Children need adult advocates in the ED

By Robert A. Wiebe, MD, FAAP, FACEP
Professor and Director
Division of Emergency Medicine and Department of Pediatrics
UT Southwestern Medical Center Dallas

Guest Column

Infants and young children don’t have a vote. That’s why they need adult advocates to represent their needs in an emergency setting. In an unnamed hospital, an example of how a child advocate can make a difference was seen recently when a small abused child with extensive burns was having a dressing change without analgesia. The physician child advocate immediately recognized a lack of regard for pain in a small, defenseless pediatric patient. This was addressed systemwide with improved pain management and sedation protocols for burn dressing changes.

Many things are done to children that we would never do to adults because their complaints (in the form of crying) can go unheeded.

The recent guidelines from the Dallas-based American College of Emergency Physicians and the Elk Grove Village, IL-based American Academy of Pediatrics recommends that every ED have a nursing coordinator and a physician coordinator to address issues related to pediatric emergency care. (For more information about the guidelines, see ED Nursing, June 2001, "New guidelines warn: You may not be prepared to take care of sick children.")

Qualifications for a physician coordinator include credentialing as a specialist in emergency medicine, pediatric emergency medicine, or pediatrics. The physician coordinator is required to have a special interest, knowledge, and skill in the emergency medical care of children. This must be demonstrated by training, clinical experience, and ongoing continuing medical education. This may be a shared role and, when local resources do not allow one, a physician coordinator may be appointed through formal consultation from professional resources of a hospital capable of providing definitive pediatric care.

The role of the physician coordinator is to oversee the quality and management of pediatric care patients and to serve as an advocate for children. This includes maintenance of a quality improvement program, quality physician performance, and pediatric clinical care protocols. This individual also will serve as a liaison for emergency medical services, out-of-hospital care, inter-facility transport, and as an interface with regional pediatric referral resources. He or she also serves as a facilitator for professional education in pediatric emergency care.

Qualities of a nursing coordinator

A nursing coordinator for pediatric emergency care must demonstrate interest, knowledge, and skill in emergency care and resuscitation of infants and children. They are responsible for coordinating and implementing quality improvement and clinical care protocols. They also serve as a nursing liaison for the out-of-hospital and in-hospital system of pediatric emergency care that includes EMS, interfacility transport, and regional referrals.

The nursing coordinator should work closely with the physician coordinator to ensure that policies and procedures and care plans are periodically reviewed and updated.

The roles of a nursing and physician coordinator need not be a separate defined individual but can be a shared role. The important issue is that this person advocates for and ensures that the needs of children are met in an emergency. Children need adult advocates.

[Editor’s Note: Wiebe can be contacted at UT Southwestern Medical Center at Dallas, 1935 Motor St., Dallas, TX 75235. Telephone: (214) 456-6116. Fax: (214) 456-7736. E-mail:]


The American College of Emergency Physicians/ American Academy of Pediatrics (ACEP/AAP) policy statement, "Care of Children in the Emergency Department: Guidelines for Preparedness" (published in the April 2001 issues of Pediatrics and Annals of Emergency Medicine) can be downloaded free of charge from the AAP web site: (Click on "Policy Statements." Under heading "C," click on "Care of children in the emergency department: Guidelines for preparedness.") Also, they can be purchased for $2.95 each, including shipping and handling. To order materials, contact:

AAP Publications Department, P.O. Box 747, Elk Grove Village, IL 60009-0747. Telephone: (800) 433-9016 or (866) 843-2271. Fax: (847) 228-1281.