You would not overlook or underestimate the seriousness of major bleeding, not breathing, severe choking, a seizure, or a coma (can’t wake up). These are life-threatening emergencies and you would rightfully call 911. For a poisoning, you would call 1-800-222-1222. Some emergency symptoms, however, are either difficult to recognize or are not always considered serious. If your child has any of the following symptoms, call your child's doctor immediately or go to the nearest ER..
Your baby is less than 1 month old and looks sick (vomiting, cough, poor color) or acts abnormal (poor feeding or excessive sleeping) in any way. At this age, these symptoms are serious until proven otherwise. During the first month of life, infections can progress quickly.
Your child stares into space, won't smile, won't play at all or hardly responds to you. Your child is too weak to cry, floppy, or hard to awaken. These are serious symptoms. Note: sleeping more when sick is normal, but when awake your child should be alert.
The sudden onset of confusion (delirium). Your child is awake but says strange things, sees things and doesn’t recognize you. Note: Transient delirium can be seen for 5 minutes or so with higher fevers. However, if not brief, confusion can have some serious causes.
Inconsolable constant crying is due to severe pain until proven otherwise. Suspect this in children who are unable to sleep or will only fall asleep briefly, and when awake, will not engage in any normal activities. Caution: Instead of constant crying, severe pain may also cause your child to groan, moan or whimper.
If your child has learned to walk and then loses the ability to stand or walk, he may have a serious injury to the legs or a problem with balance. If your child walks bent over, holding his belly, he may have a serious problem such as appendicitis.
Press on your child's belly while she is sitting on your lap and looking at a book. You should be able to press an inch or so in with your fingers in all parts of the belly without a problem. If your child winces or screams, it suggests a serious cause. If the belly is also bloated and hard along with the pain, the problem is even more worrisome. Note: if your child just pushes your hand away, it probably means you haven’t distracted her enough.
Tender testicle or scrotum
Hard time breathing
Breathing is essential for life. Most childhood deaths are due to severe breathing problems. If your child has trouble breathing, tight croup (harsh sound when breathing in called stridor), obvious wheezing or grunting with each breath, she needs to be seen immediately. Other signs of respiratory distress are fast breathing, bluish lips, or retractions (skin pulling in between the ribs). Children with severe respiratory distress, can’t drink, talk or cry. Note: Nasal congestion causes vibrations and some noisy breathing, but usually without any trouble breathing. Check the breathing after you clean out the nose with nasal washes and nasal suction.
The sudden onset of drooling or spitting when your child is ill means your child is having trouble swallowing. The cause can be a serious infection of the tonsils, throat, or epiglottis (top part of the windpipe). A serious allergic reaction can also cause trouble swallowing. Swelling in the throat could close off the airway.
Dehydration means that your child's body fluids are low. Dehydration usually follows severe vomiting and/or diarrhea. Suspect dehydration if your child has not urinated in 8 hours (more than 12 hours if over 1 year old); crying produces no tears; the inside of the mouth is dry rather than moist; or the soft spot in the skull is sunken. Dehydrated children are also tired and weak. If your child is alert and active but not making much urine, he is not yet dehydrated. Children with severe dehydration become dizzy when they stand. Dehydration requires immediate fluid replacement by mouth or vein.
Bulging soft spot
To test for a stiff neck, lay your child down, then lift his head until the chin touches the middle of the chest. If he is resistant, place a toy or other object of interest on the belly so he will have to look down to see it. Older children can simply be asked to look at their belly button. A stiff neck can be an early sign of meningitis.
Purple or blood-red spots or dots
Any fever (over 100.4°F or 38 °C) in the first 3 months
Fever over 105° F (40.6° C)
All the preceding symptoms are stronger indicators of serious illness than the level of fever. All of them can occur with low grade fevers as well as high ones. Fevers alone are considered a risk factor for serious infections only when the temperature rises above 105°F (40.6°C). Therefore, if your child has a fever above 104° F (40° C) that doesn't come down below 104° F (40° C) after taking a fever medicine, call your child's doctor.
Most active chronic diseases can have some complications. If your child has a chronic disease, be sure to find out what those complications are and how to recognize them. The chronic diseases at highest risk for serious infections are those that weaken the immune system (such as sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids, etc). If you are talking with a doctor or nurse who doesn’t normally see your child, always tell them about your child’s chronic disease (such as asthma). Never assume they already know this.
Author and Senior Reviewer: Barton D. Schmitt
Content Set: Pediatric HouseCalls Symptom Checker
Pediatric HouseCalls Symptom Checker