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Why are acute admissions to hospital of children under 5 years of age increasing in the UK?
  1. Sarah Neill1,
  2. Damian Roland2,3,
  3. Matthew Thompson4,5,
  4. Alison Tavaré6,
  5. Monica Lakhanpaul7
  1. 1 Faculty of Health and Society, University of Northampton, Northampton, UK
  2. 2 Health Sciences, University of Leicester, Leicester, UK
  3. 3 Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Hospitals, Leicester, UK
  4. 4 Department of Family Medicine, University of Washington, Seattle, Washington, USA
  5. 5 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  6. 6 West of England Academic Health Science Network, Bristol, UK
  7. 7 General and Adolescent Paediatrics Unit, UCL Institute of Child Health, London, UK
  1. Correspondence to Dr Sarah Neill, Faculty of Health and Society, University of Northampton, Northampton NN2 7AL, UK; Sarah.Neill{at}northampton.ac.uk

http://dx.doi.org/10.1136/archdischild-2017-313958

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    Children’s use of hospital services in the UK has been increasing rapidly since the late 1990s.1–6 Findings from the latest QualityWatch report show significant increases in emergency hospital admissions for infants (23%) and young children aged 1–4 years (11%) between 2006/2007 and 2015/2016 (data have been adjusted for population increases in each childhood age group), while children over the age of 15 years showed a decrease in emergency admissions6 (see box 1 for their definition of emergency admission).

    Box 1

    Definition of an emergency admission

    ‘An admission to hospital that is unpredictable and at short notice because of clinical need. This admission can come via a variety of routes, including the hospital’s A&E department, a general practitioner, a consultant clinic or a bed bureau. Our definition excludes transfers of admitted patients from other hospital providers in an emergency’.6

    This paper discusses some of the theories and research which provide some insight into the increase in hospital admissions for infants and children under 5 years of age in the UK. Research has been identified in the following areas: social expectations of parents with a sick child, the media and parental anxiety, access to primary care, acuity of the illness, thresholds for admission, duration of hospitalisation and readmission rates, and the impact of health policy, each of which is discussed briefly below.

    Social expectations of parents with a sick child

    The unwritten rules of society place pressures on parents to conform to social expectations. When their children are acutely ill, parents are expected to contain the management of the illness within the family if the illness is minor and to seek help if the illness is serious.7 Parents learn from experiences, in the early days as parents, that they will be subject to felt or enacted criticism if they seek help at the wrong time, or in …

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    Footnotes

    • Contributors SN drafted the first version of the paper. Coauthors then added missing text, comments on and edited the first draft of the text. SN collated the edits and comments and revised the paper. SN shared the feedback from the first draft with the coauthors, who made suggestions which were used to inform revisions of the text.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; externally peer reviewed.