- At present in England, 1- 4 year-olds are more likely to attend Emergency Departments than any other age group, with attendance figures in 2024/25 reaching well over 1.7 million.
- More than 40% of A&E attendances for children are ‘non-urgent,’ and are potentially avoidable, adding increased demand on already overstretched emergency departments.
- The RCPCH Emergency Care Standards have been revised to reflect key developments in paediatric emergency care over the past seven years when the current standards were published.
- The standards were developed by an intercollegiate committee with several other organisations including RCEM, APEM, RCN and RCGP
- Originally published in 1999, the standards are an established feature of the paediatric emergency care landscape and are a recognised part of how services are organised and delivered.
- Providers and service planners across the UK must consider these standards when designing effective, high-quality care for the future.
Children must be seen by the right people, at the right time, and in the right setting – and supporting high quality, integrated emergency care is a core part of this. RCPCH has published a new, up to date set of emergency care standards which draws from the significant changes we have seen in the urgent and emergency care landscape over the past seven years.
Services for children and young people have not recovered well as adult services post-COVID. The majority of funding remains focused on adult care, leaving paediatric emergency services consistently under-resourced. As a result, paediatric emergency care is under more pressure, with growing demand outpacing the system’s ability to cope. Demand for emergency department services in England among 0 to 18-year-olds is on the rise, with attendances climbing from just over 5.4 million in 2018-19 to more than 6.3 million in 2024-25. Many emergency departments now lack the space, staffing, and infrastructure needed to meet the growing needs of their young patients.
The latest standards – developed by a wide group of child health experts - encourage collective working and integration to make our emergency departments work better for all our children, so that we can face the challenges of both the present and the future.
RCPCH President, Professor Steve Turner, said:
Dr Ian Higginson, President of the Royal College of Emergency Medicine, said:The delivery of high-quality emergency care to children and young people is more challenging today as it has ever been. Children and young people have the highest unnecessary emergency department attendance of any group, with almost 40% of attendances classified as ‘non urgent’, and an even higher proportion of those attending out of hours. This avoidable footfall inevitably leads to overcrowding and puts even more demand on our already overstretched Emergency Departments.
These revised standards aim to support the paediatric workforce so that every child can receive safe, compassionate, and timely care in the right place - no matter their needs.
Chair of the Intercollegiate Committee on Emergency Care for Children and Young People, Dr Scott Hendry, said:RCEM welcomes the publication of these updated Joint Intercollegiate Standards, which help shape the nature of emergency care provided by general Emergency Physicians and Paediatric Emergency Physicians in departments across the country. Most paediatric emergency care in the UK is provided in general emergency departments.
Almost a quarter (23%) of our patients are children. Standards of this nature are important to ensure that children are equally and properly considered when so much attention is on problems affecting our adult patients.”
Children and young people across the UK deserve the very best emergency care. As demand grows and resources remain stretched, these newly revised standards aim to support the efforts of hard-working frontline paediatric emergency care staff to ensure children and young people receive high-quality, equitable care when they need it most. They aim to strike the right balance between aspiring to the very best, whilst remaining pragmatic and locally deliverable.
This 5th edition update is part of a broader overhaul across the initial 12 chapters, with a newly added chapter on health improvement and inequalities. Each chapter addresses critical aspects of paediatric emergency care, from workforce and training to mental health, safeguarding, and care for children with complex needs.
The newly revised standards introduce critical improvements in a wide range of areas, such as:
- The importance of pre-hospital integrated care and appropriate alternatives to attending paediatric emergency departments
- A renewed focus on adolescent health issues within emergency departments
- New information on redirection, escalation and emergency department crowding policies, marking a shift in how emergency services respond to rising demand
- Updated guidance on appropriate emergency department staffing numbers, training and career development, whilst highlighting other key specialist roles including Play Specialists, Learning Disability Liaison Nurses, Violence Reduction and Family Support workers which help to facilitate high-quality holistic patient care
- The management of mental health crises in the emergency department and the importance of timely mental health specialist review and admission
- Highlighting health inequalities as avoidable and unfair, and positioning emergency departments as a key place to assist children and their families by promoting health and wellbeing support
The standards reflect the evolving challenges faced by emergency departments and sets new standards to improve outcomes, equity, and experience for children, young people, and their families. These standards also form part of the wider Facing the Future framework, which will be refreshed in 2026.