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6 Assessment and management of paediatric primary survey negative patients
  1. F Jewkes1,
  2. M Woollard2
  1. 1Wiltshire Ambulance Service NHS Trust, UK
  2. 2Pre-hospital Care Research Unit, Department of Academic Emergency Medicine, The James Cook University Hospital/University of Teesside, UK
  1. Correspondence to:
 Mr M Woollard
 Department of Academic Emergency Medicine, Education Centre, The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK;

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This paper describes the assessment and findings associated with illnesses that commonly affect children. It aims to be a guide to common presentations and treatment rather than a comprehensive review of all paediatric conditions. A previous article has described the identification and initial management of potentially life threatening problems. Box 1 describes the objectives for this article.

Box 1 Article objectives


  1. To describe the approach to the secondary survey in children and its main features

  2. To discuss differential diagnosis for children with common presenting symptoms

  3. To describe the differential diagnosis, management, and disposition of children with a range of common conditions

  4. To review indicators of the need for hospital referral

  5. To describe the care of common problems affecting technologically assisted children

  6. To consider the importance of communication in the care of the sick child


A secondary survey will be required on all children who have not required transfer to hospital after the primary survey (see article 5 in this series). Its aim is to fully assess the child so that decisions about their future management and disposal can be safely made. The SOAPC system (box 2) can be used to undertake this survey but is modified to take account of the particular needs of children (see article 5).

Box 2 SOAPC assessment strategy

  • Subjective assessment

  • Objective examination

  • Analysis and diagnosis

  • Plan (treatment and disposal)

  • Communication

Subjective assessment

Most parents and carers will be very sensitive to changes in their children’s health. Consequently if they express concern about their child’s wellbeing they are often right. Ask parents or carers what they think the matter is and, if appropriate, what treatment they might be expecting. They may relate treatments that have helped the child during similar illnesses, and this will help to identify the parent’s expectations about what …

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