1 Has your child injured his or her head in the past few days?

2 Does your child have a temperature of 38°C (100°F) or above?

3 Does your child have any of the following?

• Severe headache
• Reluctance to bend the head forward
• Dislike of bright lights
• Flat, dark red spots that do not fade on pressure ( Checking a red rash)

4 Might your child have swallowed any of the following?

• Drugs prescribed for an adult
• Poisonous plants or fungi
• Cleaning products

5 Does your child have one or more of the following?

• Unexplained weight loss
• Increased thirst
• Passing more urine than usual

6 Is your child being treated for diabetes?

7 Is there evidence that your child has had a seizure, for example has your child done either of the following?

• Bitten his or her tongue
• Wet him- or herself

8 Has your child had diarrhoea, with or without vomiting, in the past 24 hours?

9 Has your child been exposed to hot sunshine or high temperatures recently?

10 Is your child taking any prescription drugs or over-the-counter drugs?

11 Could your child have been drinking alcohol?

12 Could your child be using recreational drugs or inhaling solvents?

13 Emergency! Call an ambulance

Possible causes In many cases, confusion following a head injury is short-lived. However, it may be an indication of a serious brain injury or be associated with bleeding between the skull and the brain.

Action Do not give your child anything to eat or drink while waiting for the ambulance. Your child will be fully examined in hospital and may need tests such as a skull X-ray or CT scanning. He or she may need to stay in hospital for monitoring.

14 Emergency! Call an ambulance

Possible causes Meningitis, inflammation of the membranes surrounding the brain due to an infection, may be the cause of these symptoms. Encephalitis, inflammation of brain tissue as a result of a virus infection, is also a possibility.

Action If meningitis is suspected, your child will be admitted to hospital immediately. He or she will be given urgent treatment with antibiotics and may need intensive care. Encephalitis often gets better by itself but may need treatment with an antiviral drug.

15 Call your doctor now

Possible causes Your child's confusion may be the result of a severe infection, such as pneumonia or a urinary tract infection.

Action Take steps to reduce the fever (see Bringing down a fever), and make sure your child drinks plenty of fluids. Your doctor will examine your child, and if there is an obvious site of infection, he or she may prescribe antibiotics. Otherwise, your child may need to be admitted to hospital for tests to determine the cause and treatment needed.

16 Emergency! Call an ambulance

Possible cause and action Your child's symptoms may be due to poisoning. While you are waiting for medical help to arrive, follow the first-aid procedure for swallowed poisons. Try to find the container or a sample of the substance that your child has swallowed to take with you to the hospital.

17 Call your doctor now

Possible cause Diabetes mellitus is a possibility. This condition is caused by insufficient production of the hormone insulin, which is needed by the body to get energy from sugar and carbohydrate foods.

Action Your doctor will take a blood sample to test your child's blood sugar level. If the diagnosis is confirmed, your child may need to be admitted to hospital for insulin injections and intravenous fluids until the condition is controlled. Insulin will be needed for life.

18

Possible causes Confusion or drowsiness in children with diabetes may indicate a low blood sugar level, particularly if the symptoms have come on suddenly. Less commonly, these symptoms may be the result of a high blood sugar level and may have developed gradually.

Action If your child is sufficiently alert, give him or her something very sweet to eat or drink. This should correct a low blood sugar level and will do no harm if the sugar level is too high. If your child cannot cooperate or is no better within 10 minutes, call your doctor at once. However, you should call an ambulance if your child becomes unconscious.

19

Possible cause and action If your child has had an epileptic seizure, it may have left him or her drowsy or confused. If your child has been diagnosed as having epilepsy, consult your doctor because your child's treatment may need adjusting. However, you should call your doctor immediately if your child has not previously been diagnosed as having epilepsy: he or she needs to be assessed promptly.

20 Call your doctor now

Possible cause Your child's symptoms may be due to dehydration.

Action Your doctor will examine your child to assess how severely dehydrated he or she is. In most cases, giving your child fluids at home will treat the dehydration and prevent it worsening (see Preventing dehydration in children). However, if your child is very unwell or unable to drink sufficient fluids to treat the dehydration, he or she may need to be admitted to hospital.

21 Emergency! Call an ambulance

Possible cause Your child's symptoms may be due to heatstroke, in which a high temperature and dehydration can cause confusion and drowsiness.

Action While waiting for help, lay your child in a cool place and remove all his or her outer clothing. Sponge him or her with tepid water. If your child is able to cooperate, offer him or her cool drinks.

22 Call your doctor now

Possible cause and action Drowsiness or confusion may be a side effect of some drugs, including antihistamines and anticonvulsants. If your child is taking a prescribed drug, ask your doctor's advice before the next dose is due. Your child should stop taking any over-the-counter drugs.

23

Possible cause Your child may be intoxicated or have alcohol poisoning.

Action Encourage your child to drink plenty of water, and wait for the effects to wear off. If your child becomes unconscious, call an ambulance.

24

Possible cause Drug or solvent abuse may cause drowsiness or confusion.

Action Watch your child carefully while he or she seems confused or drowsy. If your child becomes unconscious, call an ambulance. While waiting for help, follow the first-aid procedure for unconsciousness. Delay discussing the problem with your child until he or she is well enough to understand. If you think your child is becoming dependent on drugs, consult your doctor. Advice and support is also available from many self-help groups.

25

Call your doctor now if your child is drowsy or confused and you are unable to make a diagnosis from this chart.