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by Dr. Jeffery Schor

Related: child, sick, hospital, emergency, room,

Most life threatening emergencies are readily identifiable to parents or other caregivers. Most people will think of calling 911 if a child was having a prolonged seizure, choking and unable to breathe, unconscious, or bleeding profusely. However, there are a few true emergencies in which the symptoms can be more subtle and may be overlooked or not recognized by a caregiver. If your child should have any of the following signs and symptoms, you should contact your doctor immediately or bring them right to a doctor.


Sick Newborn - any babies that are less than a month old and sick in any way may have a serious problem. Particularly worrisome are fever (over 1000F by rectum), persistent cough, poor color, vomiting or diarrhea, poor appetite, or lethargic appearance.

Severe Lethargy - it is normal for children to be tired when they are sick. However, if a child stares off into space, does not respond, is too weak to cry, is floppy, or is hard to awaken, there may be a more serious problem.

Severe Pain - it is worrisome if a child cries when you touch or move him in any way. It is also worrisome if a child does not want to be held. Constant screaming or the inability to sleep also may point to severe pain.

Can't Walk - a child that has learned to walk and then loses the ability to stand or walk may have a serious injury to the legs or an acute problem with balance. If the child walks bending over and holding his abdomen, he may have a serious abdominal problem such as appendicitis.

Tender Abdomen - normally, you should be able to press about an inch or so on a resting child's belly without resistance. If the child pushes your hand away or screams or if the belly is bloated and hard, you should contact a doctor immediately.

Tender Testicle or Scrotum - in boys, the sudden onset of pain in the groin area may be due to a twisting of the testicle, especially in an early adolescent. This would require rapid surgery to save the testicle.

Labored Breathing - the best way to observe a child's breathing is after you have cleaned out the nose and they are not coughing. If the child is working hard to breathe, has a constant croup ("a "bark-like" cough that may sound like they are gasping for air), or has obvious wheezing, he should be seen immediately. Other signs of breathing difficulty are more than 60 breaths per minute (that persists for at least 5 minutes), bluish lips (see next), or pulling in between the ribs in the chest.

Bluish Lips - bluish lips can be a sign of cyanosis and may indicate a reduced amount of oxygen in the bloodstream.

Drooling - the sudden onset of drooling or spitting, especially if it is associated with difficulty in swallowing, can mean a serious infection of the tonsils, throat or epiglottis (the top part of the windpipe).

Dehydration - dehydration means that your child's body fluids are at a low level.  This may follow severe vomiting and/or diarrhea.  Signs of dehydration include no urine in 8 hours, crying without tears, a very dry mouth, and a sunken soft spot in a baby.  Dehydration requires immediate fluids, either by mouth or through an IV.

Bulging Soft Spot - a tense, bulging soft spot may indicate that the brain is under pressure.  Since there is normal bulging when the child is crying, assess when the child is quiet and sitting up.

Stiff Neck - a stiff neck can be an early sign of meningitis.  The best way to test for this is to try to raise the child's head while he is lying on his back. If he resists this, put a toy or other interesting object on his belly so that he will have to look down to see it.

Injured Neck - any injury to the neck, regardless of symptoms, should be discussed with a physician because of the risk of damage to the spinal cord.

Purple Spots - purple or blood-red spots on the skin, especially on the legs, can be a sign of a serious infection in the bloodstream.  This is not the same as a bruise that can be explained.

Fever Over 1050F - all of the symptoms previously discussed are more concerning than the level of fever and all can occur with low fevers as well as high fevers.  However, although usually nothing more than a virus, serious infections become more of a concern when the temperature rises above 1050F.  In infants, it is also concerning when the rectal temperature is less than 97.50F.

Suicide Concerns - because of the marked increase in suicide attempts in adolescence, parents should be aware of the following warning signs: preoccupation with thoughts of death or suicide; themes of death in writing or conversation; abrupt withdrawal from friends and family; abrupt loss of interest in favorite activities; abrupt decline in schoolwork; reckless or risk-taking behaviors; and depressed mood. These may also be signs of drug use.

Dr. Jeffery Schor, an expert on Pediatric Emergency Medicine, is the founder of PM Pediatrics in Long Island.

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