In brief
- If your child is sick, you can take their temperature to see if they have a fever.
- Make sure to watch for other symptoms to see if your child is very sick.
- Check on your child regularly. Is your child behaving differently than usual?
- Is your child drowsy, having trouble breathing or crying inconsolably? Or does your child look grey or ashen? Does your child have red spots that do not go away when you press on them? Is your child refusing to drink or not peeing enough? Is your child feeling worse and worse? Then phone your general practitioner immediately.
- Drinking is very important, especially in the case of fever, vomiting and/or diarrhoea. Give your child small sips often if they are not drinking well.
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Symptoms to watch for when your child is sick
As a parent, you can usually tell when your child is sick. Your child looks paler, is Lethargic or behaves differently than usual. Do you think your child is getting sicker? Are you worried? In that case, it is important to follow your instinct.
What should you look for to see if your child is very sick? Watch for the following symptoms:
- fever
- drowsiness
- shortness of breath, rapid breathing, wheezing or making different noises while breathing
- groaning or crying inconsolably
- a pale greyish skin colour or blue lips
- red spots that do not go away when pressed
- not drinking or peeing enough
- repeated vomiting or diarrhoea
- pain in 1 part of the body (for example, stomach ache, earache or pain in an arm or leg)
Read more about these symptoms below and about when to call your general practitioner immediately.
Does your child have a fever?
Your child has a fever if their body temperature is 38 degrees Celsius or higher.
It is best to take the temperature rectally (in the bottom). This is the most accurate method.
Is your baby less than 3 months old? Then taking the temperature rectally is the only accurate method.
An ear thermometer is less accurate.
Taking the temperature once a day is enough. You do not have to take your child’s temperature if they no longer feel sick.
Fever is a normal reaction of the body to an infection (a virus or bacteria).
A high fever does not necessarily mean that your child is very sick. Having a fever for a long time also doesn’t necessarily mean that your child is very sick.
Fever along with other symptoms does say something about how sick your child is. So watch closely to see if your child with fever has or develops other symptoms, which are described below.
Call your general practitioner immediately if your child has a fever in one of the following situations:
- Your child is less than 3 months old (and the fever is not due to a vaccination).
- Your child develops a fever again after a few fever-free days.
- Your child has a heart or lung disease or diabetes mellitus.
- Your child uses medication that weakens the immune system.
- Your child has a weaker immune system, for example because of Down’s syndrome.
- Your child has missed vaccinations at the well baby clinic.
- Your child has been outside Europe in the last 4 weeks.
Your child has one of the other symptoms described below:
for example, your child is drowsy, is having trouble breathing, looks grey or ashen, cries inconsolably, gets red spots that do not go away when you press on them, drinks less than half of what they normally do, or hasn’t peed for half a day.
Is your child drowsy?
A sick child can be tired and listless. The child wants to sit on your lap and falls asleep now and then. That in itself is nothing to worry about. When you wake your child or say something to them, they react as they normally do.
Do call your general practitioner immediately if your child is drowsy. In that case, you notice one of the following:
- Your child hardly reacts when you say something to them.
- You cannot make contact with your child.
- You can’t get your child to wake up.
Is your child having trouble breathing or breathing faster?
Call your general practitioner immediately if your child:
- is having trouble breathing
- is breathing much faster than you are used to (even while sitting or lying still)
- is breathing so fast that they can’t drink (or, for an older child: can only say a few words at a time)
- is breathing faster and wheezing
- the skin in the neck and between the ribs pulls in during breathing
- the nostrils move noticeably during breathing (this is called nasal flaring)
- stops breathing from time to time
- drools and makes noises while breathing (such as gurgling)
Is your child groaning or crying inconsolably?
A sick child can cry a little; that is normal. You can usually comfort your child by remaining calm yourself and holding your child in your arms, distracting them or giving them some attention.
Call your general practitioner immediately if your child has any of the following symptoms:
- Your child keeps crying inconsolably (especially if they haven’t cried this way before)
- The crying changes into groaning or a weak, high-pitched cry.
- Your child cries whenever you bend their legs at the hips, such as lifting the legs when changing a nappy (diaper).
Your child cries or feels pain when you want to bend their head forward. The head won’t bend forward, the neck is stiff. The head can still turn sideways.
Does your child look grey or ashen or is the skin blotchy?
Call your general practitioner immediately if your child is sick and you see that your child:
- looks pale-grey or ashen (making them look sicker than you are used to)
or looks paler than usual if your child normally has a dark skin colour - has pale or blue lips and nails
- has blotchy skin
Does your child have red spots?
Many children’s illnesses cause red spots. It is almost always an infectious disease that doesn’t do much harm. You can find more information in My child has red spots (in Dutch).
