When to take your child to A&E: warning signs after fever, falls and vomiting

It is just before midnight. Your child is lying on the sofa with a temperature, has been sick twice and seems different from usual. You are standing in the hallway with your phone in your hand, wondering: do we go to A&E now — or am I overreacting?

Here is the key point first: most unwell children never need A&E. But there is a short list of signs where nobody should wait and see, and that list can be learned.

Which warning signs they are, when to call 999 and when NHS 111 is enough — sorted by situation below: fever, a fall, vomiting, tummy pain and breathing.

When does a child need to go to A&E straight away?

A child needs emergency help straight away if they are struggling to breathe, will not wake properly, have a seizure or have skin, lips or tongue that look blue, grey, pale or blotchy. A rash that does not fade when you press it is an emergency sign too. Then you call 999 or go to A&E.

This list comes from the NHS page when to get urgent medical help for babies and children under 5. The same page also lists a very high temperature — 38C or higher in babies under 3 months, 39C or higher in babies 3 to 6 months — and a very low temperature under 36C as reasons for 999 or A&E.

On the dark-skin question the NHS is specific: on black or brown skin, blue or grey colour changes may be easier to see on the palms of the hands or the soles of the feet.

Does none of this apply, is your child awake, drinking and responding to you? Then tonight is very probably not an A&E night — but it is worth looking closely at the situation that is worrying you right now.

Should you call 999 or drive to A&E yourself?

Call 999 when your child cannot be woken, is struggling to breathe, is having a seizure or turns blue or grey. For everything that needs checking today but is not life-threatening, call NHS 111 or use 111 online. They will tell you what to do, and they give advice for children under 5 too.

The NHS lists the red flags above as "call 999 or go to A&E", so both routes are open. If your child is awake, responding and breathing steadily, taking them to A&E yourself is an option. If they are not, an ambulance brings help to you.

The NHS puts one line above all the others: trust your instincts. Get immediate medical help if your child is unwell and you think something is seriously wrong. And keep checking for new or changing symptoms while they are unwell, even during the night.

Healthier Together, an NHS service for parents, adds a practical note for a child with breathing difficulty who needs to be seen today: if you cannot get through to your GP practice or NHS 111 for 4 hours or more, consider taking them to your nearest emergency department.

When should you go to A&E with a fever?

A high temperature on its own is rarely the reason for A&E. What matters is how your child seems and what comes with it. The NHS says to call 999 for a stiff neck, a rash that does not fade under a glass, a first febrile seizure, unusual drowsiness, or blue, grey or blotchy skin.

The NHS page on fever in children also lists these 999 signs: being bothered by light, unusually cold hands and feet, extreme agitation or confusion, difficulty breathing and not responding like they normally do.

For babies, the number itself matters more. The NHS urgent-help page lists 38C or higher under 3 months and 39C or higher at 3 to 6 months as reasons for 999 or A&E. For older children, call NHS 111 if:

• a high temperature has lasted for 5 days or more
• there are other signs of illness, such as a rash, as well as a high temperature
• your child does not want to eat or is not their usual self and you are worried
• they seem dehydrated — nappies that are not very wet, sunken eyes, no tears when crying

What to do during a febrile seizure is covered step by step in Febrile seizure in children: what to do. How to judge a fever without warning signs is in Fever in children: when is it dangerous?, and how the glass test works is explained in Meningitis rash and the glass test.

When should you go to A&E after a bump to the head?

After a head injury, the NHS says to call 999 if your child was knocked out and has not woken up, cannot stay awake, has fallen more than 1 metre or 5 stairs, or has clear fluid coming from their ears or nose. Vomiting after a head injury is a reason to call NHS 111.

The NHS page on head injury and concussion lists further reasons to call 999:

• problems with vision or hearing, or a black eye without hitting the eye
• bleeding from the ears or bruising behind the ears
• new numbness or weakness, or problems with walking, balance, understanding or speaking
• a head injury at high speed, such as in a road accident
• a bruise, swelling or large cut on the head in a baby under 1 year old
• a change in behaviour, such as being more irritable, distracted or losing interest in things

Most head injuries are not serious. If your child is looked after at home, the NHS advises that an adult stays with them for at least the first 24 hours. Symptoms can last up to 2 weeks; if they go on longer, see a GP. How to read headaches in children more generally is covered in Headaches in children.

When should you go to A&E with vomiting or a stomach bug?

Most vomiting bugs can be managed at home. The NHS says to call 999 or go to A&E if your child vomits blood or has vomit that looks like ground coffee, has yellow-green or green vomit, or may have swallowed something poisonous. Call NHS 111 if they keep being sick and cannot keep fluids down.

The NHS page on diarrhoea and vomiting lists these reasons to call 111 now:

• you are worried about a baby under 12 months
• your child stops breast or bottle feeding while they are ill
• a child under 5 has signs of dehydration, such as fewer wet nappies
• they keep being sick and cannot keep fluid down
• they have bloody diarrhoea or bleeding from the bottom
• diarrhoea for more than 7 days or vomiting for more than 2 days

If you think your child has taken too much of a medicine, Child given a double dose by accident walks you through the next few minutes. How to get fluids into a child who keeps being sick is covered in My child can't keep fluids down.

