A few weeks ago, my 6-year-old son developed a fever, severe abdominal pain and repeated vomiting in the middle of the night. Concerned, my husband and I brought him to the emergency department at Queensway Carleton Hospital in Ottawa.
At triage, a nurse assessed him, checked his vital signs and collected a urine sample to rule out a urinary tract infection. Then we waited.
It was more than eight hours before a physician examined him.
During that time, his condition visibly worsened. He vomited repeatedly. The pain intensified to the point where he struggled to stand or walk. We returned to triage to explain that his symptoms were escalating and asked whether he could be reassessed. We were told there was nothing that could be done and were given vomit bags before being asked to continue waiting.
When we were finally seen, the urine test was clear and we were advised to proceed to the Children’s Hospital of Eastern Ontario for further evaluation.
There, we waited another four hours before an ultrasound confirmed appendicitis. We were told surgery was urgent because appendicitis in children can progress rapidly and lead to serious complications if untreated. Yet even after diagnosis, several more hours passed before surgery began.
Thankfully, the surgery was successful and our son recovered well. But what stayed with us was not only the diagnosis –it was what the surgeons told us afterward: his appendix was severely inflamed and close to rupturing.
The most troubling part of this experience was not the wait itself. It was the absence of any meaningful reassessment while his condition deteriorated in real time.
Ontario’s emergency department crisis is well documented. Overcrowding, staffing shortages and long wait times have become normalized across the province. But far less attention is paid to what happens to patients during those waits –particularly children whose symptoms may escalate quickly.
In our case, there appeared to be no structured process to reassess a child whose condition had visibly worsened after triage. His place in line did not change even as his symptoms became more severe.
This reflects a broader systems issue rather than an isolated experience.
Emergency department triage is designed to prioritize patients based on urgency. But urgency is not static. Conditions evolve while patients wait, especially in pediatric cases in which children may deteriorate rapidly and may not always be able to communicate worsening symptoms clearly.
That is why reassessment matters.
Yet in practice, reassessment protocols during prolonged waits can be inconsistent, especially in overcrowded emergency departments operating under severe staffing pressure. Families are often left uncertain about how to escalate concerns when symptoms change.
For children, this gap carries particular risks.
Conditions such as appendicitis depend heavily on timely intervention. Delays in diagnosis and treatment can increase the likelihood of complications, including perforation and infection. While emergency departments cannot eliminate wait times entirely, they can improve systems for identifying patients whose condition changes while waiting.
Relatively simple interventions could make a meaningful difference:
- scheduled reassessment intervals for pediatric patients,
- clearer escalation pathways for caregivers,
- and dedicated staff responsible for monitoring patients in waiting areas during periods of high demand.
While these measures would not solve the emergency care crisis, they could reduce the risk of children deteriorating unnoticed while waiting for treatment.
The current reality places too much responsibility on parents to continuously advocate for reassessment within already overwhelmed systems. No parent should spend hours wondering whether their child’s worsening symptoms are becoming dangerous while remaining effectively frozen in the same queue position.
Canada’s health-care system is built on the promise of timely and equitable care. Yet experiences like ours reveal that access alone is not enough. Safety also depends on what happens after triage –particularly when conditions evolve faster than the system can respond.
Long emergency wait times are now widely recognized as a structural problem. Until that is alleviated, the next conversation we have should focus on what protections exist for patients, especially children, while they are waiting.
Because children should not deteriorate unnoticed in emergency department waiting areas.
