There are about 5 million attendances to the Emergency Department each year and children account for 20-25% of these. Children may present with either injury or illness, and the balance varies widely from department to department – each forming 30-70% of the total.


Paediatric attendances to the ED account for about 5 million attendances each year – which is about 1 in 4 children. The vast majority of Emergency Departments in the UK see adults and children. Children make up 20-25% of attendances.

Most Emergency Departments in the UK now have a separate area for children, but this varies from just a separate waiting area to a self-enclosed ED (RCEM website).

Children may present with either injury or illness, and the balance varies widely from department to department – each forming 30-70% of the total.

Remember: The commonest presenting complaints of children to an ED are limb injury, head injury, difficulty in breathing, fever, rash, abdominal pain, fitting and dehydration (RCEM website).


  • Recognise the sick child

  • Evaluate fever in children using hospital and NICE guidelines

  • Evaluate children with difficulty in breathing (DIB) and formulate a differential diagnosis


Complete the following before the face-to-face session:

Tasks 1, 2 & 3: Spotting The Sick Child

Duration: 40 mins

Spotting the Sick Child is an excellent resource (and features some familiar faces). You will need to register (this is free) then you should complete the following:

  1. Watch the '3 min toolkit' video (in Basic Child Assessment)

  2. Watch the 'How to and Communication Videos' (in the basic Child Assessment Section)

  3. Watch the videos on 'Difficulty in Breathing' (in the Symptoms Section)

Task 4a: Feverish Illness in Young Children

Duration: 60 mins

Complete this BMJLearning module of Feverish Illness in Young Children. It is Designed to cover the relevant NICE guidelines and to help you implement them. (This module does require you to log in). There is also a link to the guideline in the additional resources.


Task 4b: The REMIT Project

Duration: 60 mins

This educational package on the NICE traffic light system for Children with Fever has been designed by Dr Damian Roland. To login:

  • Username: damian

  • Password: remit

Task 5: Difficulty in Breathing

Duration: 60 mins

Return to Spotting the Sick Child and watch the videos on Difficulty in Breathing (in the Symptoms section).

Work through this section. It will take about 1 hour to get through all the content but it is definitely worth it.

#EM3 Content

Lightning Learning:

Paeds SimBlogs:

Case Discussion

We have written a series of interactive cases (wikis) with short answer questions to be answered by trainees prior to the face to face teaching sessions. Currently this is only available to East Midlands Trainees.

Answer one or two questions before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. We will also provide tutor comments. If you find good resources that answer a question why not include links in your comment.

Part of the face-to-face teaching will be spent discussing the case(s) below:

An 18 month year old female child is brought to the Paediatric Emergency Department by her parents. She has been generally unwell over the last day, and not quite herself.
A 2 year old boy is brought into the Emergency Department with his parents. He has had a 48 hour history of diarrhoea and vomiting.


Here are some extra resources to review if you want more information:

Head Smart:

Each week in the UK, around ten children or teenagers are diagnosed with a brain tumour in the UK. The time taken from a child’s first symptoms to diagnosis of a brain tumour for half of the children to be diagnosed is currently 12-13 weeks (median) in the UK.

The aim of the HeadSmart campaign is to reduce the time it takes to diagnose children and young people with brain tumours in the UK by educating healthcare professionals and the public about the symptoms of brain tumours in children and young people.

Course Feedback

Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form:

Updated: 5th January 2017