As I discussed in an earlier post, when a child has a fever or cold, doctors sometimes recommend allowing the body’s immune system to work on its own to resolve the infection. When your child is feeling generally OK, it’s often OK to wait a few days before calling your doctor, even in the case of a fever.
However, certain danger signs can indicate the need for immediate medical attention. As I see it, if you’re aware of these warning signs in your child, you know when to worry and take action, and when you can sit tight and watchfully support your child’s immune system. In this post you’ll find:
- My four part decision making process for what to do in case of serious-looking symptoms
- A handy-dandy list of eight danger signs to make it quick and easy to know what to look for and when to worry
When is a Child’s Fever Serious?
Though a child may begin with symptoms of a cold or high fever, those symptoms could mask a more serious condition.
Or, in the case of a cold, a more serious condition may develop over time. The common cold is viral infection and is generally, as doctors like to say it, “self limiting.” The body will fight the infection and the virus will run its course. Sometimes, however, when a cold lasts longer than 7-10 days, the buildup of mucous creates a breeding ground for bacteria to grow.
When a population of bacteria grows too high, a child can develop a secondary bacterial infection. The body is equipped to handle and fight bacterial infections as well, but when things do not go well the possibility of dangerous conditions arises, some of which that can cause serious repercussions like hearing loss or even death.
But don’t freak out!
As a parent, I see my choices in caring for a cold or fever as:
- An immediate trip to the emergency room when an emergency situation is suspected
- An immediate call or page to the doctor for advice when a serious condition is suspected
- A proactive visit to the doctor for a diagnosis only, with the intention of avoiding antibiotics or medication unless a more serious condition is present
- Treatment at home with active watching for any signal of complications
It’s up to me to decide which step to take. But by seeing the situation as one of clear choices, and keeping in mind certain danger signals, it’s possible to take an active stance in your powerful role as a parent — caring for your child in cooperation with the medical resources available to you, and knowing what important pieces of information to communicate to your health providers if necessary.
And remember, you should always trust your instincts and the advice of your trusted medical provider. Never let information on this website or any website substitute for a qualified diagnosis and advice from your health provider, and don’t delay treatment or disregard advice based exclusively on the stuff you find floatin’ around in my noggin’. Be informed, and be prudent!
And now without further adieu, here’s my personal list of…
1. Heat Stroke Masked as Fever
Heat stroke is caused by conditions of surrounding heat, not internal temperature. Never leave a baby unattended in a vehicle, or overdressed in high heat conditions. Heat stroke is an emergency condition and requires immediate medical attention. According to the American Academy of Pediatrics, in cases of fever above 105 F (40.5 C), fever should be reduced immediately by sponging, fanning, and removal to a cool place. After the baby or child has been cooled, he should be taken immediately to the emergency room.
Meningitis is an extreme life and death emergency condition, though rare. For more information, read Dr. Sears on Meningitis. If your child has a number of the following symptoms, especially a stiff neck or refusal to look down, go immediately to the emergency room, do not wait to call or page your doctor. Its symptoms are:
- Stiff neck and back, or pain when attempting to look down
- Aversion to bright lights
- Severe headache, high fever, and vomiting
- Purple rash that doesn’t fade when the bottom of a glass is pressed against it
- Drowsiness and confusion
3. Extreme Lethargy, Limpness or “Floppiness”
More than just a sleepy baby or child, this means inability to make eye contact and lack of response to your voice. A limp and lifeless baby can be a sign of extreme dehydration and requires immediate medical attention. Always hydrate your baby or child well with lots of clear liquids in case of fever, vomiting, or diarrhea.
Croup is a viral infection causing swelling in the vocal chords and difficulty breathing. According to Dr. Sears, moderate to extreme cases of croup may require an immediate trip to the emergency room, mild cases can be treated at home followed by a visit to your doctor in the morning. For detailed instructions on how to assess croup and determine its severity, see Dr. Sears’ article on croup. Symptoms of croup include:
- A barky cough and a hoarse voice
- A harsh, whoopy gasping sound on breathing in (stridor)
5. Signs of Respiratory Distress
Call or page your doctor if any of the following symptoms are present. See Dr. Sears for more information on how to distinguish these them. They include:
- Shortness of breath
- Moderate to severe wheezing
- Rapid breathing
- Chest pains
6. Dangerously High Fever
Certain high fevers merit an immediate call to your doctor to assess the situation and discuss your child’s behavior and symptoms accompanying the fever. They are:
- Fevers above 100.4 F (38 C) in infants 2 months of age or younger
- Fevers above 101 F (38.3 F) in infants 2-3 months of age
- Fevers above 103 F (39.4 C) that are non-responsive to fever-reducing medications
7. Febrile Seizure
Febrile convulsions can occur in babies with a fever. They are almost always harmless, but they still warrant a call to your doctor to be sure of their cause. Your child may stiffen, twitch and roll her eyes and will be unresponsive for a short time, usually less than one minute but possibly up to fifteen. (It’s pretty scary!) Contact your pediatrician and follow his or her recommendations.
8. Extreme Ear Pain
Beyond minor discomfort, extreme ear pain may indicate signs of an ear infection and warrants a diagnosis by your health practitioner at their office.
Be aware, however, that studies have determined that ear infections (otitis media) are often self-limiting and that antibiotics may be not only unnecessary but damaging in the long term. In double-blind, controlled trials by Dr. R. Damoiseaux, antibiotics were found to provide no benefit over placebo after four days.
And, once antibiotics are given, the likelihood of future infection is increased. Per Damoiseaux: “We found that 54% of children receiving placebo did not have another episode, versus 36% of those who received amoxicillin.” Dr. Damoiseaux’s recommendations for a “wait and see” approach have now been corroborated in a study by David Spiro and colleagues published in the Journal of the American Medical Association.
Eight Danger Signs: Did You Memorize Them?
I reviewed the following books and resources to compile the information in this article. Get a copy for yourself and keep them handy! They’re a great short list of references toward feeling truly be confident in your power as a parent.
- “Coughs, Colds and Sinus Infections”, article from AskDrSears.com
- Boost Your Child’s Immune System: A Program and Recipes for Raising Strong, Healthy Kids (aff) by Lucy Burney (recommended by Richard Saphir, MD, Professor of Pediatrics Mt. Sinai School of Medicine). An important addition to your arsenal, this book does cover what to do in case of illness, but more importantly equips you with the tools you need to prevent illness and strengthen your children’s bodies against infection.
- Your Baby’s First Year (aff), American Academy of Pediatrics. More conservative than the Dr. Sears article, but good to have on hand.
- How to Raise a Healthy Child in Spite of Your Doctor (aff). This one I don’t actually own yet, but it comes highly recommended and is quoted in some of my other books. And isn’t the title so compelling? I need to get my hands on a copy!
As a natural parent, my goal is always to support natural processes. But of course, I so so in the service of my child’s health and well-being!
By being aware of these eight signs of “when to worry” and taking a “wait and see” approach otherwise, I can feel confident that I’m actively caring for my children’s colds and fevers, while also allowing the body to do its work.
What are your thoughts? Does having a list of danger signs make you feel safer or just invite worry? For me, somehow, I feel “armed and dangerous” myself!
Happy empowered parenting!
Disclaimer: The above content is for informational purposes only and is not intended to give medical advice. This content not intended as a substitute for professional advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional advice or delay in seeking it because of content found on this site.