Warning words in older children

Older children can describe symptoms more clearly, but parents, carers and school staff are often the first to notice serious illness. Wording that suggests urgency should be treated as urgent, not softened into a routine query.

A child with severe pain, breathing difficulty, a non-blanching rash, confusion, a seizure, neck stiffness or signs of dehydration may need immediate clinical assessment. Reception staff should escalate based on these warning words rather than trying to determine the cause.

Listen or look for

• Breathing difficulty: fast breathing, struggling to talk, ribs sucking in, blue lips, grunting or worsening asthma-type symptoms.
• Non-blanching rash: a rash that does not fade when pressed, especially with fever or if the child looks very unwell.
• Seizure or collapse: a fit that continues, repeated fits, incomplete recovery, fainting with ongoing symptoms or difficult to rouse.
• Neck stiffness, confusion, severe headache or sensitivity to light.
• Dehydration signs: very little urine, very drowsy, unable to keep fluids down or very dry mouth.
• Severe pain or sudden deterioration, especially if the child is described as behaving very differently from normal.

Take parent and carer concern seriously

Parents and carers may not use medical terms. Phrases such as "the rash looks wrong", "he is not making sense", "she is breathing with her whole body" or "I cannot keep him awake" should be treated as factual and escalated when they meet local thresholds.

A child's presentation may be affected by communication needs, disability, anxiety, distress or safeguarding issues. If information is incomplete but suggests potential danger, escalate rather than wait for clarity.

Safeguarding awareness

When a parent or carer describes a child as behaving very differently from normal, record their words and escalate rather than converting them into a vague note.