"Experience with our child"

During lunch at the park, our 4 year old child fell off the playground. We did not see how they fell, all we knew was that they were in pain and that they fell from a 2-3m height, onto woodchips. A lady ran towards our picnic area to tell us that she got a glimpse of how our child fell and that they had fallen quite badly. Our child was screaming in pain holding their wrist, they would not speak and their screaming got louder as time passed. I made the call to take them to the Perth Children's Hospital Emergency Department which was located a few minutes away from this parkland.

On arrival, I explained to the triage nurse what had happened and the situation our child was in at this stage. When the ED Doctor came to see us in the waiting bay I explained the story of how our child fell from such a height, the fact that we do not know how they fell and the type of ground they fell on. The clinical team which were looking after our child decided that they will perform an X-Ray on their wrist being the main area which our child showed discomfort towards. After the X-ray was completed it was not long until the Doctor returned and commented on how ‘fine’ our child looked. We were informed that they had a fracture in their wrist and that a cast is required to be put on, along with a sling. The Doctor then proceeded to tell us that a few follow up appointments with the OPD Orthopaedics will take place and that our child will be fine.

The story does not end here.

That night our little child kept having a fever in their sleep. We could not figure out why this was the case so we proceeded to administer paracetamol to bring down their temperature.

The next day our child kept complaining about the pain in their neck. Our child then would not let us brush their hair or give them cuddles and would cry if anyone touched their neck.

The next day I called the outpatient department to seek some guidance on this as this was not our area of expertise and we were still in shock from the fall. I was encouraged to see our local GP.

The next day our child woke up crying with pain in their neck. Their fever kept coming and going throughout the day. At this stage they could not move their head, but instead would move their whole body to look left, right, or up and down. My spouse facetimed me whilst I was at work and told me what was happening. This was now about 72 hours after the fall. I had booked a GP appointment for an examination of our child’s neck that afternoon. When I rushed home from work, I decided to open up the sling and let my child’s arm rest as they were restless and could not stop crying, telling us they were in pain. To our shock, our child had swelling under the sling, to the point where they nearly had a webbed neck. Our child could not open their mouth and would refuse to eat, saying they had pain if they moved anything.

The GP suggested an X-Ray to be taken a day later and to come back once results arrive - they did not examine our child nor understand the urgency at that time.

I decided to take our child back to Perth Children's Hospital ED. We got ready thinking we would be home for dinner that night.

Our child cried themselves to sleep on the way to ED. On arrival the swelling had grown to both sides of the neck, more on the right side. On examination in ED, the Doctor decided to perform blood tests and send our child to CT. Once the bloods returned and the CT Scan had been completed - the diagnosis was Lymphadenitis. They were administered steroids to prevent the swelling from obstructing their airway and I was informed that our child must be admitted to a ward for 3 days, administered IV anti-biotics every 8 hours, given pain relief & OBS taken every 4 hours and consistently monitored.

I asked the ED Team why a CT or MRI was not carried out on our first visit following the fall- with the ED team knowing they had fallen from such a height, given their weight and the surface they fell on - there should have been a more thorough investigation carried out.

Admitted onto Ward 2A, we spent 3 restless days, with our little child in so much pain.

An X-ray of their shoulders were completed, MRI of their spine and the cervical region of their neck, and an ultrasound on their neck where the swelling was.

We were finally discharged on the third evening.

I kept querying our first visit and asking the team what the correct process should have been? Why we were sent back home with just a wrist X-Ray? Why was there no thorough examination done by the Neuro and Ortho Team on our child’s head, neck and vertebrae? No response from anyone.

The mental distraught this placed my family and I was unthinkable, to see our little child go through this was our worst nightmare.

What is the correct process for when a 4 year old falls, un-observed onto wood chips, showing signs of distress, distracted by a fractured wrist? What risk category does this fall under in ED? What improvements will the hospital make to ensure that the Emergency Department performs the correct investigation in order to prevent children returning in a worse condition? Must a full examination be carried out if a child falls from a certain height however does not show symptoms?

An acknowledgement to the Ward nurses and ENT Surgical team who gave the best care to our little child on those 3 days, our child will remember you all.

A response would be appreciated.