To go to A&E

[Mushroo]

I’ll preface this my saying I’ve never been to A&E in my life so I’m absolutely not a habitual user, and very much in the ‘don’t waste resources’ camp.

However, my daughter has developed a swallowing problem. It started around March as coughing when she ate.

We’ve seen the GP who started out saying her chest was fine, it’s just viral.
We’ve seen a private respiratory doctor who thinks it’s asthma, but steroid and inhalers haven’t helped.
Weve seen an NHS paediatrician who did a chest x ray, she had a chest infection which antibiotics cleared up, but the cough when eating has gotten worse.

It’s got to the point this week she can’t eat at all without coughing / vomiting.

We’ve been referred to a speech and language therapist but the waitlist is at least a month.

Im so worried as she can’t eat comfortably and there’s no pathway to help at all for months. I’m worried there’s something in / wrong with her oesophagus, would going to A&e be wrong?

I can’t sit and watch her vomit everyday for at least a month

To me, that comes under the 'emergency' end of things, so I'd bring her. She can't not eat for a month. Is she able to drink at all?

Also, I'd wonder if the chest infection had been caused by the swallowing issue, rather than the reverse.

Yes, I would take her along and ask them to have a look.

Gosh what a worry, if it’s every day then yes I would go to A&E. How old?

She’s 18 months but before this all starred has always been a brilliant eater. It’s so sad watching her cough through trying to eat her favourite foods

Has she been checked for reflux?

Yes, take her.

Especially at 18 months

Yes get her seen by whatever means you can! Is it worth also making another GP appointment now other things have been ruled out? You might get a better GP this time

We saw them again yesterday and then just said to wait for the speech and language referral.

I chased them this morning and got told it would be at least 5 weeks which is what has prompted desperate measures, as I just don’t feel we’ve made any progress at all, and no avenues to making any progress either.

Ah, she's only tiny. Absolutely take her. Is there a kids' A&E where you are? We have a separate waiting area and process in our local one.

Bring her buggy and lots of entertainment, screens and headphones if that will help keep her content - it could be a long wait. I'd say snacks and drinks, but that's complicated for you! Is there anything she has less trouble with? Supplies for yourself too - and a power bank if you have one. Dress her lightly, it'll probably be roasting.

Definitely at that age if shes struggling to eat

I'm not sure how helpful A&E might actually be? Ours seem to either admit patients to wards, or patch them up and discharge them - not refer on for longer term issues. Though I totally agree she needs to be seen & dealt with quickly!

Could you try for a GP appointment again? Video what happens when she eats, over a few different favourite foods. They can't simply leave an 18-minth-old barely able to eat anything for a month.

It's absolutely not feasible to let her wait that long.

I would go and ask them to check her throat. It sounds to me like the difficulty swallowing could be the cause of the chest infection not the other way around.

This is kind of my worry, but I’m hoping they’d at least maybe triage us for a endoscopy to see if there’s something going on in her throat?

At the minute, I just feel a bit lost as we won’t see the SLT for 5 weeks, I assume the first appointment with be ‘fact finding’ / watching her eat, and then we’ll have to wait from there to actually find out what’s wrong, so realistically, it’ll be months!

I will push the GP again as it does seem ridiculous.

She is eating enough for now as she absolutely loves food, but coughing / gagging away throughout the meal and I’m completely on edge she’s going to vomit.

As she is already under the care of different teams, it's highly unlikely they'll do anything unless she is choking or it affects her eating so badly🫢, she is loosing weight or getting dehydrated.

An A&E doctor won’t make the decision to scope a one year old, especially as it’s an ongoing issue that you’re already under a paediatrician for.

If you feel it’ll help go, but I think you need to manage your expectations slightly, I think it’s more likely they’ll check her over have a look in her ears and throat and say follow up with the specialist team.

Yeh I’m worried we’ll just get fobbed off! She isn’t dehydrated and hasn’t lost weight, but she’s starting to eat a bit less than usual and i think it’ll only get worse the longer we leave it

I’ve messaged the GP (again 🙄) and will see what they say before I go.

OP I work with adults - but as a SALT I'd be really flagging up that she is coughing and vomiting on ALL meals, any weight loss or dehydration and getting her to A+E if her intake's starting to fall off. Plus as well if her chest health starts to decline - that's another big red flag in my population. Paeds SALT is a system barely holding together though compared to my niche area!

Worth getting a feel of WHEN the coughing starts during a meal as well, plus how long it goes on for after meals and anything that makes it better/worse. Possibly video some of it so that you're not there trying to describe or perform an equivalent cough as well! Possibly start a bit of a log of what she's eaten, when, and if she coughed at all during it - whether it was on food or fluid - cut out some of the initial information gathering stage of the process.

A child who can't eat without coughing/vomiting should be in A&E. Take her.

@TorturedParentsDepartment that’s really helpfull thank you. I have taken a few videos and collated details.

With water is usually the first sip.

Shes generally ok with milk / weetabix but now anything more textured it’s like it’s gone down the wrong way after a few bites and she has to cough / gag / vomit to get it out.

As soon as she’s not eating she’s absolutely fine, so I don’t think it’s reflux as that would linger a bit? It’s definitely the actual swallowing that’s the problem.

Whenever she gets a cold now she instantly gets a cough, and as someone said up thread, I think maybe this is causing some chest infections.

It’s so confusing because before March (and when she had no teeth as a baby!) She could eat anything no problem! We used to laugh as when she was about one we went out and she ate more pizza than I did 😂)

Right, seeing the GP this afternoon. Not sure what I’m expecting really but will see how it goes…

Has she been checked for tongue tie? My daughter was similar, she was given meds for reflux. It turns out she had quite a severe tongue tie that wasn’t picked up until 2 years old. Good luck

Show the videos to the gp

Having read your update that she can keep milk and weetabix down it doesn’t sound like she’s fully going without / is dehydrated so while I would say go to a&e prepare for them to say that she’s not in any immediate danger because she can keep some fluids and food down, isn’t choking, can breathe etc they can’t hear any obstruction and to await the referrals

in my experience they don’t triage you to a different department in a&e it’s either admit you for immediate treatment or discharge and ask you to follow up with GP

Personally I’d be explaining the the GP that you are not satisfied and you want an Ent referral urgently

@Amba1998 thank you, I’ll push for that with the GP