Image: (left to right) Dr Adam West, Director, Paediatric Emergency Medicine, Monash Health, Adjunct Senior Lecturer, Monash University. Dr Erin Mills, from Monash University's School of Clinical Sciences at Monash Health. Professor Dr Simon Craig, Emergency Physician, Monash Medical Centre, Monash Health, Adjunct Clinical Professor, School of Clinical Sciences at Monash Health, Monash University.
A new study published in The Lancet Child & Adolescent Health has found that a parent's concern that their child is deteriorating in hospital is as strongly associated with serious illness as abnormalities in vital signs like heart rate, breathing rate or blood pressure.
The research, led by Dr Erin Mills and Professor Simon Craig from Monash University's School of Clinical Sciences at Monash Health, introduces compelling new evidence that listening to parents could play a crucial role in preventing adverse outcomes in paediatric patients.
"We know that parents are the experts in their children," said Dr Mills. "But stories of parents not being heard, followed by devastating outcomes, are all too common. We wanted to change that."
The study introduced a simple question for clinical staff to ask parents during every vital signs check: "Are you worried your child is getting worse?" The results showed that children whose parents said they were worried were significantly more likely to experience serious illness – even when their vital signs appeared normal.
"If a parent said they were worried, their child was around four times more likely to require intensive care. That's a signal we can't afford to ignore," Dr Mills said.
While the findings mark an important step forward, they come with difficult context. In recent years, several high-profile cases in Australia have shown the tragic consequences of not acting on family concerns. Dr Mills works on oversight and review of cases where children are harmed in hospital and says these findings address a major gap. "There's been no standard way to capture or act on parent concern," she said. "We wanted to test whether parent input could help us identify deterioration earlier – and it can."
The study highlights the need to formally integrate caregiver concern into hospital early warning systems, noting that current tools often rely solely on physiological measurements. Unlike escalation pathways such as Ryan's Rule or REACH – which require families to initiate urgent reviews – this approach places responsibility with clinicians to routinely ask about concern.
That's especially important because many families are unaware of these escalation options, or may not feel confident using them in high-pressure situations.
"This isn't just about improving systems. It's about changing how we listen," said Dr Mills. "When we ask families directly, we create trust – and we act earlier."
The authors say parent concern should be included in clinical review processes and treated as an important source of information, alongside physiological signs.
"Parent concern should be part of every clinical review," Dr Mills said. "It's not a complaint, it's important clinical information."
The message to parents is clear: your instinct matters, and your voice could make a critical difference.
"Parents are not visitors – they are part of the care team," said Dr Mills. "We want every hospital to recognise that and give parents permission, and power, to speak up."
To read the paper, please visit: here.
