Respiratory Surge in Children - elearning for healthcare
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This programme is in partnership with...
  • Health Education England_New logo 2021
  • NHSI-partner
  • Paediatric Critical Care Society
  • London Transformation and Learning Collaborative

About the Respiratory Surge in Children programme

Our aim
The Respiratory Surge in Children Programme aims to support the cross-skilling of the NHS workforce to manage:

  • existing demand in children
  • potential future spikes in paediatric demand as a result of respiratory syncytial virus (RSV) and other respiratory illnesses in children
  • longer-term increasing paediatric acuity and demand in children

We aim to provide content that is appropriate for various settings where a child will present with respiratory illness, including home, primary and community care, and across the acute hospital environment. Within the skills matrix (below) and educational resources on this page, the term child is used to represent infant, child and young person. We are continuing to build this site and more content will be added in the coming days and weeks. The additional resources will include educational materials and links curated from different sources such as educators across the NHS and other organisations, existing HEE elfh sessions, and commissioned sessions to fill gaps (see section on ‘Share your resources’).

How to use the Respiratory Surge in Children programme:

Step 1: Explore the multimedia resources
Step 2: Share any new resources or feedback with our team
Step 3: Tell your colleagues about the programme with this downloadable poster / PDF

**The ‘Interprofessional Skills Matrix’ has been temporarily moved to the bottom of this programme page as it is under revision whilst we improve the functionality.

  • See further detail here

    Staircase graphic showing the 3 steps for how to use the programme
    Step 1: Explore the multimedia resources to:

    Step 2: Share any new resources or feedback with our team

    • Help us expand and improve this resource by sharing resources or feedback (see how in the ‘Share your resources and feedback’ section below).

    Step 3: Tell your colleagues about the programme with this downloadable poster / PDF

    • Print / share this poster with your colleagues to make them aware of the programme and resources available
  • Current updates in progress

    Completed in update 22 September 2021:

    • New skills matrix uploaded with most of the resources on the programme hub mapped to competencies
    • 45 new resources added

    Current updates in progress / ongoing work includes:

    • Creation of “Rapid Access Reading lists for Subgroups” (e.g. for community nurses to revise RSV presentation and escalation of care, for the ward nurse deploying to HDU / ITU, and for those wanting to understand basics of High Flow / High Velocity Therapy.)
    • New “Educators” section to include competency documents and simulation scenarios (Please submit content you’d be happy to share to or any additional suggestions for this new section)
    • Review of where “Differences between adults and child” should sit – possibly merge with “Family Centred Care”
    • New drop down in Family Centred Care for “Patient Information Leaflets to make these rapidly accessible to staff at work
    • New learning objectives (including objectives in the domains related to “Breathing”, “Medication” Management” and “Wellbeing”)
    • We are still seeking further input to develop learning objectives for community settings
    • Ongoing review of the matrix by colleagues from various professional areas, including AHPs, ODPs, pharmacists and community teams and decisions about how to utilise the matrix effectively.

Overarching resources

This section includes:

  • Resources addressing topics which are relevant across the 6 domains listed below. Examples include infection prevent control (IPC)
  • Resources that address multiple domain topics and provide context as to why they are important. Examples include the RCPCH special webinar on bronchiolitis

1. Recognition, management and escalation: care of the sick child

This domain provides resources that enable healthcare providers and carers across all settings to use a systematic approach to identify deteriorating infants and children. Children with respiratory or circulatory failure become hypoxic and acidotic. Early recognition and treatment of respiratory and circulatory failure can prevent progression to severe illness.

2. The care and management of the child with respiratory illness

This domain outlines the pathophysiology, signs and symptoms, and recommended treatment for children with respiratory disease being cared for in various settings including viral bronchiolitis. Most cases of viral bronchiolitis are due to respiratory syncytial virus (RSV). While self-limiting, bronchiolitis can be life-threatening in infants who were premature or have underlying respiratory, cardiac, neuromuscular or immunological conditions.

3. High flow / High velocity oxygen therapy

High flow / High velocity heated and humidified oxygen therapy is being increasingly used as treatment for children with respiratory illness. This therapy delivers oxygen through the nasal passages at higher rates than is achieved through standard nasal oxygen. This domain provides information on the theory, existing evidence, and practice of using high flow / high velocity oxygen therapy. It also includes videos describing set up of 3 high flow delivery systems.

