Unfortunately, kids get sick. Fighting a virus or common cold is good for a child’s immune system and can help build antibodies that protect them from dangerous illnesses. Still, there are times when that tummy ache or cough may require medical attention.

“Parents know their child best and know when something is not right. The confusion comes from the next steps like what do I do about it? When do I call the doctor?” said Hannah Chow-Johnson, MD, pediatrician at Loyola University Health System and assistant professor of pediatrics at Loyola University Chicago Stritch School of Medicine.

According to Chow, there are 10 symptoms and signs that a child may need more than fluids and rest and a parent should call the doctor.

1. Extreme changes in behavior
• Not being aware of surroundings or familiar people
• Changes in speaking, such as difficulty forming words or completing thoughts.
• A child who is truly lethargic

“I hear parents talk about their child being lethargic, but this term is often used incorrectly,” said Chow. “Lethargic is when a child sleeps a lot and barely can awaken despite plentiful sleep or has difficulty staying awake. If your child is tired but alert and aware of what is going, this is reassuring.”

2. Signs of dehydration
• Unable to keep down liquids
• Frequent vomiting or diarrhea
• Diminishing urine output
• Little oral intake and a dry sticky mouth
• Urinating infrequently (less than every 8 hours in children younger than age 1, less than every 12 hours in children older than age 1)

3. Pains that awaken a child at night
“Headaches, stomach aches or muscle aches that awaken a child from a sound sleep should be taken seriously. Call and make an appointment to see your child’s doctor if this happens,” says Chow.

4. Abdominal pain that worsens and persists
• If pain does not improve with child over-the-counter pain relievers
• If a fever also is persistent
• Pain with physical movement like walking

5. Blood in urine or stool
• Blood in urine is very uncommon in children and could be a sign of infection or a kidney problem
• Blood in stool when a child has not been constipated
• Blood in stool when there is a history of travel
• Painless bleeding without bowel movement

“There are several reasons why a child may have blood in his or her stool so it’s best to get it checked out to rule out anything serious,” said Chow.

6. Pain or frequency with urination
• Going to the bathroom many times in an hour
• Pain when trying to urinate
• Eating and drinking a lot but still losing weight
• If a child is not verbal look for these clues:
o Irritability
o Crankiness
o Fever for 2-3 days with no known cause

7. Fevers in certain age groups
• Any child younger than 2 months with a rectal temperature of 100.4 degrees or higher should be evaluated immediately
• Ages 2 months – 3 years with a fever for two to three days but no known cause
• Fevers lasting longer than five to six days
“Viruses are the most common cause of fevers. They tend to scare parents, but most likely they will go away when the virus is gone,” said Chow.

8. Breathing problems
• If your child does not have asthma and any of the following are persistent
o Rib cage squeezing
o Flared nostrils
o Straining abdominal muscles
• Audible wheezing, which is a noise that sounds like harsh air blowing through a straw
• A tight whistling sound during inhalation. If this your this isn’t helped by a cool mist or humidity seeks medical attention immediately
• Coughing that is so severe that your child can’t breathe

9. Difficulty drinking
• Can’t drink enough to urinate every 3-4 hours
• Going 8-12 hours or more without urinating

10. Parent’s gut instinct that something is wrong
“Generally speaking, if a healthy child is drinking well, urinating well and acting within normal limits, he or she is most likely doing fine,” said Chow. “Still, I tell my patients’ parents that if they can’t sleep through the night to give us a call and be reassured.”

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Source: Loyola University Health System