When to call the doctor for your baby: red flags by urgency

Call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) straight away if your baby is struggling to breathe, looks blue, grey or blotchy, is floppy or hard to wake, has a seizure, or has a rash that doesn't fade under a glass. The same goes for a temperature of 38°C or more in a baby under 3 months, green or yellow vomit, and no wet nappy in 12 hours. Other signs, such as feeding much less or white poo, need a doctor the same day. Many everyday worries can wait for your GP or child-health nurse.

This guide sorts the warning signs into three tiers so you can act quickly. No list covers everything. If you think something is seriously wrong, get help anyway.

How urgent is it? The three tiers at a glance

Cocoon guides use the same three tiers for every health topic, so a sign means the same thing wherever you read about it.

If a sign in a lower tier gets worse, or you can't get a same-day appointment, move up a tier. The NHS urgent-help guide also asks parents to keep checking for new or changing symptoms while a child is unwell, even during the night.

When should I call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) straight away?

The NHS urgent-help guide lists these as reasons to call an ambulance or go to the emergency department for a child under 5. Call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) if your baby:

• Is breathing very fast or is struggling to breathe, for example grunting or sucking in their tummy.
• Has blue, grey, very pale or blotchy (mottled) skin, lips or tongue, or skin that feels cold and clammy.
• Is floppy, difficult to wake, can't be woken, or has fainted.
• Is having a seizure (fit).
• Has a rash that doesn't fade when you press a glass against it.
• Has a weak, high-pitched or continuous cry.
• Has a temperature of 38°C (100.4°F) or more and is under 3 months old.
• Has a temperature of 39°C (102.2°F) or more and is 3 to 6 months old.
• Has a temperature below 36°C, or feels cold and shivery. The NHS suggests rechecking twice within 10 minutes to confirm a low reading.
• Has not had a wet nappy or a wee in the past 12 hours.
• Has swollen lips, tongue or throat and is struggling to swallow.

The NHS fever page lists the two temperature rules for an urgent call to its phone advice line instead, and NICE treats 39°C at 3 to 6 months as at least intermediate risk. We follow the urgent-help guide's stricter tier.

Add these signs from other sources:

• Green or yellow vomit. The Sydney Children's Hospitals Network says this can mean a blocked or twisted bowel, and that babies can look healthy while the bowel is being damaged. Call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) or go to the nearest emergency department.
• Vomiting with a swollen, hard tummy. NICE's reflux guideline says a swollen, tender tummy can suggest a blocked bowel or another surgical problem.
• A bulging soft spot or a stiff neck. NICE's fever guideline treats a bulging fontanelle and neck stiffness as high-risk signs. The Royal Children's Hospital Melbourne (RCH) also lists a stiff neck as a reason to go to hospital.
• A long pause in breathing. The AAP sleep apnoea guide says to call an ambulance if breathing stops for more than 20 seconds, or the skin turns pale, blue or grey. The RCH bronchiolitis fact sheet says the same for an unwell baby whose breathing is irregular or pauses.
• Vomiting blood. The NHS vomiting guide lists vomiting blood, or vomit that looks like coffee grounds, among reasons to call an ambulance or go to A&E. The NHS reflux page gives an urgent GP appointment instead; we follow the stricter advice.
• A cry that doesn't sound like your baby's normal cry. The NHS colic page lists this, with a weak or high-pitched cry, as a reason to go to A&E or call an ambulance.
• Not feeding and much sleepier than usual. The NHS meningitis page lists a baby under 5 who is not feeding, floppy, difficult to wake or more sleepy than usual among reasons to call an ambulance.
• Severe dehydration. The RCH dehydration fact sheet says cold hands, mottled skin, sunken eyes or a very sleepy, low-energy child need hospital care fast, and an ambulance if there's breathing trouble or blue or grey skin.

For a fever under 3 months, 39°C or more at 3 to 6 months, green vomit or severe dehydration in a baby who is alert and breathing normally, it's fine to go straight to the nearest emergency department if you can get there quickly. For breathing trouble, colour changes, a seizure, a non-fading rash or a baby you can't wake, call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) and wait for the ambulance. The NHS meningitis page says not to drive yourself to A&E. Use your local emergency service if you're travelling or unsure of the number.

