5. Ms L complains that clinicians at the Trust did not diagnose her son, A, with a fractured collarbone in early January 2025.
6. As a result, Ms L says A was in pain longer that he should have been. She also says this caused her significant anxiety, distress, and difficulty in sleeping.
7. As outcomes for her complaint, Ms L would like service improvements and a financial remedy.
8. In early January 2025, Ms L attended the ED at the Trust with A after he fell from his highchair at home.
9. Clinicians assessed A and discharged him home on the same day. The Trust said it advised Ms L to return if he stopped using his arm so it could carry out further assessments.
10. On the next day, Ms L attended the ED at a different Trust. Clinicians there performed X-rays and noted that A had fractured his clavicle (collarbone).
15. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.
16. Section 6 of the above GMC guidance says, ‘You must provide a good standard of practice and care. If you assess, diagnose, or treat patients, you must work in partnership with them to assess their needs and priorities. The investigation or treatment you propose, provide, or arrange must be based on this assessment, and on your clinical judgement about the likely effectiveness of the treatment options.’
17. Section 7 says, ‘In providing clinical care you must:
• ‘adequately assess a patient’s condition(s), taking account of their history, including • symptoms • ii. relevant psychological, spiritual, social, economic, and cultural factors • iii. the patient’s views, needs, and values • carry out a physical examination where necessary’.
18. Ms L says clinicians at the Trust failed to diagnose A with a fractured collarbone in early January 2025 when they attended the ED there. She believes clinicians did not assess him as they should have and, had they done so, would have diagnosed the fracture.
19. The Trust said A did not display any symptoms which indicated a scan was needed. It also said clinicians are cautious about radiological investigations in young children as it involves radiation at an early age that may have long term adverse outcomes.
20. Ms L attended the Trust with A after he fell from his highchair. We can see from A’s clinical record that at 2.53pm on the same day, a triage nurse in the ED wrote that he had, ‘equal limb movement’.
21. Our adviser said this is good practice as clinicians often look for head injuries in the first instance and can overlook smaller fractures. They said it was reassuring as the triage nurse was clearly looking for evidence of other fractures.
22. From A’s records, we can also see a different clinician wrote that he had been, ‘crawling and playing in waiting room’.
23. At 5.33pm, a doctor reviewed A and wrote that he, ‘sits up on mum's lap throughout exam reaching with both arms to pull mum’s hair and play with sister and wiggling his legs symmetrically’. They also wrote that A has, ‘no developmental concerns and is crawling well’.
24. From the records, we cannot see any evidence of any other symptoms including bruising. Ms A did not raise any concerns regarding changes of movement or that A could not move his arm.
25. The doctor then wrote, ‘examination cont [sic] child fully exposed’. We note Ms L told us the clinician did not remove A’s clothes to complete the examination. Our adviser said it is important to feel a child’s head and limbs, but clinicians do not need to remove clothes to complete an assessment like this.
26. Our adviser gave their opinion that while the Trust did not diagnose a fracture there were not any symptoms present which indicated this. Evidence would be concerns about arm movement or bruising.
27. From our review of the records, we have seen that A had been crawling normally with no bruising recorded.
28. Our adviser said that collarbone fractures are very common in children and clinicians can usually diagnose these without the need for an x-ray. They added that they are stable fractures and clinicians would not normally complete any intervention or follow up treatment (including appointments at a fracture clinic). Children can experience pain for a few days, but the fracture will then generally heal by itself.
29. We can see the Trust discharged A on the same day without diagnosing a fracture. The discharge information said, ‘home with reassurance and written advice leaflet. return if LOC [loss of consciousness], seizure, abnormal behaviour, vomit, concern. mum happy with advice and plan’.
30. Our adviser said that the assessments and information clinicians gave Ms L on A’s discharge were in line with the above sections of the GMC guidance.
31. Clinicians said that if symptoms worsened, Ms L could return to the Trust with A. At the time, they recorded that she was ‘happy with advice and plan’.
32. We know now that unfortunately A did have a fractured collarbone at the time of the assessment. A different Trust diagnosed this by X-ray when Ms A attended while visiting family in a different area.
33. While we know this is the case, we find the Trust acted within guidelines in its assessment of A. Clinicians did not see any symptoms at the time which indicated he had a fracture and completed the assessment in line with GMC guidelines. As such, we will take no further action on the complaint.
34. We fully acknowledge the distress Ms L felt when she knew A had a fracture. We know the real worry she felt for him knowing this. We hope A has fully recovered from his injury.
35. We also hope that our report has provided some reassurance to Ms L about the nature of this type of fracture, how it is assessed, and what is usual practice following a diagnosis.
1. We have carefully considered Ms L’s complaint about her son, A’s, assessment at the Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust (the Trust).
2. We are very sorry to hear about A’s fall and know that as his mum, this was a really worrying time for her.
3. After considering Ms L’s complaint, which included a review of A’s medical records and clinical advice we received from an independent emergency department (ED) consultant, we have seen no indication that anything went wrong. We will therefore take no further action on the complaint.
4. We will explain the reasons for our decision in detail below.