Premature babies, newborns and infants

Children with malnutrition

Children with cancer

Chronically ill children

Children with immune deficiency (congenital or acquired)

Children with reduced circulation (e.g. congenital heart defects)

Chronic bacterial colonization of children with pathological germs (e.g. cystic fibrosis)

Critically ill children

Children with foreign bodies in the body such as bladder catheters, central venous catheters, ventilation tubes, etc.

Disadvantaged social circumstances

Spleen missing

Missing vaccinations

Raised temperature (more than 37.5° C for five days or more

Shivering or shaking

Nostrils change size with each breath

Breathing that’s noisy or sounds ‘crackly’

Cough that sounds like a seal barking

Unusually pale skin

Dry mouth, lips and/or tongue

Baby who is not feeding (taking less than half their usual amount of milk)

Eating much less than normal

Has vomited (been sick) more than twice in the last 24 hours

More than five watery poos (diarrhoea) in the last 24 hours in babies younger than one year of age

Only one wee or wet nappy in eight hours

Less interested than usual in playing

Difficult to wake up or unusually sleepy

Swelling of a limb or joint

Not using/putting weight on an arm, leg, hand or foot

Temperature over 38°C in babies under three months

Temperature over 39°C in babies aged three to six months

Any high temperature in a child who cannot be encouraged to show interest in anything

Low temperature (below 36°C, check three times in a 10 minute period)

Finding it much harder to breathe than normal – looks like hard work

Making ‘grunting’ noises with every breath (in newborns this may sound like a lamb bleating)

Very fast breathing (more than one breath each second in babies)

Can’t say more than a few words at once (for older children who normally talk)

Breathing that obviously ‘pauses’

Skin is blue, mottled (purplish, red) or very pale

Lips or tongue are bluish

Eyes look ‘sunken’

Hands and feet are unusually cold to touch

Rash that does not fade when pressed firmly (use a clear glass)

New baby under one month old with no interest in feeding

Not drinking for more than eight hours (when awake)

Extremely thirsty

Unable to keep fluids down

Persistently vomiting for more than 24 hours

Bile-stained (green), bloody or black vomit/sick

Not had a wee or wet nappy for 12 hours

Soft spot on a baby’s head is bulging

Child cannot be encouraged to show interest in anything

Baby is floppy

Weak, ‘whining’ or continuous crying in a younger child

Older child who’s confused

Not responding or very irritable

Hard to wake up, won’t stay awake or doesn’t seem to recognise you

Stiff neck, especially when trying to look up and down