Anyone who has ever cared for children knows how difficult and scary it can be when a child is sick or injured. It is not always clear how best to proceed. Certainly you do not want to go to an emergency room every time you have a question about your child’s health. Emergency rooms can be crowded and noisy, and often have long wait times. The visit can be stressful for both you and your child. On the other hand, you do not want to miss something serious.

The two most important questions that decide whether your child is seriously ill:

How does your child look?
How is your child responding?

Watch for the following red flags. If your child shows any of these symptoms, immediate medical care is required.

Is your child extremely tired, limp or not responding?
Does your child have pale or blue skin?
Does your child have a stiff neck?
Is your child’s speech garbled or confused?
Is your child unable to stand or walk properly?
Is your child crying and cannot be comforted?

For most common injuries and illnesses, children do not need to see a doctor urgently. Often, you can wait to visit your family doctor in the next day or so.

Doctors and other health care providers have a list of criteria they use to decide whether or not a child is seriously ill or just under the weather. For instance, it makes a difference if your child is very dehydrated or unconscious. You can ask yourself certain questions to help decide if your child needs immediate medical attention.

Fevers

Use a thermometer to measure your child’s temperature. Anything above 38 C (100.4 F) is considered a fever. Fever is one of the ways the body fights infection. It is not necessarily cause for alarm. As long as you do not notice any red flag symptoms, immediate medical care is not necessary. Watchful waiting is warranted if your child is playing calmly or sleeping comfortably, or happy to be cuddled.

If your child is crying or appears uncomfortable, you may want to bring the fever down with an anti-fever medication like acetaminophen (Tylenol™). Never give your child ASA (acetylsalicylic acid-Aspirin™).

If your child’s fever is above 41 C, then at the least seek medical advice by phone. A high temperature does not necessarily mean that your child is seriously ill (just as a lower temperature does not guarantee that your child is less sick). However, it is a good idea to get some professional advice if the temperature is way up.

Special note: Any infant less than six months old who has a fever (measured by thermometer) should be seen by a doctor as soon as possible.

Vomiting and diarrhea

The most common cause of vomiting and diarrhea in a child is a viral infection in the digestive system. This is often called stomach flu. Most of these infections are self-limiting, meaning that they will get better on their own. The main thing to watch for is whether or not your child is properly hydrated (has enough fluid in the body). Signs of poor hydration include fewer wet diapers or fewer pees in the toilet, crying without tears, and a dry stickiness inside the mouth.

If your child vomits or has diarrhea repeatedly, offer small amounts of fluid often. This helps ensure your child stays hydrated while fighting the bug.

For instance, give 25 millilitres of apple juice or Pedialyte® every 15 minutes. If you give a whole bottle or entire cup of a favourite drink, it likely will be vomited.

If your child has not wet a diaper in four to six hours, or not gone to the toilet in six to eight hours, seek medical care.

Special note: If your child’s vomit is black and looks like coffee grounds, or bright green, or appears to have blood in it, seek immediate medical care. If there is blood in the stool (poo), this is also an emergency.

Breathing

Sometimes a sick child’s breathing may sound raspy and rough, especially with a cough and cold. Signs that your child may be working too hard to breathe include:

breathing faster than usual
grunting or wheezing
indrawing at the ribs on every breath – this is when the muscles between the ribs suck in with every inward breath
retraction when breathing – the chest just below the neck appears to sink as the child breathes in.

Older children may become very quiet as they concentrate on breathing. If your child is showing any of the above signs of working harder to breathe, turns bluish around the lips, or has pale and cool skin, seek immediate care.

Skin

Many infections caused by viruses can result in harmless rashes that go away on their own. Allergies also cause rashes. The best way to tell if the rash is an emergency is to observe your child’s behavior. If your child is feeling well and the rash is not particularly itchy or painful, you can probably wait to see your family doctor. On the other hand, if your child has a fever, and is irritable and otherwise unwell, seek immediate care. A rash caused by allergies that is accompanied by any difficulty in breathing is an emergency.

Special note: a child with small red or purple spots (called petechiae) should be seen immediately.

Poison

If your child has consumed something that may be poisonous, call your local poison control centre or the emergency department immediately for instructions. They will explain the next best steps.

Seizures

Signs of a seizure can be:

jerking legs or arms
falling down for no reason
passing urine
biting the tongue.

It can be scary to watch a seizure, but there is no reason to panic. Most seizures will pass within a minute or so. Keeping your child safe is the first priority. Ensure that the child cannot fall or bump into anything nearby. Although seizures are not necessarily dangerous, a first seizure should be assessed medically as soon as possible. Call 911 or take the child to the emergency room.

Bleeding and cuts

Few children make it through childhood without collecting a cut or two along the way. However, most of these injuries do not need medical attention. If your child is injured, clean the area with soap and water. With a bandage, apply pressure for at least five to ten minutes. If the bleeding does not stop, your child may need stitches. Long deep cuts, gaping cuts and puncture wounds need emergency care. Cuts on the face, especially near the eye, should also be seen in the emergency room.

Special note: Cuts that have occurred in a dirty environment, and animal and human bites that have caused bleeding, are at high risk of infection. These types of injuries should be assessed quickly.

It is not usually one symptom but a combination that decides whether a child needs emergency care. Stay calm and assess the situation. The first step is to observe your child’s appearance and behavior. You know your child best. If in doubt, seeking more care is probably better than seeking less.

Is it an Emergency? Deciding when your child needs urgent care