GP won’t see 4yo for 2 weeks [Title edit by MNHQ - Please read beyond the OP before responding]

[trombolese]

Hi, just need to get an opinion on what people would do in my situation.

Some background on my 4yo - severe silent reflux from birth which meant awful awful sleep and feeding. This went undiagnosed for 7 months which then led mega tonsil problems, golf ball size which then caused severe obstructive sleep apnea. Tonsils out at 2.5. Grew back 5 months later to full size, if not bigger (didn’t think possible, consultant at Evelina said she’d never seen it happen that quickly) - constantly infected, had them out again at 3.5. Never weaned properly due to feeding issues, always bad with food. Quality of life crap due to tonsil problems. Since having them out it has only very mildly improved to be honest. He has also suffered with constipation the past year due to poor diet.

Since beginning of October he has had a fever at least once a week, sometimes explained, sometimes completely unexplained. The longest he has had fever for is 8 days with no other symptoms. GP not interested and said these things happen (we have 2 other kids…it doesn’t happen). So many lots of antibiotics, a couple of long lasting chest infections and since November an ear ache that hasn’t gone and he is still suffering with today. Yesterday he spiked another fever of 39, no other symptoms but sent home from nursery. He barely eats a thing, some days he will only eat 2 squares of toast. The rest of the day he drinks like a fish, just water other than 1 x cup of milk before bed and sometimes 1 x in the morning. He’s lost about 3kg so far. He’s so so unbelievably pale, puffy eyes and big bags under his eyes too. He’s recently taken to crying a lot. A lot, a lot. Over things very trivial to the average person but these crying episodes can last up to an hour. He’s extremely irritable and sad. He seemingly can’t walk longer than about 15 minutes without complaining his legs are hurting loads (to the point where he will just crawl along the floor instead if we let him!) and more recently he is waking in the night complaining of itching. His tiredness and lethargy some days is another level.

Seeing as this is his 10th fever in as many weeks (I am keeping a diary now) I contacted the GP with a massive list of his symptoms as I am now actually really concerned. They can’t see him for 2 weeks and have told me to “contact the HV” for advice in the meantime. What advice can they possibly give?! I am really concerned he is lacking something important in his diet or god forbid, something even worse.

AIBU to call 111? Do I take him to a&e?! This just seems crazy now. He has missed so much nursery and it just breaks my heart that his QOL is so shit.

Go to A&E i'd be querying diabetes

Sorry just seen your previous update, you are in the right place.

Our GP policy is of a high fever for i think its 4-5 days for under 5's and no other obvious symptoms (cold/cough type thing) and no cause they can find (infection), they send us up to paediatric triage. This is obviously if the child is unwell with the fever.

Its a bit of a pain as it has meant a trip i could do without. But its a good policy. I'd be phoning my GP Practice and demanding he be seen. I wouldn't care who it was by (my favourites are the paramedics at our practice) but by a qualified medical professional. Depending on how well he is see if it can wait till monday call then insist on a same day appointment. Use some good buzz words. High fever for 4-5 days. Worried about infection. Dont talk about the long term stuff. Talk about the immediate stuff as if you talk historically they'll think it can wait. So talk up current symptoms.

Go in with a history and also say you want further investigation (blood work would be a good start). Insist and also if they refuse ask their reasoning. Then explain yours.

If not i'd consider A and E as a last resort. If hes not in immediate danger they'll likely fob you off though.

In my experience, with a baby less than 1yo they will make an effort to see them, but beyond that (I live in England in Hertfordshire) it's a struggle to get any face to face time. How they expect to evaluate a child presenting with an acute issue after several days over the phone escapes me entirely. I've written to my MP about this, with a predictably lacklustre response

Shockingly bad advice. He's too sick to wait till Monday.
And she's in a and e.
Because he's too sick to wait.
She's way past explaining politely or buzz words.

Agree with others - would get kiddo in front of a paediatric doctor- let them check over for serious illness. If the paediatrician tells you that you shouldn’t have come in, tell them how mortally worried you are/have been and that your GP couldn’t see your DC for two weeks.

OP I'm a GP. The throat infections are unfortunate but in themselves wouldn't worry me massively as it's quite normal (although admittedly bloody frustrating) for kids to get repeated infections at this age. However the big red flags for me are the leg pains especially if they're this dibilitating and the weight loss and the randomness of the fevers. These can be a sign of something more sinister underlying. I would be highlighting these things to 111 and the GP receptionist and insisting that the receptionist relays this to the GP on call.

If appointments are gone they're gone. Everyone has a limit to what they can do in a day unfortunately and this is sadly the state of things. However, I'd be asking the receptionist to be completely open with you on the best way to get an appointment. Are appointments released in person at the reception desk if you go to the surgery just before opening? If so I'd be doing this on Monday.

