"Felt belittled"

Dear hadarcy65

Thank you for sharing your story with us. I acknowledge that it can be extremely distressing for a parent when their child needs to be admitted into hospital. We hope the information provided below is useful for you and explains oxygen use and monitoring for children in hospital.

Children and adults can have differing oxygen saturation levels, and these can vary with underlying illness. In general, healthy children with no previous airways disease or heart conditions, have oxygen above 90% to 92% when awake or asleep. But when unwell, a child’s oxygen saturations can drop. The exact level which is acceptable differs depending on the individual’s circumstances, but saturations down to 88% in air, whilst the child is asleep, and 90% to 92% in air whilst the child is awake, are ball-park figures for most children.

Below this level, oxygen may be needed in some circumstances. There is no level that is “safe” or “unsafe” as these levels depend on the illness and the child. Levels below 90% to 92% could mean your child may need to be medically assessed to see what the underlying illness is and if they could deteriorate further. This is why doctors suggest review in hospital at these levels. If your child is stable and already in hospital at these levels, then oxygen may or not be needed depending on the circumstances. Oxygen levels below 70% may be life threatening.

There are 2 other things to consider at home. The first is the measurement of the oxygen. Saturation monitors vary significantly in quality, and those purchased outside of hospital can be of variable standard. They will read inaccurately if there is an adult probe (shaped like a clothes-line peg) compared to a child’s probe (shaped like a bandaid which wraps around the end of a finger, for example). The other thing is the trace or wave form of the reading. Readings should be averaged out over several minutes, not taken as “heartbeat to heartbeat” readings, which change rapidly. The average reading is reliable, whereas quick changes are due to the accuracy of the probe. For those machines that show a “trace” (like a wave-shaped line going up and down on the monitor), the line should be strong and regular for the reading to be reliable.

Finally, be aware that the administration of the oxygen doesn't treat the underlying illness. Oxygen helps the child breathe more comfortably and spend less effort to keep oxygen in the body. It will allow the child to spend energy on getting better rather than the work of breathing. But the underlying illness such as pneumonia will not be treated by oxygen. For that, we might need the combination of the body’s natural immunity plus antibiotics for bacterial illnesses. Sometimes administrating oxygen can mask the severity of an illness so medical staff must give careful consideration to using oxygen. It can “make the numbers look better” but it will not be treating the underlying condition.

JHC sincere apologises that you felt belittled by one nurse who questioned your use of home oximeter. It is our intention that staff form partnerships with patients and/or their families so that they can be actively involved in care, and it is disappointing that this was not your experience.

If you would like to contact consumer liaison on 08 9400 9672 or email consumerliaison.jhc@ramsayhealth.com.au we can look into your child’s care in greater detail including having a conversation with the staff members who cared for your child.

Wishing you and your family all the best.

Kind regards

Dr Kevin Hartley

Director of Medical Services

Joondalup Health Campus