When intuition speaks: the evidence behind listening to caregivers

Picture this: A 2-year-old child presents to your emergency department with mild respiratory symptoms. They're febrile, slightly tachycardic, but otherwise, the clinical picture suggests a standard viral illness. You conduct your assessment, reassure the parent, and recommend fluids, rest, and paracetamol.

But the mother lingers. “He just doesn’t seem like himself,” she insists. “I’ve never seen him this sick.”

It’s a situation many clinicians will recognise. Internally, you may wrestle with the question—is this simply an anxious parent, or are they noticing something that I’m not?

Until recently, the role of parental concern in identifying deterioration lacked strong evidence, despite being widely promoted in sepsis recognition tools. Now, a landmark study published in The Lancet Child & Adolescent Health lends weight to what many experienced clinicians and families have long believed: 

Caregiver concern matters—and it saves lives.

New evidence: what the data shows

In this large multicentre observational study, researchers analysed over 73,000 presentations to paediatric emergency departments. Of these, caregiver concerns were documented in roughly one-third of cases (24,000).

Key findings include:

• Children whose caregivers expressed concern were significantly more likely to require ICU admission (6.9% vs. 1.8%) and mechanical ventilation (1.1% vs. 0.2%).
  
  

• After adjusting for clinical variables, including abnormal vital signs, caregiver concern remained a strong independent predictor of critical illness.
  
  

• Caregiver concern was more predictive of ICU admission than any individual vital sign, including tachycardia or tachypnoea.
  
  

This research challenges us to reconsider how we integrate caregiver observations into our clinical frameworks.

Applying this insight to clinical practice

To harness the value of caregiver concern in practice, consider the following strategies:

• Ask explicitly: build structured questions into your assessment. For example, “Are you worried that your child is getting worse?” can open up crucial conversations.
  
  

• Document clearly: record caregiver concerns alongside clinical findings. This ensures their observations are visible and included in care decisions.
  
  

• Educate staff: provide training that emphasises the evidence and importance of caregiver insights, particularly for early warning signs of deterioration.
  
  

• Develop protocols: incorporate caregiver input into escalation policies and response systems. Consider adding caregiver concern as a standalone trigger for review.
  
  

• Create feedback loops: encourage caregiver feedback post-discharge or admission. This builds trust and helps refine systems for future care.
  
  

Final say

Caregivers know their children best. Their voices, often rooted in deep familiarity with subtle changes in behaviour or condition, can offer early warning signs that vital signs alone may miss. This latest research reminds us that listening, and acting, on these concerns is not just good practice, it is evidence-based.

Reference

Mills E., Lin P., Asghari-Jafarabadi M., West A., & Craig S. (2025) Association between carefiver concern for clinical deterioration and critical illness in children presenting to hospital: a prospective cohort study The Lancet - Child & Adolescent Health 9(7) P450-458

Learn more about the role of caregiver concern in these courses:

Paediatric Assessment of Clinical Emergencies & Deterioration (PACED)

Sepsis in Primary Care