There are multiple, widely used abbreviations for High Flow Therapy or High Velocity Therapy, with little consensus. For clarification, the Respiratory Surge in Children programme refers to these devices as “High Flow/ High Velocity Therapy” to encompass the wide range including specialist devices and ventilators that can provide this support. All can be used with or without oxygen. You may also see these devices referred to as Heated Humidified High Flow therapy (HHHFT), High Flow Oxygen Therapy (HFOT), High Flow Nasal Cannula (HFNC) or simply High Flow. These are all referring to same devices, unless otherwise stated.

EQUIPMENT GUIDES: We are in the process of adding high flow / high velocity oxygen to our LTLC Equipment Guide. This mobile friendly web app allows the user to rapidly access quick guides, manuals, and training videos for most of the equipment used in critical care units. Please explore it and let us know of any equipment we should add by emailing

4. Medicines management and Differences between child and adult

This domain provides guides to support safe management of medications for sick children, including opportunities to practice calculations. This is relevant for both paediatric and adult trained staff across a variety of settings.

It also includes essential information on physical and psychological differences between adults and children, and critical variations in physiology which are important to understand in all contexts, including when prescribing.

5. Family centred care

Family centred care is central to the provision of healthcare for any child in the UK. This domain describes how family centred care is practiced, what this means for those providing care, and essential communication techniques when working with a hospitalised child and their family. This section also explores key information about safely discharging patients, safety netting and approaching conversations about the COVID-19 vaccination in pregnancy.

6. Emergency advanced stabilisation and transfer

All children’s acute care providers must be able to appropriately assess, treat, stabilise and escalate all critically ill children, including those requiring transfer, to a level 3 unit internally or externally. This domain includes resources to support safe delivery of advanced stabilisation of the critically ill child, covering recognition, monitoring, treatment, escalation and use of transfer equipment.

7. Wellbeing and staff recovery resources

During patient surges staff may need to flex to support different areas. We have learnt from other surges that the better prepared staff are in advance, the easier this is physically, emotionally and mentally.

It is important we check in with each other regularly, so these resources are designed to help us all have honest conversations, de-fuse and connect with colleagues. Not all people approach wellbeing by the same means; these resources acknowledge those differences and cover a variety of approaches.

Staff Recovery Resources page

The Royal College of Paediatrics and Child Health (RCPCH) have collated wellbeing materials from across the country which can be accessed here.

Interprofessional skills matrix

Graphic representing the Skills Matrix documentWe have developed a skills matrix, appropriate to all professions, that maps key educational content to the skills they address, by domain (e.g. Recognition, management and escalation: care of the sick child) and level of paediatric care (primary and community care / out of hospital, ward based / Level 1, Level 2 or Level 3). The content is matched against RCPCH and RCN / NMC professional competencies to aid presentation for revalidation and appraisal.

Download the London Transformation and Learning Collaborative (Microsoft Excel, 162KB)

The skills matrix is under active revision, so please regularly check this document for the latest version. Please use the blank worksheets in the skills matrix download to note and feedback suggested amendments to existing learning outcomes or additional content you feel should be included. E-mail these suggestions to:

Share your resources and feedback

We want to make this Respiratory Surge in Children programme as comprehensive and fit for purpose as possible for you, the user. To do this, we need your help through sharing your resources, making suggestions and feeding back on content that needs changing or improving:

  • Share resources

    Please email if you have any paediatric educational resources to share (related to the existing topics list or others), so we can continue to build this resource. Author recognition will be given.

  • Provide feedback

    We are keen to improve, so let us know any feedback you have about this site or resources via email (

  • Further information

    NHS England/Improvement and Health Education England have worked in partnership to develop this approach which has already been extensively tested with stakeholders.

    Please contact us for any further information or questions about the programme (

How to access

In order to access the Respiratory Surge in Children programme, you will need an elfh account. If you do not have one, then you can register by selecting the Register button below.

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To view the Respiratory Surge in Children programme, select the View button below. If you already have an account with elfh, you will also be able to login and enrol on the programme from the View button.

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Registering large numbers of users

If you are a HR, IT or Practice Manager and would like to register and enrol large numbers of staff within your organisation for access onto the Respiratory Surge in Children programme, please contact elfh directly.

More information

Please select the following link for more information on how to use the elfh Hub.

elfh is a Health Education England programme in partnership with the NHS and professional bodies