If you're going to seek out of hours help I'd just take him to A and e tbh and make clear the above concerns and insist that it's at least discussed with a paediatrician before you leave. It could be then that even if they don't admit him he's given an urgent appointment in their outpatient clinic. A and E is the only place that will definitely have easy links to paediatricians. Walk in centres not so much hence why I'm advising A and E

You shouldn't have to be doing this but I'd also keep track of his weight so that you have quantative evidence of his weight loss and I'd check his neck, under his arms and his groins for any raised lymph nodes and voice concern about these if there are any

If the worst comes to the worst just take him to A and E. It's the only safe thing you can do

3kg of weight loss in a 4 year old is huge, I'm surprised that alone hasn't got attention. Insist he's weighed by whatever clinician you next see.

Your gp is crap btw. Mine has an online system and they ring you back very promptly, ive never yet not got a same day appointment for a child.

So glad you took him in OP. Hope you get some answers and he starts feeling better soon.

I think you made the right call, my sister had leukemia as a child and the doctor kept fobbing my mum off.
One day she went back saying I think my child is dying in tears.. My sister literally was pale, covered in bruises and constantly had a temp.

Doctor fobbed off again but my mum said she wouldn't leave until bloods done and that's when the doctor told her my sister had cancer.
So yeah I'm of the opinion if you think something is up trust your gut and get it checked out. Luckily my sister survived but I never can fully trust the gp now.

Im glad you've gone to A&E. I would also tell them your doctor is shite. It is not normal for a healthy 4 year old to fall asleep at 3pm amongst everything else you have said. Sound like he is lethargic due to lack of food and other issues. The itching would worry me too. Keep us updated

This is one of the main reasons why our A&Es are so busy. People who should have been seen by primary care and then referred to specialities (urgently or not) are ending up - and understandably so - in A&E as it's the only remaining option.

This is NOT a criticism of the OP, it seems to me that you have been left with no choice. Just voicing my despair over the state of the NHS. I hope your little one is seen soon and they get to the bottom of what is going on.

Sending you hugs and praise for being so proactive and on the ball....you can't mess around with little ones. My son has recurrent uti's and after being on the 4th antibiotic in a row (a new one each week because it wasn't clearing) I took him to a&e and demanded he at least have a blood test to check his kidneys as his protein reading was off the chart. I had an amazing experience with 2 very compassionate doctors who listened to the whole history (a years worth) and my concerns. We had bloods which were reassuringly OK and a plan put in place which included scans and referrals to urologists. We are still going through it all and yet to fully find out a cause but the prophylactic treatment is keeping things at bay. Sometimes you have to fight a little.
I hope they listen to you and I truly hope he is OK. X

I am glad you went. The pale stools and itching are a definitely red flag for liver issues.

I was hospitalised for obstructive jaundice in December and (on top of pain) the key signs for me were pale stools and all over intense itching. My liver enzyme levels were through the roof (upwards of 30 times the normal upper readings), including bilirubin, although I didn't have the typical jaundice yellow skin/eyes, so them being absent does not indicate there is nothing wrong.

I hope it's nothing, and will be thinking of you. But it's definitely better to be checked out sooner rather than later.

Similar to @Candyflosscrochet we also had to go to A&E and demand a blood test (and 2nd, 3rd and 4th opinions) before being admitted to PICU and getting a diagnosis (we also had recurrent UTIs here as well). I say always push if you feel something is off. I hope you are getting on ok in A&E and fingers crossed you get to the bottom of it all soon!

I'm so sorry you're little boy is so poorly. I hope you get some answers now

Extreme thirst + loss of appetite and weight loss could be symptoms of type 1 diabetes. Please mention this to whichever doctor you see and make sure they check his blood glucose levels. Urine levels may not give you the whole picture.

@trombolese your child needs a full work up. Itchy at night etc check liver function.
you need full labs to see if there are issues eg liver function, kidney function, infection markers, h pylori, blood count, endoscopy to see if any anatomical reason for not eating. What about the adenoids? Does your child need gromits?

they need to be seen by a paediatric consultant and fully worked up. It’s probably just something that is being masked by assuming they have bugs regularly. Once u find it they’ll probably feel so much better. Good luck.

I would take him to the walk in. Just as a side note apparently scabies are rife at the moment so might not be linked, but you would soon find out when you start itching.

So glad you’ve taken him in. There could be several things going on here. He needs a proper check over.

Bless him hope you get sorted xx

Good, I’m glad you’re at A&E. fingers crossed you get some answers.

Take him to A and E, he needs a blood test

He needs to be seen by a paediatrician