If you’ve ever stood over your child at 2 a.m., thermometer in hand, wondering whether a fever warrants a call to the pediatrician or just a cool washcloth and a wait-and-see, you’re in good company. Most childhood coughs, rashes, and tummy aches resolve on their own, but knowing when something needs a doctor is one of the quietly essential skills of parenting, and it rarely comes naturally.

To help demystify that gray area, we turned to Dr. Angela Cabarcas, a board-certified pediatrician with Bluebird Kids Health. Her advice is refreshingly grounded: look at the whole child, not just the number on the thermometer. Below, she shares seven signs worth paying attention to.

7 Signs Not to Ignore 

+ Fever with Concerning Symptoms

The definition of fever is a body temperature of 100.4°F (38°C) or higher.  Fever itself is not necessarily a cause for alarm, but the circumstances surrounding the fever matter. Any baby under 3 months with a fever should be evaluated. For older children, a fever that lasts more than three days may deserve a visit to the doctor, especially if your child is not improving or develops new symptoms.  Also, a new fever in the setting of already being sick with a common cold can sometimes indicate a secondary infection like pneumonia or an ear infection. Fever plus neck stiffness or pain with urination are other reasons to contact your pediatrician.  I encourage parents to look at the whole child, not just the number on the thermometer.  If your child is happy and playful, it is okay to let the fever run its course without giving fever-reducing medication because a fever can actually help the body fight the infection better.

+ Difficulty Breathing

Nasal congestion can certainly make it difficult for a young child to breathe comfortably through their nose, but that is different from actually struggling to breathe. Look for signs that your child is working harder to breathe – belly breathing or retractions, when you can see the skin pulling in around the ribs or above the collarbone, indicate the child is using accessory muscles to breathe. Rapid breathing, persistent wheezing, blue/gray lips, grunting, struggling for each breath, or having trouble talking because of their breathing warrants immediate medical attention.

+ New Rash that is Worsening or Painful

There are numerous causes of rashes – irritation from touching something their skin didn’t like, bug bites, viral infections, or chronic conditions, like eczema, are just a few examples. Your child should see their pediatrician if they have a rash that is rapidly worsening, painful, swollen, or increasingly red. One simple trick can help you determine whether an area of redness is getting better or worse: carefully mark the outer edge of the redness with a pen and note the time. If the redness continues to spread beyond the mark, contact your pediatrician. Oozing or crusted sores can also indicate infection and may warrant an antibiotic prescription. Of course, any rash accompanied by difficulty breathing, swelling of the face or lips, or a child who appears seriously ill requires urgent evaluation.

+ Unable to Keep Down Liquids or Urinating Less Than Usual

Children can become dehydrated because they are losing too much fluid from vomiting, diarrhea, or sweating, but they also because they are simply not drinking enough. Sometimes a child refuses liquids because they have sores in their mouth or their throat hurts. It can be difficult for parents to see far back into a child’s throat, so an examination by their pediatrician may help identify why drinking has become so difficult. If your child cannot keep liquids down or is urinating less than usual, contact your pediatrician so we can evaluate the level of dehydration and possibly prescribe medication to help alleviate nausea so your child can rehydrate effectively.

+ Severe or Unexplained Pain

Pain, particularly when it is severe, persistent, or worsening warrants evaluation. For example, sudden hip or knee pain without a known injury should be evaluated rather than simply assuming it is a minor muscle ache. Persistent abdominal pain that is becoming worse in intensity or frequency should be checked by their doctor.  If your child appears very ill, has difficulty walking, or has pain that is rapidly worsening, prompt medical evaluation is appropriate.

+ Concerns About Developmental Delays

You know your child better than anyone, and if you feel that they are not reaching milestones or have stopped progressing, please bring up those concerns with your pediatrician. The earlier we identify a developmental delay; the sooner we can connect a child with appropriate therapies and support.  Early intervention can lead to better outcomes. This is why routine well-child visits are so important. We incorporate developmental screening into those check-ups to identify delays as early as possible.

+ Change in Behavior or Unusual Fatigue

Finally, I always tell parents to trust their instincts when their child simply isn’t acting like themselves. A sick child may understandably be tired, but there is a difference between needing extra rest and being unusually difficult to wake or move out of bed.  Pay attention if your child seems to tire much more easily while doing activities that were previously easy for them.  If your child is difficult to arouse, confused, or not responding normally, they should be evaluated urgently.

As a pediatrician, I don’t expect parents to know exactly what is causing every symptom their child experiences; rather, I want parents to notice the change and seek help when their instincts tell them that something is wrong. When in doubt, call your pediatrician’s office so your child’s medical team can help determine whether you should monitor symptoms at home, schedule an appointment, or seek urgent care.

Dr. Angela Cabarcas is a board-certified pediatrician with Bluebird Kids Health