How to Survive a Sick Child at 2am
At 2am there are only three answers: call an ambulance, go now, or it can wait until morning. Everything a frightened parent needs at that hour is a way to pick between them quickly.
The single most useful thing to know is that how a child looks and behaves matters more than the number on the thermometer. A child at 39.5°C who is drinking, responsive and grumpy is in a better position than a child at 38.2°C who is drowsy, floppy and refusing fluids.
The emergency numbers in this guide are Australian. If you are somewhere else, call your own country’s emergency number instead — 911 in the United States and Canada, 999 in the United Kingdom, 112 across Europe and on most mobile phones worldwide. The clinical signs are the same everywhere.
The 10-minute version
- Call 000 for difficulty breathing, blue or grey skin, a seizure, unresponsiveness, or a rash that doesn’t fade under pressure.
- Any fever of 38°C or above in a baby under three months is an emergency, regardless of how well they seem.
- When unsure, ring healthdirect on 1800 022 222 (Victoria: Nurse-on-Call 1300 60 60 24). A registered nurse, free, 24 hours. That is precisely what it exists for.
Call 000 now
Do not drive, do not wait, do not ring anyone else first.
- Difficulty breathing — fast breathing, grunting, ribs or the hollow of the neck sucking in with each breath, nostrils flaring, unable to speak in sentences
- Blue, grey or very pale skin, especially lips, tongue or face
- A seizure, or a first-ever fit
- Unresponsive, floppy, or cannot be woken
- A rash that does not fade when you press a clear glass firmly against it
- A stiff neck with fever and light hurting their eyes
- Severe or worsening pain they cannot be distracted from
- Choking, or a swallowed button battery — a battery is a genuine emergency even with no symptoms
- A significant head injury with vomiting, drowsiness or confusion
- Anaphylaxis — swelling of the face or tongue, trouble breathing, sudden collapse. Give the adrenaline autoinjector first, then call
Go to an emergency department or after-hours doctor
Not an ambulance, but not the morning either.
- Any temperature of 38°C or above in a baby under three months
- A fever in a baby aged 3–6 months that is high or accompanied by any other symptom
- Signs of dehydration — markedly fewer wet nappies, no urine for 8–12 hours, dry mouth, no tears when crying, sunken eyes, unusually sleepy
- Persistent vomiting, cannot keep any fluid down, or green vomit
- Severe abdominal pain, particularly if it settles in the lower right
- A fever lasting more than about two days, or one that clears and returns
- They look sicker than earlier in the evening, or are getting worse rather than better
- A limp or refusal to weight-bear with fever
- You are worried and cannot say why. Parental concern is on the official red flag lists as a clinical sign in its own right
Probably fine until morning
- A miserable, hot, cranky child who is drinking, responsive between temperature spikes, and settling
- Runny nose, cough, sore throat without breathing difficulty
- A single vomit followed by keeping fluids down
- Mild diarrhoea with normal wet nappies
- A fever responding to comfort measures in a child over six months who is otherwise behaving reasonably normally
What actually helps at 2am
Fever is a response, not the disease. The goal is a comfortable child, not a specific number.
- Fluids, constantly and in small amounts. A few sips every few minutes beats a glass they will refuse. Oral rehydration solution, water, diluted juice, ice blocks, or continued breast or bottle feeds for babies
- Paracetamol or ibuprofen for discomfort, dosed by weight, not age, and only if they are distressed. It will not prevent a febrile convulsion — that myth causes a lot of unnecessary clock-watching
- Never give aspirin to a child
- Do not alternate medications on a rotating schedule unless a doctor has told you to
- Dress them lightly. One layer. No cold baths, no sponging, no fans blowing on them — those cause shivering, which raises temperature
- Let them sleep where you can hear them. A mattress on your floor is fine
- Write down what you gave, how much, and at what time. At 4am you will not remember, and the doctor will ask
If they have a febrile convulsion: it is terrifying and usually harmless. Put them on their side on the floor away from hard objects, do not put anything in their mouth, do not restrain them, and time it. Call 000 if it lasts more than five minutes, if it is their first, or if they do not recover normally afterwards.
