Nursing children and young people requiring emergency care is a unique and challenging area of paediatrics. The emergency children’s nurse has to be equipped to manage a broad spectrum of presentations ranging from a critically ill or injured child to those with more minor illnesses or injuries.

Standards for Children and Young People in Emergency Care settings (RCPCH 2012) provides health care professionals, providers and commissioners with clear standards of care applicable to all urgent and emergency care settings across the United Kingdom. Roles, responsibilities and competencies required in nursing teams are included within this paper.

Prior to the RCPCH (2012) paper, Why Children Die: A pilot study (CEMACH 2006) delivered important recommendations that can be applied to emergency children’s nursing. Problems in recognizing serious illness in children were one of the key findings of the study.

The emergency children’s nurse requires knowledge of other specialities in paediatrics. Many of these areas are covered in greater detail in other chapters of this book (e.g. fever, asthma, fractures, plaster care, resuscitation, PEWS, physical assessment, safeguarding, head injury and coma management).

This chapter provides a snapshot of common presenting complaints to an emergency department in relation to the developmental stages of childhood.

The unwell baby

The unwell baby is a common presentation to an emergency department. Babies present a different challenge to the emergency nurse, and this can range from the ‘worried parent’, minor viral illnesses to a severely sick baby requiring critical care or resuscitative management. The children’s nurse is crucial during the assessment of these babies with the assistance of a paediatric early warning score to identify severe illness and prompt escalation to the appropriate senior clinician.

Parents are very aware of the careful balance between breathing, feeding and production of wet nappies. A change in one of these will lead to the baby being brought to an emergency department. These concerns can also be accompanied with a fever, rash or ‘strange episode’. There is no way of predicting at what stage in the baby’s illness they will present. Bronchiolitis, viral-induced wheeze, gastroenteritis, febrile convulsion, and oesophageal reflux are commonly diagnosed.