My child is unwell - when should I see a doctor?

I often get a text message from parents especially at times when medical advice is difficult to obtain: 
“My child has a fever of over 40ºC, do I have to worry?” 
or 
“My child has been unwell for 4 days; do I need to do anything now?”

Many parents want someone else to help reassuring them: “Yes all is fine!”

At other times another doctor or I have assessed your child recently and decided the child is able to be looked after at home but he or she has become worse since then and when should you worry again? 

“When should I return to see a doctor again?”

A fever is a temperature over 38 ºC best measured with a digital thermometer in the mouth or under the arm, an ear thermometer in either ear or an infrared thermometer over the forehead.  

In children under 3 months, I would advise to seek immediate medical advice if the temperature is 38 ºC even if measured rectally. 

In children > 6 months the degree of temperature alone is not a good indicator whether there is something seriously wrong or not as many viruses can cause temperatures of 40 ºC and over.

But remember always trust your instinct and if you are worried let a doctor review your child even if you have had a recent review.


See separate advice on if your child has fever and you do not need to see a doctor urgently:

Acute viral illness: What can I do? see: Should I give something for fever?


  • Tip: Rectal temperatures can be 0.5-1.0 ºC higher.
  • Tip: If you are not sure then measure the temperature two or three times and if it varies more than 0.2 ºC each time there are likely some measurement errors (common with ear thermometers in small children)
  • Tip:
Fever

I find infrared thermometers are more accurate if pointed at the side of the forehead which is called the temple area — there is an artery running relatively close under the skin and the temperature of the overlying skin is reflecting the central body temperature better than the skin of the forehead.

What are certain features when I personally would advice to see a doctor urgently (i.e., immediately take your child to an Emergency Department, Urgent Care, GP or to an emergency clinic):

1.     You are 

  • worried your child may be very sick
  • met sure whether your child is very sick or not

2.     A fever if your child is 

  • under 3 months and has a temperature over 38 ºC (*)
  • under 6 months and has a temperature over 39 ºC
  • under 6 months and has a temperature over 38 ºC and you are not sure how unwell your child is or is not fully immunised
  • immunocompromised (significantly reduced immune system)

(*) if you see by me in clinic with a child less than 3 months who has a fever I will always refer you to a unit which will observe your child and treat your your child with intravenous antibiotics after a series of tests.

3.     Your child 

  • has pauses when breathing (apnoeas)
  • is breathing very fast and/or laboured and / or is grunting
  • you can see or you think your child is struggling to breathe and/or talk
  • is under 1 year old and takes 60 breaths in 1 minute
  • is over 1 year old and takes 50 breaths in 1 minute
  • makes a loud noise from their throat when breathing in (stridor), (especially with drooling or high fever >=39 ºC)
  • has become pale, mottled or feels cold to touch
  • is going blue around the lips or tongue
  • has not passed urine 3 times or more in 24 hours or none in the last 8 hours without being able to pass urine when asked
  • you have not been able to observed any urine for 12-24 h due to severe diarrhoea 
  • has his first fit or seizure
  • has an unusual seizure compared to previous seizures
  • has become confused / very lethargic or unresponsive
  • has not had at least one alert episode in 24 hours during the current illness
  • talks nonsense or gibberish with or without a fever
  • develops a non-blanching rash (rash that does not disappear with pressure (glass test)
  • any head injury from a fall in a child under a year of age
  • has symptoms listed on the head injury advice sheet (see Parent Information: Accidents) after a head injury
  • any testicular pain in young boys and especially teenagers

If the answer is yes to any question below you should take your child to be seen immediately (next ½ – 4 hours):

O     Is my child under 3 months and has fever?

O     Has my child been lethargic for 24 hours without a period of being alert and to some degree interested in activities or surroundings?

O     Have you seen a rash which does not blanche or does not go away with the glass test or are you unsure whether it does or does not?

O     Has your child passed less than 3 times urine in 24 hours, or you cannot be sure?

O     Are you very worried about your child’s breathing?

O     Is our child under the age of 1 year and sustained an injury or head injury?

O     Has your child had a first seizure, or you are not sure whether it may have been a seizure?

O     Is your child talking gibberish, is confused or is not making sense?

O     Are you very worried about your child?

O   Any additional condition in the “Conditions which should prompt you to take your child immediately  (within a few hours) to see a doctor”.

 

 

Please do understand that it is always impossible to give 100% reliable advice whether your child needs to be seen without having taken a full history and most of the time without having examined the child in a face-to-face consultation. Any advice given is to the best of the ability of a doctor given the circumstances but if you continue to be concerned or the situation is worsening you must take your child to be seen immediately.

What are certain features when you must see a doctor soon and usually next 12-24 hours (You should be able to take your child to see your GP or to an emergency clinic):

  1. Your child is working hard to beath (indrawing below or in-between their ribs or in the neck or fast breathing up).
  2. Any fever for more than 4-5 days
  3. A child that has not been interested in the surroundings or looked alert over a 24-hour period but has remained responsive (see also red box)
  4. Blood in stool (poo) or urine (wee)
  5. New onset of limping without trauma
  6. Vomiting over 5 times a day
  7. Persistent pain after an injury
  8. Fever in an unimmunised child but is looking well