Going to A&E with children: a UK parent’s practical guide

For a child, the threshold for going to A&E is lower than for an adult. Children compensate well for serious illness right up until they don’t — they can look relatively well shortly before deteriorating fast. NHS guidance, the RCPCH and our editorial team all agree: when in genuine doubt about a child, go.

Call 999 — or take the child straight to A&E — if you see any one of the following:

• A rash that doesn’t fade when you press a clear glass against it (suspected meningitis or sepsis).
• Pale, blue, mottled or grey skin, especially of the hands and feet.
• Very fast breathing, grunting noises, ribs sucking in with each breath, or pauses in breathing.
• A bulging soft spot on a baby’s head when calm and upright.
• A first-ever fit or seizure, or any fit lasting more than 5 minutes.
• Floppy and unresponsive — won’t wake fully even with a pinch.
• Persistent green vomiting in babies (suggests an obstruction).
• Severe head injury — loss of consciousness, repeated vomiting, drowsiness, fluid from ears or nose.
• A baby under 3 months with a temperature ≥ 38 °C.
• Any child you genuinely think is dying. Trust your gut — parental instinct is taken very seriously by paediatric staff.

Most large UK hospitals run a separate paediatric A&E (also called ‘Children’s A&E’ or ‘CED’). Differences from adult A&E:

• Smaller, brighter, child-friendly environment.
• Staffed by paediatric emergency clinicians and nurses with specific paediatric training.
• Play specialists who can prepare children for procedures.
• Equipment and drug doses calculated for child weight.
• Usually accept children up to their 16th birthday (some up to 18).
• Dedicated mental-health pathway for under-18s with the local CAMHS crisis team.

Smaller district hospitals may not have a separate paediatric area, but will have paediatric protocols and access to a paediatric on-call team. Either way, your child is in safe hands.

• The child’s Red Book (Personal Child Health Record).
• NHS number if known (in the Red Book).
• List of any medications, including doses and times taken today.
• Allergies and known conditions (asthma, eczema, epilepsy, autism, etc.).
• Their immunisation history (also in the Red Book).
• A favourite comforter — soft toy, muslin, dummy, blanket.
• Formula or expressed milk for under-1s; baby food and spoon for older babies.
• Nappies, wipes, change mat for under-2s.
• A change of clothes for the child (and an extra layer for a sleepy night).
• A tablet with downloaded shows + headphones + chargers.
• Snacks and a water bottle they will actually drink from.
• If they have a hospital passport, autism passport or care plan — bring it.

See our full guide: What to bring to A&E.

1. Booking-in. Reception takes the child’s name, date of birth and who has parental responsibility.
2. Triage. A paediatric triage nurse takes observations — heart rate, respiratory rate, oxygen saturation, temperature, capillary refill — and assigns one of the five MTS categories.
3. Wait in a child-friendly area. Toys, books and a TV are usually available. Some hospitals have a separate ‘quiet room’ for distressed children.
4. Doctor or ANP review. History from the parent and child, then full examination.
5. Investigations if needed — observations, urine sample, blood tests, X-ray, ECG. NICE guidance keeps imaging in children to a minimum.
6. Treatment — usually pain relief, fluids, antibiotics, nebulisers, dressings, splints.
7. Decision — discharge home with safety-netting and follow-up, or admission to the paediatric ward.

• Tell the truth, simply. ‘The doctor is going to look in your ear with a torch — it doesn’t hurt.’ Surprises are scarier than warnings.
• Stay calm yourself — children read parental anxiety faster than they read their own pain.
• Distract before, during and after — a screen, colouring, a story, breathing games.
• Ask for the play specialist for procedures — they have specific techniques for blood tests and dressings.
• Praise specifically — ‘you held really still for that’ works better than ‘good girl’.
• For sensory needs: ask for the quiet room, dim lights, ear defenders.

Under-18s presenting with self-harm, suicidal thoughts, eating-disorder crises or psychosis are seen in paediatric A&E (or the closest equivalent) and assessed by a CAMHS (Child & Adolescent Mental Health Services) crisis team rather than the adult liaison service.

• Treatment is the same urgency as a physical emergency — there is no ‘just’ about a mental-health attendance.
• CAMHS will assess and arrange community follow-up before discharge.
• For under-18s in crisis but not at A&E, call NHS 111 and choose option 2 to be put through to a local crisis service. Several areas now run dedicated under-18 crisis lines.
• YoungMinds and PAPYRUS HOPELINE247 (call 0800 068 4141, text 88247) provide free under-35 crisis support 24/7.

See our companion guide: A&E for mental-health emergencies.