What symptoms are worrying in a sick child?

Viral coughs are common in children, and sound awful, especially when they lay down for the night. They are narrower airways and a thinner rib cage, so we hear all of the rattling in their upper airways, and this makes us think they have a chest infection or pneumonia. In this case, they would be quite unwell, with a high fever, lethargy and refusing to eat. It’s best to get them checked out urgently.

As parents, it’s your job to nurture your children, and providing sustenance in the form of food feels a core part of this. Therefore it can be alarming when your sick child is reluctant to eat. You worry they will starve.

Continue offering them bland foods little and often, like toast, or perhaps something easily digested like soup or pureed food, and take it away if they refuse, but don’t force them. They can cope for a few days without eating, but drinking is the vital thing to keeping them well and fighting whatever illness they have. Ensure they are properly hydrated.

Most children get a bit more clingy when unwell, and their usual playfulness and bounciness depletes. They will likely need more naps in the day. Most children will have fits and starts – they feel a bit better at times, especially if they’ve had paracetamol for a fever, and they’ve eaten or drunk something.

It’s worrying if they are lethargic throughout the day, sleeping significantly more and difficult to rouse when you try to wake them or they don’t stay awake for long. They may be irritable, but most mildly unwell children will smile, interact or show curiosity at times, those who are very unwell will not respond and may appear either inconsolable, with a weak, high-pitched or continuous crying, or the opposite: very quiet and disengaged.

Children are destined to pick up lots of viral illnesses and build their immune system from there. Some we can identify, like the tiny blisters or crusty spots of chickenpox, but often you or we, as doctors, can’t specifically name the virus causing it. Many appear as tiny flat or raised red bumps, either during or just after a cough or cold, and this is called a post-viral rash or viral exanthems. It carries no threat and will get better within a few days.

An eruption of tiny red dots that don’t blanch under pressure (we’ll explain) is the rash to worry about. There may only be one or two, but this could be a sign of meningitis. In this case, they’re likely to appear very unwell, feverish, lethargic and inactive, too, possibly with neck stiffness and reluctance to open their eyes to the light.

The blanch test is done by taking a glass tumbler from your kitchen cupboard and pressing on the red dot – if it disappears, this is reassuring, and if it remains red (doesn’t blanch), you should seek urgent medical attention. If you are concerned about their condition even without a positive blanch test, do seek a doctor out urgently.