When does a child need to see a paediatrician?

A parent rarely needs an answer to 'what is my child ill with'. Almost always the question that needs answering is a different one: can this be watched at home, does the child need to be seen today, or can it not wait at all. This page helps tell those three situations apart.

Three different decisions

Routine consultation

The child feels generally fine: playing, drinking, sleeping. There is a question, but it is not urgent — a preventive check-up, recurring complaints, vaccination, development, behaviour, preparation for nursery or school. You book at a convenient time.

An examination soon (today or tomorrow)

The child is ill but stable: a temperature persists, a cough has appeared, vomiting or diarrhoea has started, there is a rash — while the child still drinks and responds as usual. What matters here is an examination, not putting it off for a week.

Emergency care

The child is struggling to breathe, is not responding as usual or is hard to wake, has convulsions, a rash that does not fade when pressed, bluish or mottled skin, or is not drinking. In these cases you do not wait for morning, do not book an appointment and do not watch at home — emergency medical care is needed; in Georgia, call 112.

The main guide is not the symptom but the condition

One and the same symptom means different things in different children. A temperature of 39 in an active child who drinks and plays between spikes, and a temperature of 38 in a listless child who is hard to wake, are two different situations — and the second is more worrying. So assess first of all activity, response to you, the ability to drink, and passing urine.

The main reasons for concern — by category

Temperature

Urgency is set not by the number on the thermometer but by the child's age and behaviour. Fever in a child under 3 months needs immediate attention, as does any temperature in a listless child who is hard to wake. An examination soon is needed if the temperature has lasted several days or has returned after improvement.

Breathing

Breathing is a category with almost no 'let's wait'. Fast breathing, pulling in of the spaces between the ribs and of the hollow above the breastbone, grunting on breathing out, bluish lips, being unable to finish a sentence or to feed because of breathlessness — these are reasons to seek emergency care; in Georgia, call 112.

Dehydration

A child who has stopped drinking or is passing noticeably less urine needs examining whatever caused the losses. The degree of dehydration cannot be determined at home — home signs tell you only that it is time to see a doctor.

Vomiting and diarrhoea

What matters is not the number of episodes but the ability to keep fluid down. Separately: vomiting with blood or green contents, blood in the stool, vomiting after a head injury, vomiting with a severe headache — these are emergencies, not 'an intestinal infection': emergency care is needed; in Georgia, call 112.

Rash

A rash that does not fade when pressed is a reason to seek emergency care (in Georgia — 112), especially against a background of fever and feeling unwell. Swelling of the lips, tongue or eyelids and difficulty breathing are also reasons to call 112. Other rashes are assessed at an examination: the cause of a rash cannot be determined from a photograph.

Behaviour and level of alertness

This is the most underestimated category. Unusual sleepiness, listlessness, being unable to wake the child, inconsolable crying for hours, the absence of the usual response to parents — signs with which you seek care immediately, even if the temperature is normal and there are no other symptoms.

Babies in their first months

In infants the threshold for seeking care is lower: they tolerate fluid losses less well, and the signs of illness are less noticeable in them. Fever in a child under 3 months, refusing the breast or bottle, unusual listlessness, a dry nappy for a long time, repeated forceful vomiting — reasons to seek care urgently.

Pain

Worrying signs are pain that is building, tummy pain with a hard abdomen that hurts to touch, a severe headache with light sensitivity, and pain that stops the child sleeping, eating or bearing weight on a leg. A painkiller that briefly dulls such pain does not remove the need for an examination.

Symptoms that do not pass or are building

A reason to seek care in its own right is the trend. Improvement gave way to worsening; the temperature came back after a few days; a cough has lasted for weeks; the child is losing weight or has stopped gaining it. Such situations do not require emergency care, but they do require an examination rather than waiting.

Symptoms with which it is better to be seen sooner

There are complaints with which a visit is better not postponed to 'let's see how it goes'. This is not a list of diagnoses and not a cause for panic — it is a list of reasons to book without waiting several days:

• headaches, dizziness;
• pain in the area of the heart;
• pale or bluish skin;
• the appearance of a rash;
• reduced appetite, weight loss and so on;
• high temperature;
• cough, runny nose;
• nausea and vomiting;
• tummy pain;
• a change in stool.

How often routine check-ups are needed

Routine check-ups are needed even when the child is healthy: they let growth and development be followed over time rather than comparing one-off measurements. Check-ups come most often in the first year of life and gradually become less frequent as the child grows.

In practice, in the early years routine visits often coincide with vaccination ones: the child is examined before vaccination anyway, and that is a convenient point to discuss feeding, sleep, development and any questions that have built up.

Individual symptoms in detail

This page is for general information only and is not a substitute for a consultation with a doctor. A child's diagnosis and treatment are determined by a doctor during an examination.