spot severe illness in infants children & adolescents

Recognizing Deteriorating Patient Condition in Infants, Children and Adolescents

In this section :

What parents and caregivers need to know

Family members are a vital part of the healthcare team and are often best positioned to recognize the sometimes subtle, yet very important changes in your baby, infant, child or adolescent’s condition that may indicate deterioration. You may not know what is wrong, but you know something just isn't right.

Empower yourself and your loved ones with the following resource. It will help you recognize the signs of deteriorating patient condition.

Download a printable version of the resource in additional languages.

SIGNS - Spot severe illness in infants children & adolescents

SIGNS is for anyone caring for babies, infants, children or adolescents.

If you notice any of the SIGNS seek medical attention immediately.

Behaviour Change

Not reacting, not moving, not responding

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to loud noise
to touch
to being talked to
to food or drink

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to loud noise
to touch
to being talked to
to food or drink

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no eye contact
not watching moving objects
staring
looking blank

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no eye contact
not watching moving objects
staring
looking blank

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unable to stay awake

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unable to stay awake

Unusual movements, clumsy, slurred speech

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seizure: repeated jerky movements of arms, legs, lips, or eyes

floppy: limp body, arms or legs

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seizure: repeated jerky movements of arms, legs, lips, or eyes

floppy: limp body, arms or legs

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spasm: stiff body, arms or legs

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spasm: stiff body, arms or legs

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speech: jumbled or unclear

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speech: jumbled or unclear

Breathing Change

Difficult breathing

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with each breath
ribcage sucks in
neck or belly pulls in

breathing is...
noisy when resting
very fast

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with each breath
ribcage sucks in
neck or belly pulls in

breathing is...
noisy when resting
very fast

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it is difficult to speak
child says it’s hard to breathe
is out of breath
cannot drink

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it is difficult to speak
child says it’s hard to breathe
is out of breath
cannot drink

Long pauses between breaths

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~20 seconds between
breaths

rubbing or shouting
needed so they take a
breath

gasping breath after a
pause

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~20 seconds between
breaths

rubbing or shouting
needed so they take a
breath

gasping breath after a
pause

Fluid Loss

8 hours or more

not peeing
no wet diapers
not nursing or drinking

Vomit / throwing up

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throwing up every hour
for more than 4 hours

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throwing up every hour
for more than 4 hours

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red or very dark/ black vomit

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red or very dark/ black vomit

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green or brown vomit and
belly that is bigger than
normal

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green or brown vomit and
belly that is bigger than
normal

Poop / poo

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red blood
medium amount (streaks)
that keeps happening
or large amount (blobs or
more)

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red blood
medium amount (streaks)
that keeps happening
or large amount (blobs or
more)

Skin Change

New skin tone or colour

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blue lips / tongue
with crying, feeding or at
rest

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blue lips / tongue
with crying, feeding or at
rest

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purple blotches or
many small purple dots

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purple blotches or
many small purple dots

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gray / very pale /
cold / blotchy

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gray / very pale /
cold / blotchy

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cold / clammy hands or
feet

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cold / clammy hands or
feet

Infant less than one month old

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yellow skin and
eyes and sleepy
not feeding

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yellow skin and
eyes and sleepy
not feeding

Not getting better with treatment

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If a known long-term health issue
is not getting better with things that
usually help

& any SIGNS are present:
Act immediately.
Get help.

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If a known long-term health issue
is not getting better with things that
usually help

& any SIGNS are present:
Act immediately.
Get help.

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These conditions include asthma,
seizure disorders, diabetes and many
others.

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These conditions include asthma,
seizure disorders, diabetes and many
others.

 
If you notice any of these SIGNS act IMMEDIATELY. Call 911. If in hospital, get help.
  
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SIGNS – Spot Severe Illness in Infants, Children and Adolescents

Click on the link below to access the SIGNS resource to help spot severe illness in your child sooner.

Download

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SIGNS – Spot Severe Illness in Infants, Children and Adolescents

Click on the link below to access the SIGNS resource to help spot severe illness in your child sooner.

Download

Printable Resource: SIGNS – Spot Severe Illness in Infants, Children and Adolescents

Additional Languages

The SIGNS resource is also available in the following languages. Please download a printable version of the resource in your preferred language.  

Free Printable Posters

Access free printable posters to promote the SIGNS resource.

An expert panel consisting of parents and multi-disciplinary providers created the Severe Illness Getting Noticed Sooner (SIGNS)-for-Kids as a public health tool to help parents and caregivers identify and articulate the manifestations of severe illness in children.

We would like to acknowledge the contributions of the expert panel members of the SIGNS for Kids Consortium:

Christopher Parshuram MB.ChB, D.Phil.
Kristen Middaugh RN, BScN
Dawn Hartfield BSc Med, MPH, MD, FRCPC 
Joelle Fawcett-Arsenault PHEc (parent representative)
Melissa Jones BA MA (parent representative)
Gregory Moore MD, MSt (c), FRCPC
Karen Dryden-Palmer MSN, RN
Simran Singh RN, BScN, ENC (c)
Ann Bayliss MD, FRCPC
David Bayfield MD,CCFP(EM)
Sean Murray MD, FRCPC
Jonathan Gilleland MD, FRCPC 
Martin McNamara MD, CCFP (EM)
Michelle Gordon MD, FRCPC
Lisa Ladouceur PHC-NP
Anthony lacolucci HonBSc RRT
Jane Stuart-Minaret RN, BScN, MN
Mohamed Eltorki MD
Angelo Mikrogianakis  MD. Msc
Tania Principi MD
Seth Gray MD
Pragash Longonathan MD­
Hilary Whyte MB.­BCh. BAO. MSc. FRCPI. FRCPC
Helena Frndova Dipl-Ing
Zoe Parshuram BSc (Hons).

Use or reproduction of this resource is permitted within Canada for non-commercial purposes only. This resource is provided “as is” and is for informational/educational purposes only. It is not intended to provide specific medical advice or replace the judgment of a healthcare professional. Those preparing and/or contributing to this publication disclaim all liability or warranty of any kind, whether express or implied.

This work was supported by Healthcare Excellence Canada (HEC). HEC is an independent, not-for-profit charity funded primarily by Health Canada; the views expressed herein do not necessarily represent those of Health Canada.