How do you know when your child needs the doctor?

Many of us have faced that fraught, nerve-wracking decision where we have to choose whether or not to take your sick child to the GP, to the hospital’s emergency department or to call for an ambulance. It can be a daunting situation and one that we all hope doesn’t happen very often, but when faced with this decision it is important to be armed with the knowledge and skills to know how to respond appropriately.

Every day children of all ages get sick with a cough, bronchiolitis, diarrhoea, vomiting and a range of other common illnesses, and most don’t go near a hospital or a doctor. That’s usually the right approach. But when these infections change from an illness that every child experiences to one which might kill them, it’s time to act fast.

To help parents and those looking after children to make these decisions my colleagues and I have written a book to inform parents and carers how to recognise sick kids. In this book we developed a traffic light scheme to help determine when a child’s illness is becoming dangerous, drawn from the triage schemes used by emergency nurses. Triage means “to sort” and is when nurses decide how urgently a child must be seen by a doctor.

The most important, red light signs are those that are very serious and potentially life-threatening. For example, not breathing very much at all or not breathing properly; unconsciousness; unable to swallow and so on. These are signs that you should immediately call an ambulance.

The amber light signs are if the child can swallow and drink but they are very tired, looking unwell and are getting more drowsy. In that case you should take the child straight to the emergency department but you can often sit in the waiting room once they have been seen by the triage nurse.

If the symptoms have gone on for a while and they are not getting worse, and the child can get on with its normal activities but just doesn’t feel very well, then you should take them to a GP. This is considered the green light sign although it is still important to monitor and act if necessary; you know best if your child is not acting normally – trust yourself if you are not happy.

To sum up, the vital red light signs to look out for when caring for children that mean you should get on the phone and call an ambulance are:

  • Decreasing levels of consciousness, especially if they are less reactive to stimuli
  • Deterioration, for example if they have a fever and becoming more drowsy
  • Obstructions to the airways, especially if you can hear noises when they are breathing in and out
  • Working hard to breathe, especially if they are getting exhausted.

Paying attention to the trend of the child’s symptoms is very important. It is about watching your child over a period of time and seeing whether they are getting worse, getting better or staying the same. The best way to be able to identify serious illness is to understand a child’s normal behaviour, then spot departures from that behaviour, especially when they are young.

Parents should never be afraid to ask, and never be afraid to take a child to the emergency department. If you don’t feel happy when you come home from the emergency department, then go back.

Associate Professor Paul Middleton is an emergency medicine specialist and author of What To Do When Your Child Gets Sick: the Essential Emergency Manual for Parents and Carers. You can purchase the book in Australia and New Zealand, or from the website: Join the Saving Little Lives community by signing up to

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