• general paediatrics
• health Service
• media
• patient perspective

The incidence of life-threatening illness in children is at an all-time low while presentations and admissions to hospital increase.1 Healthcare professionals who have first contact with children and young people have a challenging job in judging who needs referral to secondary services and who can continue to be safely managed out of hospital. While the vast majority of children presenting for medical assessment have minor illnesses requiring little or no intervention, diseases evolve and early symptoms and signs may be very non-specific. Analysis of primary care records and retrospective questionnaires showed only half of meningococcal disease was detected at first presentation to primary care physicians.2 However, as evidence suggests that serious illness can superimpose on self-limiting infection3 not all returning patients could, or should, have been treated at first presentation. Given delayed or missed diagnoses can lead to catastrophic personal, societal and financial consequences; at the point of discharge, the advice given the families and carers is of critical importance.

Safety netting has likely always occurred but was only formally described in medicine in 1987.4 In the UK, it is a National Institute for Health and Care Excellence (NICE) quality standard defined as ’oral and/or written information on what symptoms to look out for, how to access further care, likely time course of expected illness and, if appropriate, the uncertainty of the diagnosis’.5

When children are seen in a hospital setting, they are often discharged with safety net advice. In theory, optimal education of parents during their index presentation should equip them with confidence and knowledge empowering them to manage their child at home unless ‘red flag’ symptoms or complications develop.

The outcomes of successful, and unsuccessful safety netting, are more difficult to define than might be first thought. Successful safety netting obviously includes parents …