Clinical Reference Systems: Pediatric Advisor 10.0
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Some emergency symptoms are either difficult to recognize or are not considered serious by some parents. Most parents will not overlook or underestimate the importance of a major burn, major bleeding, choking, a convulsion, or a coma. However, if your child has any of the following symptoms, also contact your child's physician immediately.

• Sick Newborn

  If your baby is less than one month old and sick in any way, the problem could be serious.

• Severe Lethargy

  Fatigue during an illness is normal, but watch to see if your child stares into space, won't smile, won't play, is too weak to cry, is floppy, or is hard to awaken. These are serious symptoms.

• Severe Pain

  If your child cries when you touch or move him or her, this can be a symptom of meningitis. A child with meningitis also doesn't want to be held. Constant screaming or inability to sleep also point to severe pain.

• Can't Walk

  If your child has learned to walk and then loses the ability to stand or walk, he or she probably has a serious injury to the legs or an acute problem with balance. If your child walks bent over, holding his abdomen, he or she probably has a serious abdominal problem such as appendicitis.

• Tender Abdomen

  Press on your child's belly while he or she is sitting in your lap and looking at a book. Normally you should be able to press an inch or so in with your fingers in all parts of the belly without resistance. It is significant if your child pushes your hand away or screams. If the belly is also bloated and hard, the condition is even more dangerous.

• Tender Testicle or Scrotum

  The sudden onset of pain in the groin can be from twisting (torsion) of the testicle. This requires surgery within 8 hours to save the testicle.

• Labored Breathing

  You should assess your child's breathing after you have cleaned out the nose and when he or she is not coughing. If your child has difficulty breathing, tight croup, or obvious wheezing, he or she needs to be seen immediately. Other signs of respiratory difficulty are a breathing rate of more than 60 breaths per minute, bluish lips, or retractions (pulling in between the ribs).

• Bluish Lips

  Bluish lips or cyanosis can indicate a reduced amount of oxygen in the bloodstream.

• Drooling

  The sudden onset of drooling or spitting, especially associated with difficulty in swallowing, can mean that your child has a serious infection of the tonsils, throat, or epiglottis (top part of the windpipe).

• Dehydration

  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; crying produces no tears; the mouth is dry rather than moist; or the soft spot in the skull is sunken. Dehydration requires immediate fluid replacement by mouth or intravenously.

• Bulging Soft Spot

  If the soft spot in the child's skull (anterior fontanel) is tense and bulging, the brain is under pressure. Since the fontanel normally bulges with crying, assess it when your child is quiet and in an upright position.

• Stiff Neck

  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 or she is resistant, place a toy or other object of interest on the belly so he or she will have to look down to see it. A stiff neck can be an early sign of meningitis.

• Injured Neck

  Discuss any injury to the neck, regardless of symptoms, with your child's physician because of the risk of damage to the spinal cord.

• Purple Spots

  Purple or blood-red spots on the skin can be a sign of a serious bloodstream infection, with the exception of explained bruises, of course.

• Fever over 105 Degrees F (40.6 Degrees C)

  All the preceding symptoms are stronger indicators of serious illness than the level of fever. All of them can occur with low fevers as well as high ones. Fevers become strong indicators of serious infection only when the temperature rises above 105 degrees F (40.6 degrees C). In infants a rectal temperature less than 97.5 degrees F (36.5 degrees C) can also be serious.