What breathing trouble looks like

The NHS describes a baby working hard to breathe: sucking in at the tummy or chest, nodding their head, or flaring their nostrils. Grunting with each breath is a warning sign, and very young babies may make a bleating sound like a lamb. Breathing that pauses or is irregular, or a baby who can't feed without stopping for breath, also needs help. NICE treats more than 60 breaths a minute as a high-risk sign.

Checking colour on any skin tone

Blue, grey or mottled colour can be harder to see on brown or black skin. The NHS suggests looking at the palms, the soles of the feet, the lips and the inside of the cheeks.

The glass test for rashes

Press the side of a clear glass firmly against the spots. If they don't fade, call your local emergency number (000 in Australia, 999 in the UK, 911 in the US). That kind of rash can be a sign of meningococcal infection, and the NHS meningitis page notes it can be harder to see on brown or black skin. Not everyone with meningitis gets a rash, so a baby who seems very unwell needs help even without one.

Which symptoms need a doctor today?

These signs need a doctor within hours, not days. Book a same-day GP appointment, use an after-hours doctor service, or call a health advice line (Pregnancy, Birth and Baby on 1800 882 436 in Australia, NHS 111 in the UK, your pediatrician's after-hours line in the US) for advice on where to go. If you can't be seen soon, or your baby gets worse, go to the emergency department.

• A fever that keeps going. NICE and the NHS treat a fever lasting 5 days or more as a reason to be checked. The American Academy of Pediatrics (AAP) sets a lower bar: call if a fever lasts more than 24 hours in a child under 2.
• Feeding much less than usual, or refusing feeds. NICE lists poor feeding in infants as a warning sign. If your baby is also much sleepier than usual, floppy or hard to wake, call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) instead.
• Any sign of dehydration in a baby under 6 months. The RCH says these babies should see a doctor because they can get sicker very quickly. Signs include fewer wet nappies, darker wee, a dry mouth and being quieter than usual.
• Vomiting that won't stop. This means being sick for 24 hours, or not keeping fluids down. Vomit with blood in it, or red, black or brown vomit, is in the your local emergency number (000 in Australia, 999 in the UK, 911 in the US) tier.
• A breathing pause of more than 10 seconds in a newborn who is now breathing normally. The AAP newborn symptom guide says to seek care straight away. It describes pauses of under 10 seconds, with normal colour, as normal; see baby sleep sounds.
• Forceful (projectile) vomiting in a young baby. The RCH pyloric stenosis fact sheet says this usually starts between 2 and 6 weeks, and to see your GP immediately if vomiting is persistent.
• White, pale grey or pale creamy poo, or dark yellow wee in a jaundiced baby. The NHS jaundice page asks for an urgent GP or midwife appointment for these. See baby poop for why pale poo matters.
• Blood in poo, or a swollen, tender tummy. The NHS reflux page lists both as reasons for an urgent GP appointment. If there's more than a streak of blood, the poo is black and tarry, or your baby is vomiting or seems unwell, call your local emergency number (000 in Australia, 999 in the UK, 911 in the US).
• No poo for around 3 days with a swollen or painful tummy, straining or bleeding. The NHS lists this among signs of serious illness.
• A baby who can't settle or seems very agitated. A weak, high-pitched or continuous cry is in the your local emergency number (000 in Australia, 999 in the UK, 911 in the US) tier.
• Not moving an arm or leg normally, or a hot, swollen joint.

When can it wait for your GP or child-health nurse?

Some concerns matter but aren't urgent if your baby is otherwise feeding, weeing and alert. Book a GP appointment or raise them at your next child-health check:

• Spit-up that isn't improving, starts after 6 months, or is affecting weight gain (see reflux and spit-up).
• Hard poos or straining in a baby who is otherwise well (see constipation).
• A nappy rash that isn't settling after a few days of care (see nappy rash).
• A cold or cough in a baby who is feeding and breathing comfortably (see colds and congestion).
• Snoring most nights, or snorts and gasps in sleep, in a baby who is otherwise well. The AAP sleep apnoea guide says to tell your doctor right away, so book a visit soon rather than waiting for a routine check.
• Questions about growth, sleep, teething or development.

