1 Does your child have a rash?

2 Is your child complaining of earache, and/or is he or she tugging at either ear?

3 Does your child have a cough and/or a runny nose?

4 Does your child have noisy breathing and/or a barking cough?

5 Is your child's breathing faster than normal? see Checking your child's breathing rate.

6 Does your child have any of the following?

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

7 Does your child have diarrhoea?

8 Does your child have a sore throat?

9 Does your child have any of the following?

• Pain on passing urine
• Frequent passing of urine
• Bedwetting or daytime wetting after being dry
• Offensive-smelling or cloudy urine

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

11

go to Rash with fever

12 See your doctor within 24 hours

Possible cause A viral or bacterial infection of the middle ear is a possible cause of your child's symptoms.

Action Your doctor will examine your child. If the diagnosis is confirmed, he or she may prescribe painkillers and/or antibiotics. You can also try self-help measures for relieving earache.

13 Call your doctor now

Possible cause A condition such as croup, in which the throat becomes swollen and narrowed due to a viral infection, is possible.

Action Your doctor may give your child an inhaled or oral corticosteroid drug to ease his or her breathing. You should also try self-help measures for relieving a cough. If your child's symptoms are severe, he or she may need to be admitted to hospital for monitoring and further treatment.

14 Call your doctor now

Possible cause A chest infection such as pneumonia (infection of the air spaces in the lungs) is possible.

Action If your doctor confirms the diagnosis, he or she will probably prescribe antibiotics and may arrange for a chest X-ray. Take steps to reduce your child's temperature (see Bringing down a fever), and make sure he or she drinks plenty of fluids. Occasionally, hospital admission is necessary.

15

Possible causes Many viral infections, such as a cold, can cause a cough and runny nose.

Action Take steps to reduce your child's temperature (see Bringing down a fever), and give him or her plenty to drink. Call your doctor if a rash develops, if your child develops difficulty in breathing, or if there is no improvement within 48 hours.

16 Emergency! Call an ambulance

Possible cause Meningitis, inflammation of the membranes surrounding the brain due to an infection, may be the cause of such symptoms.

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.

17

Possible cause Gastroenteritis, inflammation of the digestive tract, usually due to a viral infection, is the most likely cause of diarrhoea with a fever. Your child may also vomit.

Action Follow the self-help measures for preventing dehydration in children and treating gastroenteritis in children. If your child has diarrhoea for more than 24 hours, call your doctor.

18 See your doctor within 24 hours

Possible causes Pharyngitis or tonsillitis, an infection of the throat or the tonsils, are the most likely causes. The infection may be due to a bacteria or a virus.

Action Your doctor will examine your child's throat and may take a throat swab to confirm the diagnosis. He or she may prescribe antibiotics for the infection. You can also try self-help measures for soothing your child's sore throat.

19 See your doctor within 24 hours

Possible cause Your child may have a urinary tract infection.

Action Your doctor will test a sample of your child's urine. If the diagnosis is confirmed, a urine sample will be sent for analysis, and your child will be prescribed antibiotics. In some cases, further tests, such as ultrasound scanning (see Investigating the urinary tract in children), may be needed to look for any associated problems.

20

Possible cause Overheating, leading to a rise in body temperature, is the most likely cause.

Action Take steps to reduce your child's temperature by removing any excess clothing and moving him or her to a slightly cooler (though not cold) place. If your child's temperature has not returned to normal within an hour, follow the advice for bringing down a fever and call your doctor.

21

See your doctor within 24 hours if you are unable to make a diagnosis from this chart.