During her eight-year-old son's hospital stay, his mother Jodie - a registered nurse - kept telling staff something wasn't right.
However, she was left feeling like "that dramatic parent who is worrying about nothing".
Barely 48 hours after being admitted to hospital, her autistic son Hunter was dead.
A coroner has found staff at a regional Queensland hospital did not act on Jodie's calls for reassessment and failed to properly diagnose the boy who died of a bowel obstruction in March 2020.
In her non-inquest findings, acting coroner Ainslie Kirkegaard said a "constellation of issues" led to a failure to recognise and respond to the boy's deterioration.
Hunter - who was diagnosed with autism at two years old - was taken to the unidentified hospital's emergency department with stomach pain on the afternoon of March 15, 2020.
He was transferred to the paediatric ward with his mother Jodie - who staff were aware was a registered nurse - by his side.
A nursing entry made at 2.45pm the next day on March 16 noted that Hunter was "miserable".
He suffered persist abdominal pain and increasing vomiting but couldn't tell doctors specifically where his stomach was hurting.
In messages sent to her husband on the second evening, Jodie expressed concerns about their hospital stay.
She felt "like everyone is getting the s***s with me because Hunter is sick".
Jodie thought her son's condition should have improved but felt "I'm being that dramatic parent who is worrying about nothing".
Hunter vomited about 1.5 litres on the second night.
At 9.30am next day an urgent review was requested with about 20 doctors present.
"Don't worry Jodie about all these doctors here, they are here so we don't miss anything," the mother was told.
Jodie asked during the review whether they thought her son had a bowel obstruction but they didn't think so.
He deteriorated further and at about 11.45am "suddenly turned grey, his lips were blue, his eyes sunken".
Hunter was declared dead soon afterwards.
"Hunter's family expressed significant concern about the apparent failure by his treating teams to recognise and respond to his clinical deterioration despite Jodie voicing her concerns," the coroner wrote.
"The family also felt the surgical team did not have enough training in looking after children with autism.
"Her concerns that something was not right were not acted on with reassessment and further clinical investigations."
The coroner said while Hunter's autism complicated his assessment, clinical information coupled with repeated parental concerns should have prompted the junior surgical team to seek consultant input as early as his first night at the hospital.
"The lack of senior surgical and paediatric oversight, review and management was a significant missed opportunity to have further investigated and diagnosed (Hunter)...and may potentially have changed the outcome," Ms Kirkegaard said.
The coroner was satisfied that the Hospital and Health Service had conducted a comprehensive review that identified management and decision-making deficiencies.
She said the hospital had since taken appropriate steps to implement guidelines for managing paediatric patients with acute abdominal pain including those with developmental disorders.
"The circumstances in which Hunter died reinforce the vital importance of treating teams listening to and acting on parental/family/carer concerns about a paediatric patient," the coroner wrote.
"No parent or carer who knows their child best, let alone one with current clinical training and knowledge, should ever be left feeling like they are being 'that dramatic parent is who is worrying about nothing'."
