What are the three questions again?

Is my child breathing normally? Are they alert and responsive? Can they drink and keep fluids down? A no to any of them means urgent or emergency care depending on severity.

Their temperature is very high but they seem fine in themselves.

How they are matters more than the number. A child who is alert, drinking and breathing easily is in a different situation from one who is not, at the same temperature — which is what the three questions capture and a thermometer does not. Under three months, any fever remains its own emergency.

Urgent care or the ER?

Urgent care for things that cannot wait days but are not life-threatening — ear pain, stitches, mild breathing trouble, a sprain. The ER for respiratory distress with ribs pulling in, seizures, head injury with vomiting or confusion, dehydration, or severe abdominal pain.

I can't explain why, I just think something's wrong.

That is reason enough to call. You hold a baseline for this child that nobody else has, and AAP's own advice is that when in doubt you call — after-hours nurse lines exist precisely for this.

Keeping them safe · 4 min read

Unwell, or seriously unwell?

They are ill. You knew that hours ago. The question keeping you awake is a different one: is this the kind of ill that waits until morning, or the kind that does not.

You do not need a diagnosis to answer that. There are three questions that work before anything has a name.

Last updated August 19, 2026

The three questions

AAP's checklist, and it is worth memorising because it works at 2am on no sleep:

One. Is my child breathing normally?

Two. Are they alert and responsive?

Three. Can they drink and keep fluids down?

If the answer to any of these is no, seek urgent or emergency care depending on severity.

What makes these three the right three is that they cover the systems that actually fail — breathing, consciousness, and fluids — rather than the symptoms that frighten. A very high temperature in a child who is alert, drinking and breathing easily is a different situation from a moderate temperature in a child who is none of those things, and the checklist gets that right where a thermometer does not.

Where each level of care fits

The pediatrician or GP is for follow-ups, chronic issues, preventive care and non-urgent questions — constipation, a mild rash, recurring ear infections, growth concerns.

Urgent care is for things that are not life-threatening but cannot wait a few days: ear pain, a sprain, a cut needing stitches, flu symptoms, mild breathing trouble, a broken bone without deformity, allergic reactions.

The emergency department is for severe or potentially life-threatening problems needing immediate advanced care. AAP's examples are worth knowing precisely: respiratory distress with RIBS VISIBLY PULLING IN, seizures, serious head injuries with vomiting or confusion, dehydration, severe abdominal pain.

Note that dehydration appears on the ER list, not the urgent-care one. That is the reason the wet-nappy count matters so much.

The trend, not the snapshot

A single observation tells you less than the direction of travel. Better, worse or the same as two hours ago is often the more useful question than any individual number.

So write things down, with times. Temperature, last wet nappy, last drink, how rousable they were. Under pressure and without sleep, an hour ago and four hours ago blur into each other, and the trend is exactly what a clinician will ask you to reconstruct.

Deterioration that is fast matters more than deterioration that is large. A child sliding downhill over an hour deserves action even if no single sign has crossed a threshold yet.

On trusting yourself

AAP's fallback sits above the whole checklist: when in doubt, call your pediatrician's office. Many have after-hours lines with nurses who can guide you — a middle option people forget exists between doing nothing and going to hospital.

And the thing worth saying plainly, because parents apologize for it constantly: knowing your child is not right, without being able to say why, is real information. You have a baseline nobody else has. It is a reason to make the call, not a reason to feel foolish about making it.

Nobody in an emergency department thinks badly of a parent who brought in a child who turned out to be fine. That is the system working correctly.

Common questions

What are the three questions again?: Is my child breathing normally? Are they alert and responsive? Can they drink and keep fluids down? A no to any of them means urgent or emergency care depending on severity.
Their temperature is very high but they seem fine in themselves.: How they are matters more than the number. A child who is alert, drinking and breathing easily is in a different situation from one who is not, at the same temperature — which is what the three questions capture and a thermometer does not. Under three months, any fever remains its own emergency.
Urgent care or the ER?: Urgent care for things that cannot wait days but are not life-threatening — ear pain, stitches, mild breathing trouble, a sprain. The ER for respiratory distress with ribs pulling in, seizures, head injury with vomiting or confusion, dehydration, or severe abdominal pain.
I can't explain why, I just think something's wrong.: That is reason enough to call. You hold a baseline for this child that nobody else has, and AAP's own advice is that when in doubt you call — after-hours nurse lines exist precisely for this.

If it's this, not that

Still not sure

This page is the general answer. Yours is a specific child.

The advisor can be. It has read everything here, and it knows how old your children actually are — which is the whole difference wherever guidance changes with age. Ask it anything.

She's got a temperature of 100. Is that something to worry about?
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It answers from the same cited pages you are reading, and when the question is where to go, from the real clinician, hospital and childcare records behind this site — not a link to go search them yourself. It says so when we have not written about something, and it is not a doctor; for anything urgent it gives you the threshold and tells you to call.

Where this comes from

Urgent care, ER or pediatrician — the three-question checklist and what belongs whereAAP

Every claim on this page traces to one of these. See every source we use →

Written from the sources named above, and it is not a substitute for your own doctor. If something feels wrong to you, that instinct is a good enough reason to call — you know yourself and this family better than any page does.