Anytime your child feels even slightly sick it might be tempting to rush off to the doctor. While a trip to the doctor isn't always necessary, it's critical to be able to recognize when your child is sick enough that they needs medical attention. Being able to see the signs ensures your child gets help when they need it—plus, it prevents unnecessary visits to a health care provider or emergency room. Most parents know to call a health care provider when their child has a high fever, but it is important to keep in mind that a fever is not the only serious symptom of an illness. On the other hand, no one wants to be the parent that cries wolf.
Other reasons to seek medical attention include a lethargic baby (when they don't easily wake up), irritability (unusually fussy and can't be consoled), confusion, difficulty breathing, or rapid or weak pulse. Read on for a few tips about when to know for sure that it's time to call the pediatrician.
Fever
Fever is not an illness all by itself. Instead, fever is a symptom that can accompany many childhood illnesses including bacterial, viral, and fungal infections. In general, you should call a health care provider about fevers in the following situations:
- An infant under 3 months of age has a temperature at or above 100.4 F
- An infant over 3 months of age has a temperature at or above 102.2 F
- Fever persists for more than two to three days
- Fever occurs with other symptoms (such as cold and flu symptoms or vomiting and diarrhea) and persists for more than one to two days
For kids over 2 months old, it isn't the number on the thermometer that matters, but rather how the child is acting that will tell you whether to seek medical attention or not. If your child is alert, active, and playful, is not having difficulty breathing, and is eating and sleeping well, then you don't necessarily need to call immediately, but you should still follow a fever treatment plan until your child feels better.
You should call a health care provider if your child has a fever and another medical condition (for example, heart disease, cancer, sickle cell, or immune system problems).
Vomiting
Vomiting and stomach ache typically accompany diarrhea as part of an acute gastroenteritis or stomach virus in kids. It is usually not concerning if your child has only vomited a few times, is keeping small amounts of fluids down, doesn't have significant abdominal pain, and is not dehydrated.
Seek medical attention for vomiting if your child develops the following:
- Symptoms of dehydration (less urination, lethargy, thirst, sunken eyes, rapid breathing)
- Vomiting after a head injury
- Severe headache or abdominal pain
- Vomiting for more than 24 hours
Vomiting is especially concerning if it begins after your child already has abdominal pain, which often happens in children with appendicitis.
Coughing
A cough and runny nose occur commonly in children with colds. These are caused by viruses and do not need antibiotics, which kill bacteria, not viruses. If they are otherwise feeling well, then you don't need to go to a health care provider every time your child has a cough, even if they also have a runny nose with green discharge.
Seek medical advice for a cough in the following situations:
- Your child's cold symptoms continue to worsen after three to five days
- They develop a new fever a few days after a cough has started
- They aren't improving in 10 to 14 days
- They have another specific complaint, such as ear pain, a constant cough, chest pain, a wheezing cough, or trouble breathing.
Most coughs will last up to three weeks, though you should see improvement (less severe, less frequent coughing) in 10 to 14 days.
Trouble Breathing
Children often have a cough and sometimes a wheeze when they have a viral upper respiratory tract infection. If your child is having difficulty breathing, then you should call a health care provider.
If you are worried that your child is having trouble breathing, take the child's shirt off, and while the child is as comfortable and distracted as possible (like watching TV or playing on a phone), look for the following:
- Count breaths: Count how many times the child breathes in 60 seconds (this is helpful to tell the health care provider when you call and to determine whether your child's breathing is getting better or worse over time).
- Check their ribs: Look at the space in between your child's ribs. Do you see the skin suck in between the ribs when the child takes a breath? If yes, this means that the child is using more of their chest muscles to breathe and is having trouble breathing.
- Check the collarbones: Look at the space in between the child's collarbones. Does the child suck in there with each breath? If yes, this shows the child is working harder to breathe.
- Check the nostrils: Look at the child's nostrils. Are they flaring in and out with each breath? If yes, the child is working harder to breathe.
A child who is having trouble breathing may also have trouble catching their breath. You might notice that they pause to breathe in the middle of a sentence.
Dehydration
Children most commonly get dehydrated when they have diarrhea and vomiting from ongoing losses of fluid, but it is also possible to get dehydrated if your child just isn't drinking well.
The first sign of dehydration is that your child will urinate less frequently (your child should be urinating every six to eight hours). Other symptoms of dehydration can include:
- Dry mouth
- Not having tears when crying
- Sunken eyes
- Decreased activity
Weight loss can also be a sign of dehydration.
Irritability
Fussiness accompanies many childhood illnesses. If your child is fussy and crying but is easily calmed if you just hold them, there isn't necessarily a reason to worry. However, it might be concerning if your child is inconsolable and continues to cry for hours without stopping.
An inconsolable child would could also be a reason to seek immediate medical attention, especially if they also have a fever or other symptoms.
Lethargy
If you call a health care provider's office and say that you have a lethargic baby, you'll likely be told to bring your child in right away. But you need to make sure you're using the term correctly: Being lethargic, in medical terms, is usually an emergency and means your child is difficult to wake up. Be aware that lethargy does not mean that a child's activity is just a little decreased or that they seem more tired than usual.
If your child is lethargic and difficult to wake up, you should seek medical attention right away. It is less concerning if they are awake and alert but not as active as usual.
Childhood Rashes
Childhood rashes can be caused by many things, including:
- Sensitive skin
- Warts
- Poison ivy
- Chickenpox
- Fifth disease
- Roseola
In general, you should call a health care provider if your child has a rash and a fever, especially if the rash is purple and doesn't blanch or fade briefly when you press on it or an itchy rash that isn't relieved with home remedies.
Emergency Symptoms
Other symptoms that are usually concerning and require medical attention include, but are not limited to:
- Coughing up blood, vomiting blood, or having bloody diarrhea, especially if is accompanied by a fever
- Persistent pain, whether abdominal pain, a headache or knee pain, or severe pain, especially if it limits mobility and isn't relieved by home remedies
- Signs of seizures, especially if your child doesn't generally have a seizure disorder, such as febrile seizures or epilepsy
- Testicular pain, which is usually a medical emergency
- Head injuries, especially if your child had a loss of consciousness, is acting differently than usual, and may have a concussion
- Cuts and scrapes that require stitches, including those with persistent bleeding, or if the wound is deep and gaping or the skin doesn't come back together
- A severe allergic reaction that includes vomiting, drooling (which can mean that the tongue is swollen), or trouble swallowing or breathing
- A severe headache, especially if your child also has a stiff neck, irritability, vomiting, or fever
- Pain when urinating (dysuria), which can be a sign of a urinary tract infection
- Weight loss, which is hardly ever normal in children and can be a sign of a more serious or chronic illness
For children with chronic symptoms, such as headaches or stomachaches, you should call a health care provider if your child's symptoms seem worse than usual.
When in Doubt, Call a Health Care Provider
Trust your instincts and seek medical attention when your child is sick, especially if you think that your child appears visibly ill. You should also call a health care provider if your child's symptoms are worsening, even if they were recently seen.
Most health care providers have someone answering the phone 24/7, and that person can often help you decide over the phone whether the child is fine, needs to come in for a sick visit, needs to go to urgent care, or needs to go directly to an emergency room. It is always better to call if you have questions or concerns and let the medical professionals help you decide what is best for your child to get them feeling better.