When to Worry: A Parent’s Quick Guide (0–3 Years)

What parents need to know first

Some illnesses in babies and young children can become serious very quickly. Knowing the warning signs can help you act fast.

Get urgent medical help right away if your child has any of the following:

• is extremely sleepy, hard to wake, or not responding

• is struggling to breathe

• has pale, blotchy, or blue skin

• has a seizure

• has a rash that does not fade when you press on it

Go to the emergency department as soon as possible if your child:

• is crying constantly or is unusually irritable

• is feeding poorly

• is vomiting a lot, or vomiting green or blood-stained fluid

• is passing much less urine than usual

Most importantly, you know your child best. If your child seems very unwell, trust your instinct and seek medical care.

What to do if you are worried

Babies and young children who have the symptoms listed below may have a serious illness and need medical attention quickly.

If you notice any of these signs, do not wait. Get help as soon as possible.

The fastest ways to get urgent medical care are:

• call emergency services for an ambulance

• or take your child to the nearest emergency department

When to call an ambulance immediately

Call emergency services right away if your child has any of these symptoms:

• severe drowsiness or they are very hard to wake

• not responding normally

• difficulty breathing or unusual breathing

• cold hands or feet with pale, blotchy, or blue skin

• a seizure

• a rash that does not fade when pressed

Warning signs explained

1. Severe drowsiness or unresponsiveness

It is normal for babies and young children to be sleepy at times, especially after feeding. But if your child seems much sleepier than usual, this can be a warning sign.

Seek help immediately if:

• your child is very difficult to wake

• you try several times and they do not respond properly

This can happen in serious conditions such as:

• low blood sugar

• meningitis, which is a serious infection affecting the brain and its coverings

2. Difficulty breathing or unusual breathing

A child who is having trouble breathing may:

• breathe much harder than usual

• have a constant cough or wheeze

• have the skin or muscles pulling in between the ribs while breathing

• be unable to make sounds or speak normally

In more severe cases, your child may:

• look exhausted

• appear blue

• become unusually quiet

• make a grunting sound with each breath

These symptoms can happen with serious illnesses such as:

• pneumonia

• severe asthma

3. Cold hands or feet, or pale, blotchy, or blue skin

If your child’s hands or feet feel cold and their skin looks pale, patchy, blotchy, or blue, this may mean:

• poor blood circulation

• low oxygen levels in the body

This can happen in serious illnesses such as:

• bacterial infections

• pneumonia

4. Seizures

During a seizure, a child may:

• have their eyes roll back

• stop responding

• shake strongly in the arms and legs

• breathe in a shallow or unusual way

In this age group, seizures are often febrile seizures, which happen with fever. They are frightening to witness, but children usually recover completely from them.

Even so, a seizure always needs urgent medical attention.

5. A rash that does not fade when pressed

If your child has red or purple spots or blotches on the skin that do not fade when you press firmly on them with a clear glass, this can be an early sign of meningococcal infection, which is life-threatening.

This is an emergency. Get help immediately.

When to go straight to the emergency department

Take your child to the nearest emergency department if they have any of the following:

• unusual irritability or they cannot be settled

• continuous crying

• fewer wet nappies or much less urine than usual

• poor feeding

• repeated vomiting, or vomit that is green or blood-stained

Other important warning signs

1. Irritability or unusual crying

All babies cry, and some cry more than others. But crying may be a sign of pain or serious illness if your child:

• is persistently irritable

• cries in a high-pitched, weak, or unusual way

• cries continuously

• is extremely difficult to comfort or settle

2. Less urine than usual

If your child has fewer than half the wet nappies they usually have in a day, this may be a sign of dehydration.

This needs medical attention, especially in babies and young toddlers.

3. Poor feeding

If your child is not feeding well, refuses feeds, or has no interest in drinking, this may be an early sign that they are becoming unwell.

In young children, poor feeding can quickly lead to dehydration.

4. Frequent vomiting, or vomiting blood or green fluid

Vomiting can happen for many reasons. Sometimes it is the body’s way of getting rid of something it does not tolerate. But vomiting can also be a sign of:

• infection

• illness

• blockage in the stomach or intestines

Ongoing vomiting can lead to:

• dehydration

• dangerous chemical and salt imbalances in the body

Go to the emergency department if your child:

• vomits blood-stained fluid

• vomits green fluid

• has vomiting with severe or ongoing stomach pain

• cannot keep anything down and is still vomiting after 12 hours if under 5 years old

• cannot keep anything down and is still vomiting after 24 hours if over 5 years old

Fever: when should parents be concerned?

A fever means a temperature above 38°C.

Most fevers in children are not caused by a serious illness. But sometimes fever can be a sign of something more important.

Seek medical care immediately if:

• your child has a weak immune system and develops a fever

• your baby is 0 to 3 months old and has a fever

In these situations, your child should be seen urgently by a doctor, such as your GP or at the emergency department.

If your child is older than 3 months and has a fever:

Take your child to a doctor if they have a fever and:

• it has lasted 2 days or more

• they are having trouble breathing

• they are drowsy

• they seem mildly dehydrated

• they are refusing to drink

• they are urinating less often

• they have a stiff neck

• they have a mild headache

• light seems to hurt their eyes

• they are vomiting

• they have a rash

• they have had a febrile seizure

• they have mild pain or discomfort that does not improve with pain medicine
  

Also see a doctor if your child simply does not seem well, seems to be getting worse, or you are worried.

A final message for parents

Young children can become sick quickly, especially babies. Sometimes the signs are obvious, and sometimes the main clue is simply that your child is "not acting like themselves".

Trust your instincts. If something feels wrong, it is always safer to have your child checked.