When a parent says the child is not themselves, is more floppy than they have ever seen, or is different from every previous illness, that sentence is data. It performs about as well as any screening score in the febrile child, and better than most single observations — and it is the one thing that reliably disappears from the notes.
So record it verbatim, attributed: 'Mother says he has never been like this in any previous fever.' Two things follow. The next clinician to see the child inherits the observation rather than starting from the current appearance, which in early sepsis can be reassuring. And a documented parental concern that was noted and acted on is a different clinical record from one where nobody wrote it down.
The corollary matters too: when a parent is not concerned, in a child who looks unwell, that is also worth recording, because it points at a chronic or recurrent pattern that the parent recognises and you do not.
- Record the parent's words verbatim and attribute them
- Ask directly whether this illness is different from previous ones
- Treat 'not themselves' or 'never been like this' as a reason to re-examine, not to reassure
- Note absence of parental concern too; it carries information about chronicity
- Hand the observation over explicitly at shift change, not just the observations chart
Why it matters
Parental concern is named as something clinicians genuinely rely on, and it is routinely lost between one assessment and the next.
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