Looking after critically ill children

Abstract

This chapter discusses paediatrics in critical care and includes discussion on both paediatric transfers for the adult intensivist and looking after a vulnerable child (safeguarding children for the adult practitioner). With the centralization of specialist services into a limited number of hospitals across the UK, an increasing number of children require an interhospital transfer. These include but are not limited to the transfer of the critically ill child. Between 2012 and 2014, 18 500 transfers of critically ill or injured children were undertaken across the UK, of which 2400 were undertaken by non-specialist teams. These patients are some of the sickest children. It is while in transit that these patients are most at risk and the transferring team is most exposed. To minimize risks it is important that the team holds the relevant skills to stabilize and transfer children. A systematic approach is vital. The patient’s condition should be optimized before transfer and any likely difficulties anticipated and a plan to tackle any complications swiftly and effectively is agreed prior to the transfer. In this chapter we offer our approach to the safe transfer of the critically ill child. The second part of this chapter offers an introduction into the safeguarding of vulnerable children. A 2009 survey conducted by the National Society for the Prevention of Cruelty to Children asking children to self-report abuse and neglect found that 18.6% of 11–17-year-olds said they had experienced some type of severe maltreatment. The high prevalence of child abuse makes it likely for the medical practitioner who is mostly caring for adult patients to encounter vulnerable children in clinical practice. This will often happen when participating in the resuscitation of a critically ill or injured child, when anaesthetizing a child, or when looking after a caregiver of such a child. The aim of this chapter is to provide these practitioners with the information that will help them to identify possible child abuse and make them aware of their responsibilities towards these children and their options for action.