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As a pediatrician, I鈥檝e talked on the phone with lots of parents of sick children. As I ask my questions and try to understand what鈥檚 going on and how I can help, there are a few symptoms in particular that I listen for.

I don鈥檛 hear them often. Most of the time, it鈥檚 not serious (that鈥檚 one of the great things about pediatrics). But when I hear them, I get scared because I know there is a chance that the child is very sick, and that if they don鈥檛 get medical attention quickly, something bad could happen.

The thing about these symptoms, too, is that many parents don鈥檛 understand how serious they can be. Parents know that high fevers, cuts that bleed badly, lots of vomiting or diarrhea, bad injuries, or bad coughs need attention. But they don鈥檛 always understand the seriousness of the ones that terrify me. That鈥檚 why I think it鈥檚 important that parents know about them.

1. Lethargy. When doctors talk about 鈥渓ethargy,鈥� they aren鈥檛 talking about a lazy teenager who wants to hang out on the sofa all day. To us, the word means sleepiness that is really unusual. Now, sick children (sick people, not just children) need sleep, and it鈥檚 normal for them to sleep more than usual. But when a child wants to do nothing except sleep, or (this is important) is difficult to rouse or keep awake, that鈥檚 not okay. It鈥檚 also not okay when a child, although awake, only wants to lie still and seems sleepy and weak. If you can鈥檛 get the child to sit up, walk around, interact with you, and play a bit, that鈥檚 a bad sign.

There are lots of different things that can cause lethargy, such as infections, dehydration, bad bumps to the head, chemical imbalances, or toxins. All of them need prompt medical attention.

2. 聽Irritability and/or unrelenting pain. It鈥檚 certainly normal for a sick child to be cranky 鈥� and for a sick or hurt child to be in pain. But for most illnesses or injuries, you can manage crankiness or pain with TLC or medication 鈥� and with most illnesses or injuries the crankiness or pain comes and goes. But when it doesn鈥檛 let up, that鈥檚 a problem. If you can鈥檛 settle your baby or toddler, if all he does is fuss or cry (especially if he doesn鈥檛 want to eat or drink), that鈥檚 not normal; he needs to be checked out. With older children, if whatever discomfort or pain they have doesn鈥檛 go away despite your best efforts, that鈥檚 not normal either and deserves a visit to the doctor.

3. 聽Trouble breathing. You鈥檇 think that every parent would recognize trouble breathing, but it turns out that not all do, especially when a child isn鈥檛 coughing. Signs that a child might be in trouble include:

• Retractions. This is when a child uses extra muscles to help them breathe; it looks like they are sucking in around the ribs or at the front of the neck. To best see this, take off the child鈥檚 shirt and really look at the chest.
• Making a wheezing or squeaking noise when breathing that doesn鈥檛 go away when she coughs or after some time in a steamy bathroom.
• Inability to talk 鈥� or, in babies or toddlers, inability to drink 鈥� because of breathlessness.
• Breathing fast. This isn鈥檛 always obvious unless you look closely, and is easier to see with a shirt off.
• Looking pale 鈥� or worse, blue. Turn on the light if it鈥檚 nighttime. Take a good look.

4. 聽Red or purple rashes (little spots or raised areas) that don鈥檛 get paler when you press on them. Most rashes, no matter what color they are, will get pale when you press on them, but this kind, known to doctors as petechiae (little spots) or purpura (raised areas) don鈥檛, because they are caused by bleeding into the skin. They can be caused by a life-threatening infection as well as some other serious health problems.

Chances are these will never happen to your child. But if they do, don鈥檛 鈥漡ive it time鈥� to see if they will get better; either bring your child immediately to your doctor or the emergency room, or call 911.

It may be that the moment you get to the doctor your child perks up, or stops crying, or otherwise looks completely fine. Don鈥檛 feel silly if that happens. When it comes to these symptoms that terrify doctors, it鈥檚 always better to be safe than very, very sorry.