How to recognise if your child is seriously ill

Lots of children get a fever (high temperature) and most of them get better by themselves. A few children with fever may have serious infections and may develop sepsis (a blood infection) that needs urgent treatment in hospital.

This leaflet is designed to help you monitor your child’s condition, if they have a fever. It may help you to recognise if your child is getting worse and help you know when and where to get help.

You will need to keep checking your child for changing symptoms and follow any advice given to you by health professionals.

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GREEN: (Low Risk: Self Care Advice)

If your child does not have any of the worrying signs or symptoms listed below, use the advice on the next page to care for your child at home. It is sometimes hard to be sure about particular signs or symptoms.

If you feel that your child is seriously ill or something is worrying you and is not on these lists, please contact your GP or 111 for advice.

AMBER: (Medium Risk: Ask for Advice)

Many (but not all) children with these symptoms are unwell and need to be seen promptly by a health professional. If your child has any of the AMBER symptoms on the next page contact your GP, NHS 111 or walk-in centre promptly.

Temperature

• Raised temperature (more than 37.5°C) for five days or more.

• Shivering or shaking.

Breathing

• Nostrils flaring (changing size with each breath).

• Breathing faster than normal.

• Breathing that’s unusually noisy or sounds ‘crackly’.

• Cough that sounds like a seal barking.

Skin, Lips & Tongue

• Unusually pale skin.

• Dry mouth, lips and/or tongue.

• Rash that fades when pressed firmly (use a clear glass).

Eating & Drinking

• Baby under one year who is not feeding (or taking less than half their usual amount of milk).

• Feeding or eating much less than normal.

• Has vomited (been sick) more than twice in the last 24 hours.

• Under one year old with vomiting and /or diarrhoea.

Toilet/Nappies

• Under one year old with more than five watery poos (diarrhoea) in the last 24 hours.

• Only one wee or wet nappy in eight hours.

Activity & Body

• Less interested than usual in playing or “not quite right”.

• Difficult to wake up or unusually sleepy.

• Swelling of a limb or joint.

• Not using/putting weight on an arm, leg, hand or foot.

Red: (High Risk: Take Action)

Many (but not all) children with these features are seriously unwell. If your child has any of the RED symptoms below, they need to be seen straight away in an Emergency Department (A&E). Dial ‘999’ for an ambulance if necessary.

Temperature

• Temperature over 38°C in babies under three months.

• Temperature over 39°C in babies aged three to six months.

• Any high temperature in a child who cannot be encouraged to show interest in anything.

• Low temperature (below 36°C, check three times in a ten minute period).

Breathing

• Finding it much harder to breathe than normal – looks like they are working hard.

• Making ‘grunting’ noises with every breath (in newborns this may sound like a lamb bleating).

• Very fast breathing (more than one breath each second in babies under one year).

• Can’t say more than a few words at once (for older children who normally talk).

• Breathing that obviously ‘pauses’.

Skin, Lips & Tongue

• Skin is blue, mottled (purplish, red) or very pale.

• Lips or tongue are bluish.

• Eyes look ‘sunken’.

• Hands and feet are unusually cold to touch.

• Rash that does NOT fade when pressed firmly (use a clear glass)

Eating & Drinking

• Baby under one month old with no interest in feeding.

• Not drinking for more than eight hours (when awake).

• Extremely thirsty or unable to keep fluids down.

• Persistently vomiting for more than 24 hours.

• Bloody, black or brown vomit/sick.

Toilet/Nappies

• Not had a wee or wet nappy for 12 hours.

Activity & Body

• Soft spot on a baby’s head is bulging.

• Child is floppy.

• Not responding to family or carers, or very irritable.

• Weak, ‘high pitched’ or continuous crying in a younger child.

• Hard to wake up, won’t stay awake or doesn’t seem to recognise you.

• Stiff neck, especially when trying to look up and down.

• Older children who are confused.

• Your child has a seizure (a fit).

Practical things you can do to help your child

• Check your child during the night to see if they are getting better.

• If you are concerned that your child is not improving or has new symptoms (such as a new rash) follow the advice on the front of this leaflet.

• If your child is hot to touch, take their temperature with a thermometer.

• Children with fever should not be under, or over, dressed. If your child is hot to touch, remove a layer of their clothing.

• Tepid sponging is no longer recommended for the treatment of fever.

• Offer your child regular drinks (where a baby is breastfed, the best drink is breast milk).

• If your child has a fever and is due to have immunisations please consult your GP, practice nurse or health visitor for advice.

• If you need to keep your child away from nursery or school while they are unwell, please notify the nursery or school (ask your health visitor, community nurse or GP if you are not sure).

• Keep a diary of symptoms.

Using medication to help

• If your child is distressed or very unwell, you may use Paracetamol or Ibuprofen to help them to feel more comfortable. However, this is not always necessary.

Don’t routinely give both Paracetamol and Ibuprofen at the same time – use one, and if your child has not improved 1-2 hours later, you may want to try giving the other medication.

Ibuprofen should not be used for children who have pre-existing kidney conditions or who are asthmatic unless they have had Ibuprofen before with no problems

• Please read the instructions on the medication bottle first for dose and frequency. Be aware of the maximum dose that can be given over a 24-hour period.

• You could ask your local community pharmacist for more advice about medication.

• Never give Aspirin to a child.

Further Information

NHS 111
Calls to this number are free from mobiles and landlines.
Telephone: 111

NHS Little Orange Book
Website: https://newcastlegateshead.ccg.necsu.info/wp-content/uploads/sites/12/2020/08/Little-Orange-Book.pdf

References

NICE (2019) Fever in under 5s: assessment and initial management [NG143].

Acknowledgment

Thank you to colleagues at the Great North Children’s Hospital in Newcastle upon Tyne, for sharing their information leaflet from which our local leaflet has been produced.

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]

Leaflet Reference: PIL1349
Date for Review: 13/10/2024