When is tummy pain an emergency?

The NHS says to call 999 or go to A&E if a stomach ache comes on very suddenly or is severe, if it hurts to touch the tummy, or if there is blood in the vomit or black, sticky poo. A child who cannot pee, poo or pass wind also needs emergency help.

These signs come from the NHS stomach ache page, which is written for all ages. For less acute pain, ask for an urgent GP appointment or call NHS 111 if the pain gets much worse, does not go away or keeps coming back, or if peeing suddenly becomes painful.

If tummy pain comes together with any of the signs in the red box above, such as a child who is hard to wake, call 999.

When is difficulty breathing an emergency?

Difficulty breathing is always urgent. Call 999 or go to A&E if your child is going blue around the lips, has pauses in their breathing, is grunting, or is too breathless to talk, eat or drink. The NHS urgent-help page puts difficulty breathing, grunting and a tummy sucking in on the same 999 list.

Healthier Together, an NHS service for parents, lists these reasons to go to A&E or phone 999: going blue around the lips, pauses in breathing or grunting, a harsh noise on breathing in that is there all the time, or a child too breathless to talk, eat or drink. If your child is interacting normally and drinking as usual, you can watch them closely at home. If they become more breathless or struggle to drink, call your GP surgery or NHS 111.

Healthier Together also points out that a fever can make breathing faster on its own — Child breathing fast while sleeping explains how to tell that apart from a warning sign. A sudden barking cough at night is often croup — Croup in children at night explains what helps. For babies with a cough and fast breathing, see RSV in babies.

What will A&E ask you — and how do you have the answers ready?

At A&E, the team wants to understand what is going on within minutes. The questions are almost always the same: How long has your child been ill? How high was the temperature, and when? Which medicine did they have, how much, and when was the last dose? How much have they drunk, and when was the last wet nappy?

At midnight, after hours with an unwell child, those answers are gone. You guess, mix up the days, and cannot remember whether the last dose was at eight or at ten.

In Mona you log the temperature, each medicine with dose and time, and fluids in a few seconds, one-handed and at night. At A&E you then show the last few days as they happened instead of reconstructing them from memory. If your partner or the grandparents took over in between, their entries sit in the same timeline.

One more habit at the door: NHS pages advise bringing any medicines with you to A&E. Put the box of the fever medicine your child has had in your bag, and nobody has to guess the ingredient.

Frequently asked questions about taking a child to A&E

Can I just take my child to A&E myself?

Yes. The NHS lists its red-flag signs as reasons to "call 999 or go to A&E", so both are options. Driving your child yourself suits a child who is awake, responding and breathing steadily. If your child cannot be woken, is having a seizure or is struggling to breathe, call 999 for an ambulance.

When should I call 111 instead of 999?

NHS 111 is for when you are worried about your child's symptoms or do not know what to do, and it gives advice for children under 5 too. They will tell you what to do. For a child who will not wake, is struggling to breathe, has a seizure or turns blue or grey, call 999.

What if I just have a bad feeling?

Take it seriously. The NHS says to trust your instincts and get immediate medical help if your child is unwell and you think there is something seriously wrong. If you are unsure rather than alarmed, call NHS 111. Keep checking for new or changing symptoms, including during the night.

Do I need to keep my child awake after a head injury?

No. The NHS says your child does not need to stay awake if they are tired. What matters is that an adult stays with them for at least the first 24 hours. Call 999 if they cannot stay awake or keep their eyes open, and call NHS 111 if they start being sick.

What temperature means my child needs hospital?

For babies, the number matters: the NHS lists 38C or higher under 3 months and 39C or higher at 3 to 6 months as reasons for 999 or A&E. For older children, the other signs count, such as a stiff neck or a rash that does not fade. A fever lasting 5 days or more means calling 111.

What is a dangerously low temperature in a child?

The NHS says a temperature under 36C can be a sign of serious illness in babies and young children. A child with a very low temperature may shiver or feel cold, be unusually sleepy or not respond, or breathe slowly. Check twice more within 10 minutes to make sure, then call 999 or go to A&E.

Summary: 999, A&E, 111 or wait and watch?

Situation	What to do
Cannot be woken · difficulty breathing, very fast breathing, grunting · blue, grey, pale or blotchy skin, lips or tongue · seizure · rash that does not fade when pressed · swollen lips or tongue with difficulty swallowing · no pee for 12 hours · under 3 months with 38C or higher, or 3 to 6 months with 39C or higher · after a head injury: knocked out, cannot stay awake, fall over 1 metre or 5 stairs, clear fluid from ears or nose · sudden, severe tummy pain · green or blood-stained vomit · may have swallowed something poisonous	Call 999 or go to A&E
Keeps being sick and cannot keep fluids down · signs of dehydration · vomiting after a head injury · fever for 5 days or more · bloody diarrhoea · baby under 12 months with diarrhoea or vomiting · becoming more breathless or struggling to drink	Call NHS 111 or see a GP today
Your child is drinking, awake and responding to you	Watch, offer fluids — log temperature and medicines in Mona