In October 2025, the Standards for Children and Young People in Emergency Care has been updated, increasing the number of standards to comply with from 70 to 82 in all Trusts across England.

Up to 30% of patients who attend A&E are under 18 years old. These standards provide all Hospital Trusts’ A&E Departments with clear expectations as to care which start from initial presentation to discharge of any individuals under 18 years of age.

When attending A&E, there is a triaging process in which the attendance is registered and sometimes a decision will be made, often by a nurse or receptionist, for the child to be streamed away from emergency care and reviewed in an alternative setting, such as:

• Urgent treatment centre/ urgent care centre
• Emergency department
• Specialty team

However, the Standards for Children and Young People in Emergency Care confirm that all children who are streamed away from an emergency care setting must be assessed by a regulated health care professional with necessary paediatric competencies and experience in paediatric initial assessment. These initial assessments are expected to take place within 15 minutes of arrival as per the Standards; however, a rapid system of prioritisation must be implemented if this does exceed the 15 minute wait, as often occurs in A&E departments, especially during busy periods.

The updated standards have remained the same as the 2018 Standards regarding taking observations of children. This note that all infants, children and young people should have all vitals taken and recorded; this should include temperature, oxygen saturation, respiratory rate, heart rate, capillary refill time, blood pressure and GCS (Glasgow Coma Scale) or AVPU score (Alert, Verbal, Pain, and Unresponsive) to assesses the conscious state.

The updated standards provide clarification on the type of assessment that needs to be undertaken to detect abnormal or deteriorating vital signs, specifically noting PEWS (Paediatric Early Warning Signs), suggesting this will become a standardised test in all A&E Departments across England.

The new standards also suggest that A&E departments should be equipped with comprehensive list of clinical guidelines covering the common emergency presentations for children and young people.

Some of the common Clinical Negligence claims that flow from A&E departments not following the standard timeframes for review and assessments can include:

• Delay in diagnosis and treatment of sepsis – this is a very serious illness that needs to be treated with caution and within a timely manner. The guidance indicates that, should a child score 9 or above on the PEWS, they should be receiving treatment within 1 hour.
• Delay in diagnosis and treatment of testicular torsion – with these injuries, there is a very limited time period in which to review and treat the patient before damage to the testicles is lasting. It is extremely important to attend A&E as soon as symptoms present (some symptoms can include sudden, severe pain in one testicle or the scrotum, and swelling or redness on one side of the scrotum) and for review to take place urgently.

Other claims that can flow from misdiagnosis or delayed diagnosis in A&E can include:

• SUFE (Slipped upper femoral epiphysis – this is a hip condition whereby the growth plate at the top of the thigh bone becomes unstable) – with these injuries, if treated in a timely manner, it can be a very simple procedure to treat; however if misdiagnosed and left to worsen, this can lead to serious issues.
• Salter Harris Fracture – this a fracture that involves the growth plate of a long bone in a child, causing symptoms like point tenderness, swelling, and an inability to bear weight or move the affected area. This are more often seen in children’s fingers and if not diagnosed correctly and treated, can result in the finger healing in an incorrect position.

Given the fluctuations in busy periods within A&E, it is not always possible to be seen as per the standards; however, for cases where there are limited time periods to provide treatment, this can cause significant life changes and therefore should be treated as a priority to ensure children have the best outcome.

At Williamsons Solicitors we have experience in delayed diagnosis and treatment of children in an emergency setting and we appreciate how difficult this can be for individuals and their families. If you or a loved one have suffered a delay in a diagnosis and / or treatment, please contact our Medical Negligence team on 01482 323697 to discuss how we can help.