Facing the Future: Standards for CYP in Emergency Care

This episode provides an overview of the 5th Edition of the Facing the Future: Standards for children and young people in emergency care, published in October 2025. The standards serve as an evidence-based resource for driving improvements in the quality and provision of emergency care for all individuals under 18 years of age (1, 12). The new edition addresses the significant pressures on the paediatric emergency care system, including increased demand, insufficient resourcing post-COVID-19, and the need for a more integrated, whole-system approach to Urgent and Emergency Care (UEC) (4).

Key Takeaways for Emergency Department (ED) Clinicians:

• Integrated Care and ED Crowding: The standards strongly advocate for a "whole pathway" approach, developing robust alternatives to ED attendance to protect capacity. Almost 40% of paediatric ED attendances are classified as "non-urgent" (22). EDs must have escalation policies to manage surges and crowding, recognised as a "whole system" issue requiring measures to manage patient input, throughput, and output (47, 48).
• Critical Timelines and Assessments:
• Workforce and Wellbeing: The standards mandate specific staffing competencies, including a minimum of two registered children’s nurses on shift in EDs treating children and young people (CYP) (83). The importance of a multidisciplinary team (MDT), including play specialists and youth workers, is emphasised. Sustainable working practices and staff wellbeing are highlighted as critical for recruitment and retention, with a recommendation for every ED to have a lead for wellbeing (94).
• Mental Health Crisis: Acknowledging a significant increase in CYP presenting with mental health crises (164, 166), the standards require EDs to have clear pathways for assessment and management. This includes creating a low-stimulation environment, parallel assessment of physical and mental health needs, and access to CAMHS or liaison psychiatry advice 24/7. Legal frameworks regarding consent, capacity, and restraint must be understood and applied correctly.
• Safeguarding: EDs are a critical touchpoint for safeguarding. The standards mandate lead clinicians for child protection, 24/7 access to safeguarding advice, and robust systems for identifying frequent attenders and those on a Child Protection Plan/Register (30, 31, 32). Review by a senior decision maker is required prior to discharge for any CYP with safeguarding concerns or specific injury patterns in non-mobile infants (33).
• CYP with Complex Needs: A needs-based approach is required, utilising Emergency Care Plans (ECPs) and Health Passports to facilitate care. Reasonable adjustments, tailored communication tools, and senior decision-maker review are mandated to prevent diagnostic overshadowing and ensure equitable care (49, 198).