S
Send the parent outRoutinely from about eleven, which is where the guidance starts, and at any age when the question is a private one. Ingestion, self-harm and fear are rarely disclosed with a parent in the room. If you suspect abuse, ask as little as possible and refer — a detailed interview is a specialist’s job, not yours.
C
Chest — and a quiet one is the emergencyThis is the peak age for asthma admission and for preventable asthma death. The wheeze was evidence that air was moving. Silence in a tiring child, or one who has stopped fighting you, means the situation has already changed.
H
Hip, when they say kneeReferred pain is the trap of this age group. Perthes disease and a slipped upper femoral epiphysis both present as knee pain in a child who cannot localise reliably, and both are missed by examining the knee they pointed at.
O
Out of proportion to the film?If the child is markedly worse than the radiograph explains, stop attributing it to the radiograph. Something unimaged is happening — an airway that has occluded, a circulation that has embolised, or both at once.
O
Overdose is deliberate nowAt the top of this band ingestions stop being accidental. Every deliberate ingestion needs a mental health assessment and not just a paracetamol level, and the question has to be asked privately.
L
Listen for what they will not sayPain, because they are being brave or because it means a needle. Fear, because the parent is there and they are protecting them. And what they think is happening, which is usually worse than the truth. Ask directly; they will often tell you.
Choose one, then send. The button opens a reply straight to me with your choice already in it —
just add your reasoning.