Case study - Parental concern for a crying baby

A face-to-face consultation was key, says Dr Ayakannu Kandiah.

Red flag sign: always document a high level of parental concern (Photograph: Haymarket Medical/J H Lancy)
Red flag sign: always document a high level of parental concern (Photograph: Haymarket Medical/J H Lancy)

A concerned mother rang the out-of-hours (OOH) service and reported to the duty nurse that her baby was crying all the time, she could not lay the baby down and its temperature was a little high.

The baby was examined by the OOH doctor who after examination advised the mother to give the baby paracetomol and to take a urine sample.

Paediatric referral
The following day, the mother brought the baby to my surgery and explained that the baby had been crying since the visit to the out-of-hours surgery the pervious day. The baby was well hydrated, with normal colour and activity. I decided to refer the patient to the paediatric department because of the parental concern and a crying and distressed baby. The hospital diagnosed infantile colic.

The following evening the parents contacted the OOH surgery again, they spoke to the triage nurse requesting a visit. The parents were invited to go to the OOH surgery but had no way of getting there.

Over the telephone it was recorded that the baby had a runny nose and had not been feeding well, but the baby has had wet nappies, had a good colour and was crying intermittently. The advice given by the triage nurse over the telephone was to give saline drops and small feeds.

Again, the following day the parents brought the baby to my surgery. The baby was still crying, not feeding well and the parents were still very concerned. I referred the baby back to the hospital again on the observation that the child was still crying and the mother was very concerned.

Observations
The baby had fever, cold and mottled peripheries and delayed capillary refill. E coli was cultured from blood and urine samples, confirming a diagnosis of E coli UTI/septicaemia.

This was treated with IV antibiotics. If left untreated this could have led to meningitis.

Clinical care must be more consistent. During the daytime, children and babies are looked after by their own doctor, who may know the family well.

Every clinician, in every consultation when managing children must follow the NICE traffic light system chart and must decide how ill the child is.

Perhaps parents should have a similar guidance chart:

  • How ill is your child?
  • Does your child look a different colour?
  • Is your child active or lethargic?
  • Is your child's breathing shallow or rapid?
  • Is the child dehydrated?
  • Any symptoms such as fever?

The purpose of highlighting this case is to emphasise parental concern should be considered a red flag sign and documented.

Resource
NICE: Feverish illness in children. CG47.London, NICE, 2007.

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