Who to ring
- healthdirect — 1800 022 222. Registered nurse, 24 hours, free, nationwide. In Victoria, Nurse-on-Call 1300 60 60 24. They will tell you plainly whether to go now or wait
- Poisons Information Centre — 13 11 26. Anything swallowed. 24 hours, and they are extremely good
- Your after-hours GP service, or a home-visiting doctor service if one covers your area
- 000 for anything on the first list
Put all four in your phone now, under names you can find in the dark.
Thresholds
| Situation | The rule |
|---|---|
| Breathing trouble, blue, floppy, seizure, non-blanching rash | 000 |
| Fever 38°C+, baby under 3 months | Emergency department. Tonight |
| Anything swallowed | Poisons Information 13 11 26 |
| Button battery, even with no symptoms | 000. Immediately |
| No wet nappy in 8–12 hours, no tears, sunken eyes | Doctor tonight |
| Getting worse rather than better | Doctor tonight |
| Fever lasting more than 2 days, or returning | Doctor |
| Miserable but drinking and responsive | Comfort measures. Morning |
| Unsure at any hour | healthdirect 1800 022 222 |
| Fever medication | For comfort only, dosed by weight. Never aspirin |
What it costs
| Tier | Spend | What it buys |
|---|---|---|
| Free | $0 | healthdirect, Poisons Information, 000, the red flag list on the fridge |
| Solid | ~$40–70 | Digital thermometer, infant and child paracetamol and ibuprofen, oral rehydration sachets, a medication syringe |
| Better | ~$60–120 | A stocked home first aid kit with paediatric contents |
| Variable | $0–150 | After-hours GP or home doctor visit. Many bulk-bill children |
The drill: the 2am kit
Assemble it now, in one container, where you can find it half asleep.
Digital thermometer · infant paracetamol · child paracetamol · ibuprofen · a medication syringe · oral rehydration sachets or ice blocks · a small torch · a notepad and pen for the dose log · the four phone numbers written on the lid.
Then put the red flag list on the fridge. At 2am you will not be capable of recalling it, and you should not have to.
Frequently asked questions
When is a child’s fever an emergency?
Any temperature of 38°C or above in a baby under three months requires immediate medical assessment. For older children, how they look matters more than the number — drowsiness, breathing difficulty, dehydration, a non-fading rash or a child who is getting worse all warrant urgent care regardless of the reading.
Should I give paracetamol to bring a fever down?
Give it for discomfort, not to chase a number, and dose by weight rather than age. It does not prevent febrile convulsions. Never give aspirin to a child, and do not alternate medications on a schedule unless a doctor has advised it.
What are the signs of dehydration in a child?
Markedly fewer wet nappies or no urine for 8 to 12 hours, a dry mouth, no tears when crying, sunken eyes, and unusual sleepiness. Any of these means seeing a doctor rather than waiting for morning.
What do I do if my child has a febrile convulsion?
Put them on their side on the floor, clear of hard objects, do not restrain them or put anything in their mouth, and time it. Call 000 if it lasts more than five minutes, if it is their first, or if they do not recover normally afterwards.
Who can I call at 2am about a sick child?
healthdirect on 1800 022 222 — a registered nurse, free, 24 hours (in Victoria, Nurse-on-Call on 1300 60 60 24). For anything swallowed, the Poisons Information Centre on 13 11 26. For the red-flag list, 000.
My child seems okay but I have a bad feeling. Should I go?
Yes, or at minimum ring healthdirect. Parental concern appears on official clinical red-flag lists as a sign in its own right, because parents notice changes that no single measurement captures.
This article is general information, researched from the sources listed below and not reviewed by a professional in the relevant field. Check the sources, and get advice or training suited to your situation. Read our full disclaimer.