.

Is she drinking enough and how is her urine output ?

You’ve been unreasonable not to consult GP earlier, or monitor & treat temperature etc. I can understand why a&e were a bit off that you’ve not used different options available to you earlier in the illness and are then expecting them to rush to it now you’ve finally decided to seek medical support and, having ignored symptoms for over a week have now decided the same symptoms are an emergency.

HOWEVER, if you are really concerned, then go back. I was listening to some parents talk about sepsis earlier this week and how they were too easily dismissed at a&e. Parental instinct is important. Your dd does sound poorly so do go back if you feel it is needed.

Does she play or is she lethargic? Is she drinking enough fluids? I would follow up either with the GP on Monday (face to face if you can get it), or go back to A&E if you really feel something isn't right.

She’s been ill for four weeks, had what you think is a temperature for a week and you’ve not taken her to the GP or checked her temperature during that time? A&E is for accident and emergencies not for people who has decided on a Saturday afternoon that after four weeks their sick child now needs attention.
Get a thermometer and call the GP on Monday is she’s still unwell.

Out of hours private GP is not an out of hours GP led centre where they see you face to face. He sent you to A&E because he couldn’t do anything over the phone.

What do you want them to do though? You presented with a child who was not in immediate danger and was presenting with symptoms that can all be managed at home.

Why wouldn't you take her temperature properly? Over the years there have been times when I've thought DD "felt hot" but when I actually took her temperature she was within the normal range or maybe 0.1 into fever range but then as soon as she had Calpol she was back to normal range. So of course the medical professionals are not going to take "she's felt a bit hot for a while" the same as "She has been showing a consistent temperature of a minimum of 40.1 for the last three days even when given Calpol at regular intervals" one is purely subjective and the other has actual measurable values.

So she's been sick for 4 weeks, you've not taken her temperature so you don't know what it's been, and today you've decided it's been long enough?

Call 111, tell them everything the doctor said at A&E and see if they think there's something else that should have been done. If so, they'll get an out of hours appointment. It doesn't sound any more of an emergency than the last week, or 4 weeks.

I have been treating the temp. Which has been coming down. I took her temp back when we were in the depth of covid but calpoled her and kept bringing it down so wasn't worried, we just haven't kept track of it for the last week or so as it kept coming down with calpol and I don't need a thermometer to tell me its the same as it has been. I don't think it's fair to say we have ignored symptoms, not eating isn't an issue for the gp at 1 week post covid, not eating is more of an issue 3 weeks post covid. So we phoned the gp, which is an option available before a&e, and only took her following advice for Dr.

Agree with the rest, that's my worry I guess. I don't have 5+ years of medical experience so it's hard to argue...

I’m answer to your question, yes you are unreadable for being upset or even thinking that A&E have fobbed you off.
More investigations may well be needed but A&E isn’t the place for that to happen. Your GP may suggest a stool sample for diarrhoea that’s lasted that long, for example. Or they may do bloods to check for anaemia since she’s been tired and withdrawn. But A&E aren’t there to do these tests. They’ve evaluated your daughter and since she is not acutely unwell or deteriorating you’ve been sent on your way, as you should be.

How do you know her temp has been coming down if you haven't been taking her temperature?

It’s very important to carefully monitor temperature in young children because often that’s the biggest indicator of whether something is seriously wrong or not. If a toddler has a high temperature that comes down with paracetamol and ibuprofen it’s less likely to be something very serious like sepsis or meningitis. (Although a very low temperature can also indicate sepsis). If they don’t have any other signs of infection and the fever comes down with painkillers they generally wait and see if it passes and it generally does - usually a virus. Get yourself a working thermometer and monitor their temperature every few hours. Then you’ll be in a better placed position to advise A and E if you do have to return.

If your toddler is drinking lots and the temperature comes down with paracetamol and ibuprofen I’d be reassured for now. But if not then back to A and E you go.

If I were you I’d look out for signs of sepsis. Primarily because I wouldn’t trust A&E to pick up on it. I’ve read too many stories about sick children visiting A&E only to be fobbed off when they were desperately unwell.

You’ve been giving her calpol for four weeks and at no point sought medical advice until today?

So YABU that these symptoms have presented themselves for 3 weeks but now on a Saturday you've decided it's urgent and are annoyed the ACCIDENT & EMERGENCY department isn't jumping to attention.

You can't know your child's temperature by feeling them, the room you are in and your own temperature at the time will affect what you think it is. There are too many variables for it to be accurate.

After 4 weeks it’s not sepsis. There are no new symptoms or deterioration.

sepsis acts very quickly and you’d know after 24 hours.

the child isn’t “desperately unwell”. If it could wait 4 weeks it can wait until Monday for the GP.

Calpol for four weeks for a “temperature” without actually monitoring the temperature, no deterioration in that time but somehow jump from doing absolutely nothing to them needing A&E?

It doesn’t make sense.

THIS! If anything you’ve massively neglected your DDS needs by not even checking her temp and not medicating accordingly. You absolutely cannot tell by using the back of your hand. The fact you’ve waited this long to then call a GP on a Saturday is appalling. Your poor DD!

No this isn't an A& E sutuation. It's not an accident or an emergency. You have had three weeks to get this sorted put and get treatment for your child.

somehow jump from doing absolutely nothing to them needing A&E?

She contacted the GP who told her to go to A&E