Telephone triage is an essential skill for healthcare professionals, particularly in busy primary care settings. While many may feel confident in managing adult triage calls, paediatric telephone triage presents unique challenges. Children are not simply “small adults” — their physiology, communication abilities, and presenting symptoms often differ significantly. In this blog, we explore the key differences between handling adult triage calls and paediatric telephone triage, offering insights into improving your clinical decision-making when assessing younger patients over the phone.
- Communication Barriers and Parental Involvement
Unlike adults, children often cannot articulate their symptoms clearly. Younger children, in particular, may not be able to describe pain, discomfort, or specific changes in their health, making it difficult to assess the severity of the situation. Instead, you will rely heavily on parents or carers to provide a detailed history. This indirect reporting of symptoms means it’s crucial to ask open-ended, clear questions to avoid misinterpretation.
In adult triage, the patient can typically explain their own symptoms and concerns, leading to a more straightforward history-taking process. However, in paediatrics, you must guide parents to provide objective observations — such as changes in feeding, sleeping, behaviour, and any physical signs like rashes or fever.
Key tip: Encourage parents to describe their child’s behaviour in terms of changes from normal rather than simply stating the child “doesn’t seem right.”
- Understanding Developmental Stages
Another major difference between adult and paediatric telephone triage is the need to understand the child’s developmental stage. Infants, toddlers, and older children may present with similar symptoms for very different reasons. For example, a febrile infant under three months is more concerning than a febrile toddler, and the urgency of referral will vary accordingly.
In adults, symptoms like fever, breathlessness, or vomiting can be alarming, but they are usually easier to quantify and classify into differential diagnoses. With children, understanding what is normal for their age range — such as the frequency of feeding in infants or the common causes of vomiting in toddlers — becomes crucial.
Key tip: Always factor in the child’s age and developmental stage when evaluating symptoms like feeding difficulties, dehydration risk, or sleep disturbances.
- Red Flags in Paediatric Triage
While red flags in adult telephone triage are well-recognised — such as chest pain, severe headache, or sudden weakness — the red flags in paediatric triage can be more subtle and vary by age. Non-specific signs like lethargy, reduced urine output, or a lack of response to stimulation in a child are critical to assess but might be dismissed as minor if not specifically probed.
Parents may downplay symptoms such as “not feeding well” or “being a bit sleepy” without realising their clinical significance. As a healthcare professional, it’s your responsibility to identify subtle signs that could indicate a more serious condition, such as sepsis or respiratory distress.
Key tip: Always ask about hydration status, feeding, and changes in behaviour in any sick child, even if the primary symptom seems minor.
- Higher Index of Suspicion
Due to the rapid changes that can occur in a child’s health, you must maintain a higher index of suspicion in paediatric triage than in adults. Children, particularly infants, can deteriorate quickly, and their compensatory mechanisms may mask the severity of an illness until it becomes critical. Always err on the side of caution and provide parents with clear safety-netting advice, including when to seek immediate help or return for a follow-up.
In contrast, adult patients typically have more stable, predictable patterns of illness, and their clinical course may be easier to predict based on the initial assessment.
Key tip: When in doubt, lean towards an in-person assessment or refer to a higher level of care if the symptoms described leave any uncertainty about the child’s condition.
Conclusion
Paediatric telephone triage requires a nuanced approach, with an emphasis on interpreting indirect information, considering developmental stages, and having a high index of suspicion for subtle red flags. By asking the right questions and maintaining open communication with parents or carers, healthcare professionals can provide safe, effective triage that ensures children receive the care they need.
For more tips on handling paediatric telephone triage calls, explore Practitioner Development UK’s A Brief Guide to Structuring a Paediatric Telephone Triage Call.
References:
- Gunn VL, Taha A. Telephone Triage and Paediatric Assessment. Paediatrics & Child Health. 2022; 32(4):120-128.
- Huynh D, Wesson DE. Critical Signs in Paediatric Triage: Red Flags to Recognize. British Medical Journal Paediatrics Open. 2021; 5(1)
