Danger Signs in Infants and Children

It is never nice to see our children sick. Sickness can include anything from the runny nose that doesn’t bother our little ones too much up to the severe illness that requires hospitalisation.

It is not always easy to decide how sick our children truly are. Some parents become anxious very quickly, often because of a previously bad illness that required major intervention and prolonged hospital stay. In that case a slight cough can trigger the visit to a health professional. On the other side there are parents that are not worried at all even in presence of some very dangerous symptoms.

Some worrisome features requiring medical intervention are easily recognized, such as if your child is bleeding a lot and it does not stop, or when children have fallen from a great height and blacked out or obviously broken something. Further such features are if your child is unconscious or having seizures (commonly unconsciousness with jerking of the arms and legs) or is having severe pain.

In other cases the need for medical review might not be that obvious. The following paragraphs will describe some of the more common examples of dangerous symptoms that should lead to review by an experienced health professional:

Fever is a common complaint. Fever is defined as a body temperature above 38.5 degrees celsius. It is the body’s way of making it easier for our immune defense to fight the infection. However, high fevers, apart from being quite uncomfortable, can also be very dangerous. Any temperature above 39 degrees celsius requires some medication and/or sponging down with lukewarm (Not cold!) water. It is recommended to have any child with very high fevers or persistent fever reviewed by a healthcare professional. In addition, any infant under
2 months with fever needs urgent review, as these babies do not usually get fever and if present this might indicate highly dangerous infections.

Any child with difficulty or pain on moving the head/neck needs urgent review as this may be a sign of meningitis. Untreated some forms of meningitis can kill or seriously handicap the child for the rest of their life. If in addition you notice small red spots on the body an immediate review is needed (e.g. emergency department). Waiting until morning might be devastating.

Any child that is breathing fast (over 60 breaths per minute in newborns/infants and over 40 breaths per minute in small children) can potentially have a chest infection. However fever and blocked noses can cause fast breathing as well. In connection with other symptoms severe chest infections are even more likely. These symptoms are: indrawing of the chest wall below and/or in-between the ribs, very noisy breathing and in young infants under a year flaring of the nostrils, similar to a horse, while breathing as well as nodding the head with every breath.

Longstanding cough for 2 weeks or longer needs review, particularly if in combination with loss of weight, fever or sweating particularly at night. Any close or household contact with someone with tuberculosis (people with ongoing cough and loss of weight, night-sweats or general malaise) puts children under the age of 5 years at risk and these children need to be checked for tuberculosis and started on TB prophylaxis or treatment.

A child that has blue lips, especially when the tongue also has a blue tinge, has got a lung issue or heart defect until proven otherwise and needs urgent review.

When a child has diarrhoea and/or vomiting this can rapidly become a serious problem. As long as the child is drinking fluids well and keeping them down for at least 10-20 minutes it is usually not a big problem. But once signs of dehydration appear the little one has fallen behind on fluids and this can become life-threatening. The smaller the child/infant, the higher the risk of rapid dehydration. Danger signs are a sunken fontanelle (soft spot on the head in little babies), sunken eyes, reduced skin turgor as measured by picking up a skin fold on the tummy and waiting for it to disappear on letting go (anything more than immediate disappearance usually means dehydration) or if the child does not wake nicely but remains drowsy. Any of these signs, particularly in combination, require urgent medical intervention. In addition, green vomit or the appearance of blood in vomitus or diarrhoea needs urgent investigation.

Sudden bleeding or unexplained red spots or easy bruising without much trauma are suggestive of a clotting disorder. There are many different causes of clotting disorders and your healthcare provider will investigate the cause in your child urgently.

Bone or back pain is very unusual for children unless they have experienced a recent obvious trauma. Even then pain only stays for a few days maximum. Anything that continues for more than a few days needs urgent review. The same applies for headaches.

A bulge in the groin is a hernia until disproven. A hernia is a weakness in the muscle wall of the lower abdomen through which abdominal content squeezes underneath the skin or into the scrotum (male genitals). This can become very dangerous if the abdominal content twists and gets stuck inside the hernia and can lead to death of the entrapped content followed by shock and severe infection. For that reason it needs urgent review. Very urgent review is needed if it is painful, red and hot, or if one is unable to push the hernia content back into the abdomen.

Any ingestion of medicines apart from prescribed medicine in the prescribed doses needs urgent medical review. Even simple drugs like Panado taken in overdose can cause serious harm and death if not properly and quickly treated.

There are many other dangerous symptoms that cannot be included into this blog to be able to keep it short enough. The above cover most of the common danger signs in infant and children.

In short:
It is not easy to decide which symptoms of your child are dangerous. Some more common ones are addressed in this blog. However, if you are unsure but worried or other people suggest to you repeatedly to have your children checked out, it is a good idea to seek advice from a competent healthcare provider.