How do you know when your child is seriously ill?

At what point do any of us feel confident regarding assessment of child illness? There is no hard and fast rule that will flash a light when a baby or infant is changing from unwell to "really sick". There is a gradation and sometimes it can pass relatively unnoticed even to the most concerned carer.

Fever, cough and the possibility of meningitis remain the most common concerns. Temperature in a child is often used by parents to mean something important. However, there is variability in readings from whether it is taken from the mouth, beneath the arm, or from the rectum. Equally- the normal temperature for a given individual does vary as part of a daily cycle. Parents are also often concerned about crying - however crying exhibits evidence of a level of activity that does not reflect serious illness. These two examples demonstrate how tricky it can be for carers to know how sick their child is.

A useful screen for assessment is the various scoring systems which have been developed in the US, UK and Australia. These tests, combined with fluids in and fluids out which compares current with normal fluid input and wet nappy/urine production, are recommended as a means of appraisal. The two scoring systems that we cover in some detail are: See the Childalert First Aid section and look out for the Children, Accident, Resuscitation and Emergency (CARE) seminar:

Babycheck which contains 19 simple checks for different symptoms or signs of illness. The carer goes through all of the checks and adds up the score. The higher the score the sicker the baby is likely to be.
ABC which is another test that can be used on any age. It assess

arousal, alertness and activity ,

breathing difficulty

poor circulation.

As with all assessment a one off reading means very little - it requires repeating, as the important issue is to detect a change in score. These scoring systems have initially been developed for junior doctor or GP use in the assessment of childhood illness. However, with the appropriate education and information provided, they can be used by parents and carers as one tool in the assessment of their children, and help as a guide for medical support.