Whether or not your child has a fever, if they are very irritable (unusually fussy and can’t be consoled), confused, lethargic (doesn’t easily wake up), have difficulty breathing, or have a rapid or weak pulse, it’s time to call the doctor. Other reasons to call your child’s pediatrician: They are refusing to eat or drink; they are limping or refusing to use one of their arms or legs; they have a fever with no other symptoms (such as a cough, runny nose, or sore throat) for more than one or two days, or they have specific complaints like a severe headache, ear pain, burning with urination, etc.
Fever
Fever is not a disease. Instead, fever is a symptom that can accompany many childhood illnesses, including bacterial, viral, and fungal infections. According to the American Academy of Pediatrics, in general, you should call your pediatrician when:
An infant under 3 months of age has a rectal temperature at or above 100.4 degrees FFever persists for more than 24 hours in a child younger than 2 years oldFever persists for more than 3 days in a child over the age of 2Fever occurs without any other symptoms (such as cold and flu symptoms or vomiting/diarrhea) and persists for more than 1 to 2 daysFever rises above 104 degrees F repeatedly for a child of any age
For kids over 2 months old, it isn’t the number on the thermometer that matters, but rather how the child is acting that will tell you whether to seek medical attention or not. If your child is alert, active and playful, is not having difficulty breathing, and is eating and sleeping well, then you don’t necessarily need to call your doctor immediately. You should call your doctor if your child has a fever and another medical condition (heart disease, cancer, sickle cell, immune system problems, etc.).
Vomiting
Vomiting typically accompanies diarrhea as part of an acute gastroenteritis or stomach virus in kids. It is usually not concerning if your child has only vomited a few times, is keeping small amounts of fluids down, doesn’t have significant abdominal pain, and is not dehydrated. Vomiting is especially concerning if it begins after your child already has abdominal pain, which often happens in children with appendicitis.
Coughing
A cough and runny nose occur commonly in children with colds. These are caused by viruses, and do not need antibiotics (because antibiotics kill bacteria, not viruses). If they are otherwise feeling well, then you don’t need to go to the doctor every time your child has a cough, even if they also have a green runny nose.
Trouble Breathing
Children often have a cough and sometimes a wheeze when they have a viral upper respiratory tract infection. If your child is having difficulty breathing, then you should call your doctor. If you are worried that your child is having trouble breathing: Take the child’s shirt off and while the child is as comfortable and distracted as possible (like watching tv or playing on a phone), look for the following: A child who is having trouble breathing may also have trouble catching their breath. You might notice that they pause to breathe in the middle of a sentence.
Dehydration
Children most commonly get dehydrated when they have diarrhea and vomiting, from ongoing losses of fluid. But it is also possible to get dehydrated if your child just isn’t drinking well. The first sign of dehydration is that your child will urinate less frequently (your child should be urinating every six to eight hours). Other symptoms of dehydration can include:
Dry mouthNot having tears when cryingSunken eyesDecreased activity
Weight loss can also be a sign of dehydration.
Irritability
Fussiness accompanies many childhood illnesses. If your child is fussy and crying but is easily calmed if you just hold them, then that is less concerning than a child who is not consolable and continues to cry.
Lethargy
If you call your pediatrician’s office and say that your child is lethargic, you are likely to be told to bring your child in right away. Being lethargic, in medical terms, is usually an emergency and means your child is difficult to wake up. It does not mean that a child’s activity is just a little decreased.
Childhood Rashes
Children commonly get rashes, from having sensitive skin, warts, poison ivy and as part of many illnesses, such as chickenpox, fifth disease, and roseola. In general, you should call your doctor if your child has a rash and a fever, especially if the rash is purple and doesn’t blanch or fade briefly when you press on it, or an itchy rash that isn’t relieved with home remedies.
Red Flag Symptoms
Other symptoms that are usually concerning and require medical attention include, but are not limited to:
Coughing up blood, vomiting blood, or having bloody diarrhea, especially if is accompanied by a fever Persistent pain, whether abdominal pain, a headache or knee pain, or severe pain, especially if it limits mobility and isn’t relieved by home remedies Seizures, especially if your child doesn’t generally have a seizure disorder, such as febrile seizures or epilepsy Testicular pain, which is usually a medical emergency Head injuries, especially if your child had a loss of consciousness, is acting differently than usual and may have a concussion Cuts and scrapes that require stitches, including those with persistent bleeding, or if the wound is deep and gaping or the skin doesn’t come back together A severe allergic reaction that includes vomiting, drooling (which can mean that the tongue is swollen), or trouble swallowing or breathing A severe headache, especially if your child also has a stiff neck, irritability, vomiting or fever Pain when urinating (dysuria), which can be a sign of a urinary tract infection Weight loss, which is hardly ever normal in children and can be a sign of a more serious or chronic illness
For children with chronic symptoms, such as headaches or stomachaches, you should call your pediatrician if your child’s symptoms seem worse than usual.
Parenting Problems
Your pediatrician should also be a good resource for you when you have parenting problems. Many parents only make appointments for medical problems. But you can also make an appointment or call when your child has sleep or behavior problems, difficulty potty training, problems at school, etc. Don’t wait until the problem is out of control. Some early help or advice may help prevent bigger problems from developing. Most doctors have someone answering the phone 24/7, and that person can often help you decide over the phone whether the child is fine, or needs to come in for a sick visit, or needs to go to urgent care, or needs to go directly to an emergency room. It is always better to call if you have questions or concerns and let the medical professionals help you decide what is best for your child to get them feeling better.
