Telephone triage is a vital component of UK primary care provision, especially for paediatric patients. With no visual cues and limited examination tools, clinicians rely heavily on their understanding of paediatric pathophysiology to interpret parental descriptions, identify red flags, and guide appropriate interventions. A robust grasp of age‑specific physiology and disease processes is the foundation of effective, safe triage.

Age‑Specific Pathophysiology: Why It Matters

Children are not just small adults—their physiology, symptom presentation, and disease progression differ markedly:

• Infants (0–12 months): High metabolic rate, limited fluid reserves, and immature immune systems mean that conditions like dehydration or sepsis can escalate rapidly. Subtle signs such as reduced feeding or increased irritability can be early indicators of serious illness.
• Toddlers and young children (1–5 years): Respiratory rates are higher; airway obstruction and respiratory distress can develop swiftly. Coughs and wheezing are common, but rapid breathing, chest indrawing, or lethargy warrant urgent response.
• School‑aged children and adolescents (6–16 years): They present more adult-like physiology, but things like appendicitis may present atypically. Understanding underlying developmental changes helps differentiate between benign and critical presentations.

Enhancing Triage Through Clinical Insight

Understanding these physiological nuances enables telephone triage professionals to:

1. Ask Targeted Questions
   Instead of only asking “How high is the fever?”, reflecting pathophysiology means following up with “How’s their urine output or wet nappies?” for infants, which is crucial in assessing hydration.
2. Interpret Vague Symptoms Correctly
   A report of “just not right” in a baby may signal hypoglycaemia, infection, or significant dehydration. Leveraging pathophysiological knowledge directs follow-up questions and safe advice.
3. Recognise Red Flags
   Knowing that babies can’t mount strong fevers or that toddlers’ respiratory compensation can quickly fail encourages clinicians to act on subtle signs, rather than rely on temperature alone.
4. Balance Risk and Reassurance
   Presentations like fever without other symptoms in school-aged children may be low risk. Understanding the maturation of their physiological systems supports confident reassurance without over‑referral.

Training Makes a Difference

Developing this skill set doesn’t happen in isolation—it’s cultivated through structured training, case-based scenarios, and clinical experience. Clinicians who understand how pathophysiology informs presentation provide safer, more nuanced, and patient-centred triage.

The PDUK course, Paediatric Telephone Triage: Principles, Practice, and Scenarios, offers primary care professionals tailored guidance. This interactive course blends principles of paediatric physiology with real-world triage scenarios, helping clinicians ask the right questions, interpret information with confidence, and make safe, evidence-informed decisions during telephone consultations.

Conclusion

In the hands of skilled clinicians, telephone triage becomes more than solving puzzles—it’s a lifeline. By grounding telephone assessments in paediatric pathophysiology, professionals ensure that symptoms are interpreted meaningfully, risks are managed accurately, and children receive the best possible guidance from the very first phone call. Training—like that offered by PDUK—bridges knowledge to action, making those calls both safer and more effective.

References

Buchanan, H., & O’Brien, D., 2021. Paediatric telephone triage: principles and practice. British Journal of General Practice, 71(702), pp.e389–e391.

Fleming, S., Thompson, M., Stevens, R., et al., 2020. Normal ranges of heart rate and respiratory rate in children from birth to 18 years: a systematic review of observational studies. The Lancet Child & Adolescent Health, 4(5), pp. 424–432.