1 Does your child have any of the danger signs listed in the box on the right?

2 Does your child have a rash of small blisters?

3 Are the blisters confined to the hands, feet, and the inside of the mouth?

4 Does your child have a severe sore throat?

5 Does your child have a red or pink mottled or blotchy rash?

6 Does your child have red eyes, a runny nose, and/or a dry cough?

7 Does your child have a bright red rash on the cheeks with or without a lacy rash on the trunk?

8 Is your child under 2 years old, and did he or she have a high fever for 3-4 days before a rash developed on his or her body.

9 Is your child under 6 years old, and does he or she have any of the following?

• Swollen hands and feet
• Dry, cracked and swollen lips
• Red palms and soles
• Red eyes
• Swollen glands

10 Has your child taken any new drugs within the last week?

11 Emergency! Call an ambulance

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

12

Possible cause and action Your child may have hand, foot, and mouth disease, a mild viral infection. Consult your doctor, who will confirm the diagnosis. There is no specific treatment for this condition, but if your child has a sore mouth, take steps to relieve the pain (see Relieving a sore mouth). Make sure that your child drinks plenty of fluids (see Encouraging your child to drink) to prevent dehydration.

13

Possible cause Chickenpox, an infectious disease caused by the herpes zoster virus, is the likely cause of these symptoms. In children, this is usually a mild disease, and most children feel unwell for only the first few days. Consult your doctor if the symptoms are severe.

Action Keep your child's fingernails short to discourage scratching, which can lead to scarring. Itching may be relieved by adding baking soda to your child's bath water and by applying calamine lotion to the spots. Follow the advice for bringing down a fever.

14 See your doctor within 24 hours

Possible cause Scarlet fever, a bacterial throat infection, is a likely cause of these symptoms, especially if your child is also vomiting and has a rash that is particularly prominent in the folds of the skin, such as the armpits.

Action Your doctor will examine your child to confirm the diagnosis. He or she may prescribe antibiotics. Follow the advice for reducing a fever ( Bringing down a fever) and also for relieving a sore throat.

15 See your doctor within 24 hours

Possible cause Measles is the most likely cause of these symptoms, even if your child has been immunized against the disease.

Action Your doctor will examine your child to confirm the diagnosis. He or she may prescribe antibiotics. Make sure your child drinks plenty of fluids (see Encouraging your child to drink), and follow the advice for bringing down a fever.

16

Possible cause and action Rubella, also known as German measles, is a possibility, especially if your child has swollen glands. You do not need to consult a doctor unless your child has been in contact with a pregnant woman, in which case, the diagnosis should be confirmed. Take steps to reduce your child's fever (see Bringing down a fever).

17

Possible cause and action Your child may have erythema infectiosum, also known as slapped-cheek disease or fifth disease. This viral condition is usually mild. Follow the advice on reducing a fever ( Bringing down a fever). The diagnosis should be confirmed by your doctor if your child has been in contact with a pregnant woman. If you are worried or if your child is no better in 48 hours, call your doctor.

18

Possible cause and action Your child may have roseola infantum, a common early childhood infection. This condition is difficult to diagnose before the rash appears as the fever is the only symptom. By the time the rash appears, the child is usually better. If you suspect your child has this condition and he or she still has a fever, consult your doctor. He or she will examine your child and may do tests to exclude more serious problems.

19 Call your doctor now

Possible cause Kawasaki disease, a rare condition of unknown cause, which can damage the heart and joints, is a possibility.

Action If your doctor suspects that your child has Kawasaki disease, your child will be admitted to hospital, where his or her condition can be monitored and treatment given to reduce the risk of heart complications.

20 Call your doctor now

Possible causes Your child may have an allergy to the prescribed medicine, or he or she may have a viral illness unrelated to the drug.

Action Your doctor will examine your child to determine the cause of the symptoms. If your child does have a drug allergy, your doctor will be able to tell you whether your child should avoid this drug in future.

21

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