Sick Child Basics

Checking for Signs of Serious Illness

If your baby is less than 3 months of age, it’s particularly important to call their doctor immediately or go to the emergency room for a temperature higher than 100.4° F, excessive fussiness, excessive sleepiness, refusal to eat, and/or coughing.

When your child is sick, he or she may have a fever. A fever is a body temperature that is higher than normal. A fever is usually a sign that the body is fighting an illness or infection. Fevers are generally harmless. In fact, they can be considered a good sign that your child’s immune system is working and the body is trying to heal itself. Have a thermometer handy at home, so that you can take your child’s temperature when they are sick. While the average normal body temperature is 98.6°F (37°C), a normal temperature range is between 97.5°F (36.4°C) and 99.5°F (37.5°C). Most pediatricians consider a temperature above 100.4°F (38°C) as a sign of a fever.

Observing other symptoms and behavior can also help you decide the seriousness of your child’s illness.

Appearance

• Reassuring Signs: Your child appears “bright-eyed” and alert.
• Worrisome Signs: Your child appears sleepy with “dull” eyes and little expression on his or her face.
• Serious-Illness-Likely Signs: Your child just stares “blankly” and has a “glassy-eyed” look.

Cry

• Reassuring Signs: Your child cries in the usual way at the usual things.
• Worrisome Signs: Your child’s cry sounds whiny. Your child is difficult to comfort and whimpers off and on.
• Serious-Illness-Likely Signs: Your child’s cry sounds weak. Your child continues to cry or moan even while being comforted.

Activity Level

• Reassuring Signs: Your child plays and sleeps normally.
• Worrisome Signs: Your child is fussy when awake and sleeps more than usual.
• Serious-Illness-Likely Signs: Your child is hard to awaken and has little or no interest in playing.

Appetite

• Reassuring Signs: Your child asks for favorite foods and liquids and eats and drinks the requested foods and liquids.
• Worrisome Signs: Your child takes liquids or food if offered, but takes only a few sips of liquid or a few bites of food.
• Serious-Illness-Likely Signs: Your child pushes away or refuses all food and liquids.

Urination

• Reassuring Signs: Your child voids (pees) light yellow urine with the usual frequency. A baby should have six to eight wet diapers a day.
• Worrisome Signs: Your child voids dark yellow urine less frequently than usual.
• Serious-Illness-Likely Signs: Your child has very little saliva (spit), fewer tears than usual when they cry, and very little urine.

If all of the signs in all of the areas are “reassuring,” feel comforted that for the time being, your child is not seriously ill. However, remember that your child’s condition can change, so you will need to recheck signs on a regular basis. If your child has any “worrisome” signs, it is a good idea to report these to your doctor’s office and ask for advice. When “serious-illness-likely” signs are present, it is important that you make an appointment for your child to be seen promptly.

When you make the call to your doctor, give details such as when your child became ill, your child’s symptoms, and any signs that are “worrisome” or “serious illness is likely”, and any medications you have given. Do not be afraid to ask questions or have information repeated.

Unconsciousness, difficulty breathing, or abnormal color (very pale or blue), are obvious signs of a serious illness – call 911 if you ever observe these symptoms.

Common Colds

In the first 3-4 years of life, children catch an average of six to eight colds a year. The average cold can last three weeks. If you add up the time that your child is catching a cold, sick with a cold, and getting over a cold, almost half of the year is a “cold season”!

Until a child is old enough to blow his or her own nose, clearing the mucus with a suction bulb can make your child more comfortable. The use of over the counter saline nose drops (1-2 drops in each nostril) makes the mucus easier to remove. Saline nose drops can be purchased over the counter (without a doctor’s prescription).

Placing a cool-mist humidifier (vaporizer) in your child's room can help keep your child more comfortable. Be sure to clean and dry the humidifier thoroughly each day to prevent bacterial or mold contamination. Hot-water vaporizers are not recommended since they can cause serious burns.

For children over the age of one year, consider using honey to relieve a cough:

• Do not give honey to babies under one year—it is not safe.
• For children ages 1 to 5 years: Try half a teaspoon of honey.
• For children ages 6 to 11: Try one teaspoon of honey.
• For children 12 or older: Try two teaspoons of honey.

If honey is given at bedtime, make sure your child's teeth are brushed afterward.

Over the Counter Medicines

Do not use over-the-counter (OTC) medicines without first checking with your doctor. Many commonly available OTC medicines for can cause harmful side effects in children. Over-the-counter (OTC) cough and cold medicines should not be given to infants and children under 6 years of age because of the risk of life-threatening side effects. Many OTC cold medicines already have acetaminophen (Tylenol or generic) in them. Giving one of these medicines along with acetaminophen or (Tylenol or generic), would give your child a double dose.

Fever relief:

• If your child has a fever and is uncomfortable, give him or her single-ingredient acetaminophen (also known as Tylenol) or ibuprofen (also known as Motrin or Advil).
• For a baby 3 to 6 months old, give only acetaminophen. Check with your doctor first if your baby is younger than 3 months.
• Ibuprofen is approved for use in children 6 months of age and older; however, it should not be given to children who are dehydrated or who are vomiting repeatedly.
• Do not give your child aspirin, which has been linked with Reye syndrome, a rare but very serious illness that affects the liver and the brain.
• Always measure each dose using a device (syringe, cup, or spoon) that is marked in milliliters (mL).

Healthy Habits

Healthy habits can help you and your child avoid illness and the spread of infection.

• Wash hands:
  • After changing diapers, going to the bathroom, cleaning bathrooms, washing soiled linens/clothing
  • After sneezing, coughing or blowing your nose
  • After wiping or bulb suctioning your child’s nose
  • Before eating or cooking
  • After visiting sick friends or family members
  • After touching/caring for family pets
• Do not share drinking glasses, bottles, or silverware, or toothbrushes.
• Protect irritated skin from further irritation and possible infection (nose irritated from wiping/blowing, diaper irritation from having diarrhea). Petroleum jelly (Vaseline) can help a great deal with this.