Since no such handy reference exists, parents often feel uncomfortable and inadequate in determining how sick their child is. Are fears about life-threatening illness realistic? Is there real cause for concern? Is the condition serious enough to call the doctor? .

Parents are sometimes surprised to learn that the people best able to judge the seriousness of a child’s condition are the same people who sometimes feel least qualified: themselves! Recent medical studies have demonstrated repeatedly that when it comes to judging illness, "mother’s (and father’s) intuition" is usually right in catching early symptoms of serious illness: no one knows a baby as well as their parents! In addition, personal experience combined with medical knowledge is a pretty good predictor as to whether or not a child is sick. Based on my own professional experience as a pediatrician but also as a father of three, the following generalized points may be helpful:

1) What is the child’s temperature? Fever is one of the most anxiety provoking of all symptoms, yet it may be one of the least important! A crucial exception is the infant under three months of age who may fail to show any other symptoms other than fever while becoming seriously ill. Older children who have high fevers may simply have a minor cold or viral illnesses. Children with more serious diseases sometimes have no fever at all. A child who hasn’t moved in two hours with a temperature of 100 degrees may be sicker than a child with 104 degrees who is leaping off the couch at 8:00 in the morning. So look closely at your child and don’t rely too much on thermometer. How sick your child looks or acts is much more relevant than the level of fever.

2) How much eye contact is present? The first clue to illness could be in your child’s eyes. Inattention, a "vacant stare," and inability to follow movements are worrisome There is less to be concerned about if your child is alert, looking around, and making eye contact with you.

3) Is the child very active? An active and busy youngster probably is not seriously ill. On the other hand, if the child is lethargic and has little spontaneous activity, call your doctor. Another useful hint is to compare your child’s activity and appearance during past illnesses with this one.

4) How hungry is your child? Children who are not feeling well will have a poor appetite. Solid food intake may be non-existent, but it is only the seriously ill child who refuses liquids as well. If the infant is still nursing or taking a bottle, or the older child is still drinking from a cup, then their condition may not be too bad. Vomiting, especially if occurs when the child has not had anything to eat, is a cause for concern.

5) What is the skin color? This observation also gives parents another important insight into their child’s illness. Skin that is pale, bluish, dusky or gray in color usually is worrisome. Normal skin color is a healthy sign.

6) Is the breathing pattern unusual? A noisy breathing sound (stridor) during inspiration, shallow rapid breathing, or grunting at the end of expiration means something is amiss. Look at the child’s nostrils--if they are flaring or moving with each breath, the child is having a problem breathing. Children who are having difficulties getting in enough air often look anxious.

7) How has the illness changed? The severity of the child’s illness can also be judged by the progression of symptoms. If the child steadily gets worse, minute by minute, hour by hour, then something is wrong. If, on the other hand, the child gets better and then gets worse, and then repeats this pattern again over a period of hours and days, the child may not be seriously sick.