If any of these come with a sign from the tiers above, follow the higher tier.

Are there extra warning signs for newborns?

Young babies can become unwell quickly and show it in quieter ways. On top of the lists above:

• Fever in the first month. The RCH advises taking a baby under one month with a fever to hospital. For any baby under 3 months, 38°C or more is in the your local emergency number (000 in Australia, 999 in the UK, 911 in the US) tier. Our fever guide explains how to take a temperature.
• Yellow skin in the first 24 hours. The NHS jaundice page lists jaundice in a baby less than 24 hours old as a reason to call an ambulance or go to A&E. The same applies to a jaundiced baby who is not feeding, is floppy or stiff, or has jerking movements.
• Jaundice first noticed after 24 hours. The NHS jaundice page asks for an urgent GP or midwife appointment, and Australia's Pregnancy, Birth and Baby says to see a doctor for jaundice in the first 48 hours.
• Jaundice that hasn't gone after about 2 weeks. The NHS says newborn jaundice usually takes around 2 weeks to go. If it hasn't, call your GP or child-health nurse today to arrange a check, and ask to be seen today if poo is pale or wee is dark. See newborn jaundice.
• Not feeding, or too sleepy to feed. A newborn who keeps refusing feeds needs a doctor today. If they are too sleepy to wake for feeds, floppy or hard to wake, call your local emergency number (000 in Australia, 999 in the UK, 911 in the US).
• Low temperature. A reading below 36°C is in the your local emergency number (000 in Australia, 999 in the UK, 911 in the US) tier.

If your baby was born early, tell the doctor or nurse how many weeks early. It helps them judge what's expected for your baby.

How few wet nappies is too few?

Wet nappies are one of the easiest dehydration checks at home, but a count can't confirm your baby is well on its own. Use these thresholds alongside how your baby looks:

These thresholds come from the RCH dehydration fact sheet and the NHS urgent-help guide; NICE also lists a sunken soft spot among dehydration signs. The NHS dehydration page gives a sunken soft spot an urgent GP appointment, but we use the stricter tier. The NHS crying-baby page uses a shorter 8 hours without a wet nappy for a baby who is crying constantly or seems ill, so don't wait for 12 hours if your baby seems unwell. Our dehydration signs guide covers what to offer while you arrange help. Don't wait to finish a nappy count if your baby already seems unwell.

Should I trust my instinct?

Yes. The NHS urgent-help guide says to get immediate medical help if your child is unwell and you think something is seriously wrong. NICE tells clinicians to take a parent's sense that their child has a fever seriously, even without a reading. You know your baby's usual cry, colour and alertness better than anyone.

After a doctor has seen your baby, NICE advises going back for more help if your child has a fit, develops a rash that doesn't fade, or seems less well than before. Also go back if you're more worried than before, the fever lasts 5 days or more, or you feel you can't look after your child at home. Going back is expected, not a nuisance.

What should I have ready when I call?

Don't delay a call to gather details. If you have a moment, these help the nurse or doctor:

1. Your baby's age, and how many weeks early they were born if premature.
2. The sign that worries you most and when it started.
3. The latest temperature, the time, and how you took it (armpit, ear or forehead).
4. Feeds and wet or dirty nappies over the last 24 hours, plus any vomiting.
5. Any medicines given, with times, and any known health conditions.
6. Photos of a rash, vomit or an unusual nappy.

If you're not sure which tier your baby fits, call a health advice line (Pregnancy, Birth and Baby on 1800 882 436 in Australia, NHS 111 in the UK, your pediatrician's after-hours line in the US) for advice. Keep that number, your GP's after-hours number and your local emergency number (000 in Australia, 999 in the UK, 911 in the US) somewhere easy to find before you need them.

A simple note of times, temperatures, feeds and nappies can help a clinician see the pattern. Write it down as you go, but never delay care to finish it.