But red spots can also be a warning sign. Therefore, call your general practitioner immediately in these situations:
- Your child has red spots and appears drowsy or very sick. Drowsy means you cannot make contact with your child.
- Your child develops red blotches or spots on the chest, back, arms or legs, or on the whites of the eyes or the inside of the eyelids. These are red spots that do not go away when you press on them.
Is your child refusing to drink or eat?
Drinking is very important for a sick child. A child who does not drink enough can become dehydrated.
Eating is not as important. It is not a problem if your child doesn’t want to eat for a few days.
If your child is drinking and peeing well, producing tears when they cry, and producing saliva, they are not dehydrated.
Does it hurt to swallow? Then you can give your child something cold to drink, like a diluted juice, or an ice lolly. Or give paracetamol (acetaminophen). Often, your child will then drink better after half an hour.
If your child is not drinking well, you should give them a few sips every 5 to 10 minutes.
Call your general practitioner immediately if you notice one of the following:
- Your child is drinking less than half of what they usually drink.
- Your child has not had a wet nappy or has not peed for half a day or more.
- Your child has dry eyes, a dry nose and mouth, and becomes drowsy and limp or floppy.
These are signs of dehydration (in Dutch).
Is your child vomiting and/or do they have diarrhoea?
When your child vomits (in Dutch) and/or has diarrhoea (in Dutch), they lose a lot of fluids. This makes it even more important for your child to drink enough to prevent them from becoming dehydrated (in Dutch). Children less than 2 years old can become dehydrated quickly.
Are you breastfeeding or bottle feeding? Then keep feeding as usual (do not dilute the milk).
If your child is drinking well, peeing regularly (or has wet nappies), drooling, crying with tears or walking around normally, they are not dehydrated.
If your child is vomiting or has diarrhoea and is not drinking well or not keeping much down, you should regularly give them a few sips of water or lukewarm tea (every 5 to 10 minutes).
If you are breastfeeding or bottle feeding, you can keep feeding as usual (without diluting). In addition, give a few sips of water or lukewarm tea (on a dummy (pacifier) or spoon) every 5 to 10 minutes between feeds.
If your child keeps vomiting or has severe diarrhoea, you can give them a special drink (ORS junior). You can buy this from the chemist’s (drugstore) or pharmacy. You can buy ORS as a powder or as a ready-made ORS drink. Read the instruction leaflet carefully.
Contact your general practitioner in any of the following situations:
- if your baby is vomiting and has diarrhoea
- if your baby is vomiting and this does not improve after 4 hours
- if your baby vomits for more than a day
Call your general practitioner immediately in any of the following situations:
- Your new born baby has vomited heavily several times and is hardly keeping any milk down.
- Your child is drinking less than half of what they usually drink.
- Your child has not had a wet nappy or has not peed for half a day or more.
- Your child has dry eyes, a dry nose and mouth, and becomes drowsy and limp or floppy.
These are signs of dehydration.
Does your child have a stomach ache (abdominal pain)?
Many children have a stomach ache when they are sick.
Call your general practitioner if your child has a stomach ache and one of the following symptoms:
- The stomach ache is getting worse and worse.
- The stomach ache is worse when your child moves.
- Vomiting and/or diarrhoea and not drinking.
- Blood and mucus in the poo (stool).
- Fever.
- The stomach ache is in the lower right-hand side
- Pain while peeing and/or blood in the urine.
Does your child have a bad earache?
- Call your general practitioner immediately if your child has a bad earache, is sick and has a fever.
For example, if your child keeps reaching for their ear, cries and cannot be comforted or distracted.
Or if the ear is red or begins to stick out from the head.
Does your child have a swollen arm, leg or joint?
Does your child have a swollen arm, leg or joint? Are they unable to use their arm or leg, or can they not lean or stand on it? Then contact your general practitioner.
Call your doctor immediately if your child also has a fever.
Is your child getting sicker by the hour?
Are you worried? Is your child sicker or sick in a different way than you are used to? Do you think your child is getting sicker and sicker? Phone your general practitioner immediately.
Do your child’s arms and legs suddenly start shaking?
Children between 6 months and 6 years old can develop a febrile seizure. Your child becomes stiff and their arms and legs suddenly start shaking. A febrile seizure can understandably be frightening for you, but stay calm. Most of the time, a febrile seizure is not harmful. This is what you should do:
- Use a finger to make sure the mouth is empty.
- Place your child on their side.
- Make sure they cannot fall or bump or hurt themselves.
- Then phone your general practitioner immediately.
More information about sick children
The information about sick children is based on the scientific guideline for general practitioners, the NHG-Standard Children with Fever.