Unfortunately, we have all heard the heart-breaking stories of babies and children sent home from hospital, parents told there is nothing seriously wrong, only for that child to suffer a devastating and critical infection, suffering loss of limbs or life.
The difficulty in diagnosing children
Diagnosing children is difficult, the problem for medical professionals is that young children and babies cannot verbalise and tell us what is wrong, or where it hurts, and so an exact diagnosis is not easy. A lot of childhood illnesses have similar symptoms, high temperature, lethargy, reduced appetite, some illnesses are minor and some are extremely severe. For medics, this makes diagnosis much more difficult, a frightening additional risk and complication, is that young children can deteriorate rapidly and in some cases are symptom free until they are critically ill.
The importance of PEWS
There are tools to help clinicians diagnose serious infection or illness in children. Paediatric Early Warning Signs (PEWS) allows clinicians to identify those children who are at risk of rapid deterioration and serious illness. Checks on heartbeat, pulse, temperature amongst other factors are all taken together to provide a score, and a raised PEWS should alert clinicians that something may be wrong and that the child should be assessed within a certain time.
A New tool for spotting deterioration in children released for roll out in England
The ultimate aim of the PEWS is to support better health outcomes and ensure deterioration and acute illnesses in Children and Young People (CYP) is escalated and responded upon quickly.
Studies have shown that caregivers are often the first people to spot changes in the health of their child, even when surrounded by doctors and nurses in a clinical environment, and whilst Clinical measures such as heart rate, breathing rate and blood pressure are the standard practice is assessing children, the new Paediatric Early Warning System puts greater weight on parental concerns. Under this new standardised system, if a parent or carer raises a concern that their child is getting ill or sicker than the score shows, this should immediately escalate the child’s care regardless of other clinical observations.
The National Paediatric Early Warning System provides a straightforward way to track the vital signs of babies, children and teenagers, with specific systems for different age brackets.
Whilst many hospitals already have similar systems in place, this change represents a national standard for patients, families and staff.
Dame Ruth May, Chief Nursing Officer for England, said: “The national roll-out of PEWS is an important step in improving care for children and young people. This standardised method of tracking deterioration will improve working methods and safety, supporting doctors and nurses to do the very best for the children and young people in their care.
This change also comes in the wake of Martha’s rule and the Secretary of State for Health and Social Care and NHS England’s commitment to implement ‘Martha’s Rule’;
Martha Mills died in 2021 after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike. Martha’s family’s concerns about her deteriorating condition were not responded to, and in 2023 a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier.
Once Martha’s rule is fully implemented, patients, families, carers and staff will have round-the-clock access to a rapid review from a separate care team if they are worried about a person’s condition.
When as a parent, you attend at hospital with your child who is sick, you rely and trust the advice you are given, however parents do know their children best. At Great Ormond Street, leading Children’s hospital, even if your child’s PEWS might be within normal limits but something “does not seem right” – to you, as the parent; the nurse in charge or doctor will be alerted and they would identify your child as a ‘Watcher’ – someone who needs to be observed more closely. Great Ormond street advise parents that. ‘no question or concern is silly or ‘wasting our time’.
The hope and purpose of all these changes is for improved outcomes and experience through early identification of triggers to deterioration in children and young people to prevent further unavoidable injuries or death.
Writing as a parent, I know how terrifying it can be when your child is sick and you are anxiously waiting for the doctor to tell you what is wrong and how they can fix it, when that advice is wrong and the result is devastating for you and your child, there may be a medical negligence claim.
If you see it, say it
Sadly, not all sick children are diagnosed as quickly as they should be. Great Ormond Street, a leading children’s hospital advises parents, ‘if you see it, say it’. Studies show that parents or caregivers are the first people to spot a deterioration in a child’s health. Parents know their children better than anyone else, and if you think something is just not right, Great Ormond Street urge you to tell them.
Writing as a parent, I know how terrifying it can be when your child is sick and you are anxiously waiting for the doctor to tell you what is wrong and how they can fix it, when that advice is wrong and the result is devastating for you and your child, there may be a medical negligence claim.
“Parents know their children better than anyone else, and if you think something is just not right, Great Ormond Street urge you to tell them.”
Who can bring a claim for a child?
Children are minors, and as such are unable to bring a medical negligence claim for themselves. If a claim is to be brought for a child, a litigation friend must be appointed to represent them, often the parent but other categories of people such as appointed caregivers can do so too. A litigation friend must fulfill certain criteria, they must be able to competently act for child, take all steps and decisions for the benefit of the child and have no personal interest in the claim.
If an award of damages is granted for the child, approval by the court is needed. Not all medical negligence cases will require involvement of the court but in cases where a damages award is given for a minor, any settlement monies must be approved by a judge at a hearing. This hearing is called an infant approval hearing. Whist attending court can seem daunting, infant approval hearings are often informal and quick, and the purpose is simply for the court to ensure any award is fair and reasonable for the child.