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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 September 15; 335(7619): 527.
PMCID: PMC1976526
Spotting the Sick Child

Face to face always

Ffion C Davies, consultant in emergency medicine

Performing snapshot assessments in emergency settings, where time is precious, is notoriously risky. Serial assessment of the child is best but not always possible. A scientific approach of measuring heart rate, capillary refill, respiratory rate, and behaviour takes less than 3 minutes1 and is achievable in these settings. Harnden is wrong in saying that this is not achievable in primary care.2 To state that there is no evidence that measurement of these parameters helps identify serious bacterial illness may be true for primary care but is not true in hospital (emergency department or paediatric wards). Lack of evidence of association is not evidence of lack of association, so logic dictates that a similar assessment should take place in primary care.

The Intercollegiate Advisory Group for Services for Children in Emergency Departments has concerns about the abilities of telephone triage systems and inadequately trained frontline staff to differentiate seriously ill children from children with self limiting febrile illness. This includes emergency care practitioners, emergency nurse practitioners, F2 doctors, and perhaps recently appointed general practitioners. In the wake of the new General Medical Services contract, increasing numbers of parents access telephone advice, emergency departments or primary care centres for assessment of their febrile infant (particularly out of hours). These points of contact must ensure staff have basic paediatric assessment skills.3 To substitute experienced primary care, emergency medicine and paediatric staff with cheaper alternatives is not necessarily a safe strategy. The low incidence of serious bacterial illness means that most of the time, most children will come to no harm. This is no consolation for the parent of a seriously ill child.

FCD is chair of the Intercollegiate Advisory Group for Services for Children in Emergency Departments.


Competing interests: None declared.


1. Davies F. The 3-minute toolkit. Spotting the sick child DVD, 2004.
2. Harnden A. Recognising serious illness in feverish young children in primary care. BMJ 2007;335:409-10. (1 September.) [PMC free article] [PubMed]
3. Royal College of Paediatrics and Child Health. Services for children in emergency departments (intercollegiate report) 2007

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