Taking a Child to A&E: A Parent's Complete Guide

When to take a child to A&E

Children can deteriorate faster than adults, and symptoms that would be minor in a grown-up can be more significant in a young child. However, not every childhood illness needs A&E — and a busy emergency department is not the most comfortable place for a sick or injured child. Getting the decision right matters for your child's wellbeing and for the department's capacity to serve those who need it most.

Go to A&E immediately if your child has:

• Difficulty breathing — fast breathing, sucking in of the ribs, grunting, or nostrils flaring. In babies, look for head-bobbing with each breath.
• A non-blanching rash — press a clear glass firmly against the rash. If the spots do not fade under pressure, this could be meningitis and requires immediate emergency care.
• Unresponsiveness or extreme drowsiness — significantly harder to wake than usual, or floppy and unresponsive when awake
• A seizure lasting more than five minutes, or a first seizure of any length
• A significant head injury with loss of consciousness, vomiting, or confusion — see our head injury guide for full red flags
• Severe pain that is not improving with age-appropriate doses of paracetamol or ibuprofen
• A serious burn — any burn on the face, hands, feet or genitals, any burn larger than the child's palm, or any burn in a baby under 12 months — our burns guide covers first aid steps
• Swallowing a battery, magnet or sharp object
• A suspected broken bone where the limb is deformed, very swollen, or the child cannot move it — though for simple suspected fractures, a UTC may be faster; see our fractures guide

Consider alternatives if:

• The child has a temperature but is feeding, drinking and reasonably alert — give age-appropriate paracetamol or ibuprofen and monitor
• The child has a cough, cold or sore throat without breathing difficulty — a pharmacy or GP is usually more appropriate
• The child has a minor cut, graze or insect bite — clean and dress at home
• You are unsure — call 111, which has paediatric pathways specifically designed for children's symptoms

How children's A&E differs from adults

Many hospitals have a dedicated paediatric emergency department or a children's area within the main A&E. These spaces are designed to be less intimidating: brighter colours, toys, child-sized equipment and staff who specialise in treating children. If your hospital does not have a separate children's area, your child will be seen in the main department but by clinicians experienced in paediatrics.

Triage is adjusted for age

The triage system for children uses different vital-sign thresholds. A heart rate of 140 is abnormal in an adult but can be normal in a toddler. Triage nurses use age-specific charts to assess whether your child's observations are in the expected range. This is why it is important to know your child's age in months (not just years) and their approximate weight — both affect medication doses and clinical thresholds.

For a full explanation of how the triage process works, see our triage guide.

Pain assessment

Young children cannot always tell you where it hurts or how much. Staff use visual pain scales — such as the Wong-Baker Faces scale, where the child points to a face that matches how they feel — or behavioural observation to assess pain levels. For non-verbal children and babies, staff assess facial expression, body position, cry patterns and consolability.

Parental presence

Parents or guardians are expected to stay with the child throughout the visit. You are your child's advocate, translator and comfort. Staff will direct clinical questions to you, and your observations about changes in your child's behaviour are vital diagnostic information. If both parents are present, one can stay with the child while the other handles registration and fetches supplies.

What to bring

Children's A&E visits often take longer than you expect, so preparation is important. Beyond the standard items covered in our what to bring guide, pack:

• Nappies and wipes if your child is not toilet-trained — more than you think you will need
• A change of clothes — vomiting, spills and medical procedures can soil clothing
• A favourite toy or comfort item — this can make examinations significantly easier for staff and less distressing for the child
• Milk or formula and bottles for babies — the department may not have your brand
• Snacks and drinks — healthy, quiet snacks like rice cakes or fruit pouches. Avoid anything the child could choke on while lying down
• A tablet or phone with downloaded content — WiFi in hospitals is unreliable, so download games, shows or audiobooks in advance
• The red book (Personal Child Health Record) if you still have it — it contains vaccination history and growth charts
• Any recent discharge letters or clinic letters relevant to the current problem

Medications

Bring all medications your child is currently taking, including over-the-counter products and any you administered today. Staff need to know exactly what the child has had, when, and the dose. This is critical for pain relief — giving paracetamol at home then receiving another dose in A&E without staff knowing can lead to overdose.

Common childhood presentations in A&E

High fever (febrile illness)

Fever is the most common reason parents bring children to A&E, and the majority of febrile children do not need emergency care. A temperature of 38°C or above is a fever. Most fevers in children are caused by viral infections and resolve within three to five days. The important thing is the child's behaviour, not the number on the thermometer.

A child with a fever of 39°C who is drinking, playing and responding to you normally is less concerning than a child with a fever of 38.5°C who is lethargic, not drinking and inconsolable.

Falls and injuries

Children fall constantly — from beds, climbing frames, stairs and their own feet. Most falls result in bruises and bumps that need nothing more than ice and reassurance. The injuries that need A&E assessment are those with significant mechanism (falling from height, falling onto a hard surface at speed), visible deformity of a limb, persistent severe pain, or signs of head injury.

Breathing difficulties

Croup, bronchiolitis and asthma are common causes of breathing difficulty in children. Croup typically causes a barking cough and a harsh sound when breathing in (stridor). Bronchiolitis affects babies and causes wheezing and feeding difficulty. Asthma attacks can escalate quickly. Any child working hard to breathe — using tummy muscles, sucking in ribs, unable to complete sentences — needs A&E assessment.

Rashes

Most rashes in children are viral and harmless. The critical test is the glass test: press a clear glass firmly against the rash. If the marks fade (blanch), the rash is almost certainly not meningococcal. If the marks do not fade, call 999 immediately.

During the visit

Expect multiple stages

Just like adult A&E, a children's visit involves sequential stages: registration, triage, waiting, clinical assessment, possible investigations, and a decision. Our general A&E walkthrough describes each stage in detail. For children, the key difference is that investigations may take longer because paediatric blood tests often require specialist equipment or smaller-gauge needles.

Keep your child calm

Your own demeanour directly affects your child's anxiety. If you are calm and reassuring, your child is more likely to cooperate with examinations. Explain procedures in age-appropriate language: "The nurse needs to listen to your tummy" rather than "They need to check for internal bleeding."

Ask questions

You have every right to understand what is happening and why. Ask:

• What do you think is wrong?
• What tests are you doing and what are you looking for?
• What treatment are you giving and are there side effects?
• What should I watch for at home?
• When should I bring them back?

After discharge

Children can bounce back remarkably quickly from illness and injury, but they can also deteriorate faster than adults. Pay close attention to the safety-net advice given at discharge, and do not hesitate to return if your child's condition worsens. No clinician will judge you for coming back — it is far better to have a child re-assessed unnecessarily than to wait too long. If your child's symptoms change or new symptoms appear within 48 hours of discharge, always seek reassessment rather than assuming the original diagnosis still applies. Our after discharge guide covers what to expect and when to seek follow-up care.

Bottom line

For genuine emergencies — breathing difficulty, unresponsiveness, non-blanching rashes, significant trauma — take your child to A&E without hesitation. For everything else, call 111 first, consider whether an Urgent Treatment Centre is appropriate, and check live wait times to choose the quietest department if A&E is needed. Pack well, stay calm, and remember that staff in children's departments deal with worried parents every day — you are not wasting anyone's time by seeking help.