When I heard about the deadly strain of hand-foot-and-mouth disease in Cambodia, I thought: wow, this is going to freak a lot of parents out. After all, hand-foot-and-mouth is a really common illness. Hearing that a strain of it is killing children is, well, terrifying.

Hand-foot-and-mouth is generally not a fatal illness--the vast majority of children who get it recover completely with fluids and rest and snuggling. But the reality is that any illness can take a nasty turn. So it's important to know the signs that an illness is taking a turn for the worse. That way you'll know when to worry (and take action) and when not to.

If your child has any of the following, get to medical care immediately (or call 911):

Trouble breathing. How to tell: rapid breathing (or very slow labored breathing), sucking in around the ribs or neck, trouble getting a sentence out, can't stop coughing, skin pale or blue.

Loss of consciousness--like a faint or falling asleep, only you can't shake them awake. Which is similar to but not quite the same as...

Excessive sleepiness, so that it's hard to arouse them, at a time when they aren't usually that way (i.e. if it's three am and they are otherwise fine, not so much a problem).

Seizures (if your child doesn't suffer from seizures)

A dark red or purple rash that doesn't get lighter when you press on it. The spots may be small (petechiae) or larger and more raised (purpura). If your child has fever along with the rash, it can be a sign of a dangerous infection.

Severe pain--or, in an infant or younger child, inconsolability

Hives and swelling of the face, especially if your child is dizzy or has any stomachache or vomiting--it could be a sign of a severe allergic reaction.

While not necessarily reasons to call 911, here are some reasons to get yourself to the doctor's office:

A high fever. Notice I didn't give a temperature...because what counts as a high fever is going to depend a bit on the age of your child and whether they have any medical problems. Ask your doctor what temperature you should worry about.

A cut that gapes open or won't stop bleeding, because it likely needs stitching.

Weakness or dizziness that doesn't go away, especially if your child looks pale

An injury that gets very swollen or painful, especially if your child has trouble moving the body part (it could be broken)

Vomiting or diarrhea that won't stop, especially if you are having trouble getting plenty of fluids into your child, and especially if they are urinating much less than normal

Blood where you don't usually see blood (vomit, poop, urine, etc). Nosebleeds are less of a big deal, unless you can't get the bleeding to stop.

A significant change in your child's behavior (acting strangely, can't move or use a body part normally, etc)

I'm probably forgetting something, but I think those are the major points. You should also call if your child's illness, pain or injury isn't getting better--or if your gut tells you that something isn't right with your child. Over the years, I've really come to respect and trust a parent's gut instincts.





While we're talking about scary stuff and what to do, here's a great video about CPR that my wonderful friend Dr. Wendy Sue Swanson shared on her blog . Watch it--it's short and simple and could help you save a life.



