Childhood illness red flags: when to call 000

Every parent has had the 2am moment: a hot forehead, a strange cough, a rash that was not there at bedtime. The question is not whether you are overreacting. The question is whether this needs help now.

This guide is a triage tool, not a diagnosis. It covers the signs that should never wait, the ones that need a call, and the ones that can usually wait for the GP. If you are worried and cannot settle, call healthdirect on 1800 022 222. Trust your gut.

Call 000 now#

Call 000 or go to the nearest emergency department if your child:

• is struggling to breathe, grunting, sucking in under the ribs, or has blue or grey lips
• is hard to wake, unusually floppy, or unresponsive
• has a seizure that lasts more than five minutes, or has repeated seizures
• has a rash that does not fade when you press a glass against it
• is under three months old and has a temperature of 38°C or higher
• is severely dehydrated — no wet nappies, no tears, sunken eyes, a sunken soft spot, or a dry mouth
• has a severe head injury, is vomiting repeatedly, or is becoming drowsy after a fall
• has swallowed poison or a button battery
• has severe abdominal pain, a rigid tummy, or green (bilious) vomiting
• has sudden swelling of the face, lips or throat, or trouble breathing after eating or a sting

For poisoning advice, call the Poisons Information Centre on 13 11 26. For a button battery, go straight to an emergency department.

Fever: age changes everything#

A fever is generally a temperature of 38°C or higher. How your child looks and behaves matters, but age is the first filter.

A high temperature alone is not the whole story. A child with a 39°C fever who is drinking and playing is different from a child with 38.2°C who is listless and breathing hard.

Breathing: the signs that matter#

Babies are obligate nose breathers and can look dramatic with a cold. The signs that matter are:

• fast or laboured breathing
• grunting at the end of each breath
• sucking in under the ribs or at the base of the neck
• nostril flaring
• a pause in breathing (apnoea)
• blue or grey lips, tongue or face
• inability to feed, speak or cry because they are working so hard to breathe

If you see any of these, call 000.

Hydration: the nappy test#

Dehydration in a small child can happen quickly, especially with vomiting, diarrhoea or fever.

Signs include:

• fewer wet nappies, or dark, strong-smelling urine
• no tears when crying
• a dry mouth or tongue
• sunken eyes
• a sunken soft spot in a baby
• unusual sleepiness or irritability
• skin that stays “tented” when pinched (a late sign)

Offer small, frequent feeds or oral rehydration fluid if your GP or pharmacist has advised it. Do not force large amounts. If your child cannot keep fluids down or is showing dehydration signs, seek medical advice.

Rashes: the glass test#

Most childhood rashes are not dangerous. The one to know is a rash that does not fade when you press a clear glass against it. That can be a sign of meningococcal disease or another serious infection.

If the rash does not blanch, call 000. Do not wait for other symptoms.

Other rash features that need prompt review:

• a rash with fever and a very unwell child
• blisters or peeling skin
• a rash that spreads rapidly
• a rash with swelling of the face or lips
• a rash that is painful, hot or oozing

Head injuries#

Children bump their heads constantly. Most bumps are minor. Seek urgent care if your child:

• loses consciousness, even briefly
• is drowsy, confused or difficult to wake
• vomits repeatedly
• has a seizure
• has clear fluid or blood from the nose or ear
• has a large bruise or swelling, especially in a baby
• has a headache that is getting worse
• has weakness, numbness, slurred speech or problems walking

For a baby under 12 months, a fall from a height or a suspected head injury should be checked by a doctor.

Tummy pain#

Most tummy pain is wind, constipation or a passing virus. Seek urgent help if:

• the pain is severe and constant
• your child is drawing their knees up and screaming
• the tummy is rigid or very tender
• there is green or bloodstained vomit
• there is blood in the stool
• your child is pale, sweaty or unusually sleepy
• a boy has sudden pain in the groin or testicle

What to say when you call#

Have these ready:

• your child's age and weight
• the temperature and how you measured it
• how long they have been unwell
• what they are drinking and how many wet nappies
• any medicines given, including the dose and time
• any rash, breathing changes or unusual behaviour
• your address and the nearest cross street if calling 000

What to keep at home#

• a digital thermometer
• children's paracetamol or ibuprofen, appropriate for their age, with a dosing syringe
• oral rehydration fluid if your GP or pharmacist recommends it
• a phone with healthdirect and Poisons Information saved
• a simple first aid kit
• an up-to-date immunisation record

Do not give aspirin to children under 16. Do not use leftover antibiotics or someone else's prescription.

If the illness involves a rash, vomiting or breathing difficulty after food, see our baby food allergy guide.

The bottom line#

Most childhood illnesses are manageable at home. The skill is knowing which ones are not. Age, breathing, hydration, alertness and rash are the big five. If your child is under three months with a fever, call 000. If something feels seriously wrong, get help. You will never be criticised for checking.