Emergency Guide by Dr. Wasif Iqbal FCPS
🚨 Red Flag Signs in Children
Critical warning signs that every parent must know — when to go to the Emergency Room immediately
When You See a Red Flag Sign — Act Immediately
1
Do NOT wait or call doctor first — go to ER immediately
2
Do NOT give any medicine before reaching hospital unless instructed
3
Go to Mujahid Hospital ER, Madina Town or nearest emergency
Breathing
Breathing very fast (more than 60 breaths/min)
Breathing very slow or stopping (apnea)
Grunting sound with each breath
Skin sucking in at ribs or throat with breathing
Nostrils flaring with breathing
Color & Activity
Blue or purple lips, tongue or face (cyanosis)
Pale, grey or mottled skin color
Very floppy — no muscle tone
Cannot be woken up (unconscious)
Blank stare — not responsive to you
Fever & Temperature
Any fever 38°C or above in baby under 3 months
Very cold body temperature (below 36°C)
Jaundice spreading to palms and soles
Deep yellow skin from birth
Feeding & Other
Refusing all feeds for more than 8 hours
Bulging fontanelle (soft spot on head)
Seizure / convulsion / jerking movements
Umbilical cord red, swollen or smelling
No wet nappies for more than 8 hours
Breathing Problems
Fast or difficult breathing at rest
Ribs visible with each breath
High-pitched crowing sound when breathing in (stridor)
Wheezing that doesn't improve
Neurological
Seizure / convulsion / shaking
Unresponsive or difficult to wake
Head tilted back, body stiff
Circulation & Skin
Purple or red spots that don't disappear when pressed (non-blanching rash)
Cold hands and feet with fast breathing
Very pale, grey or mottled skin
Severe Illness
High fever above 39.5°C not responding to paracetamol
No wet nappies for 8+ hours (severe dehydration)
Sunken fontanelle and eyes
Breathing Emergencies
Cannot complete a sentence due to breathlessness
Lips or face turning blue
Throat swelling — difficulty swallowing saliva
Choking — cannot cry, cough or breathe
Severe asthma attack not responding to inhaler
Neurological Emergencies
Seizure lasting more than 5 minutes
First-ever seizure — call ER
Severe headache — worst headache ever
Stiff neck with fever and headache
Confusion, disorientation or hallucinations
Infection & Fever
Non-blanching purple/red rash with fever (meningococcal sign)
Very high fever 40°C+ not coming down
Child looks very sick — glazed eyes, no response
Fever with neck stiffness
Fever returning after being well — may signal serious infection
Injuries & Other
Head injury with loss of consciousness
Head injury with vomiting more than once
Suspected poisoning or medication overdose
Deep cut or wound that won't stop bleeding
Severe abdominal pain (doubled over, rigid abdomen)
Fever lasting more than 3 days in any age
Child not drinking fluids for 12+ hours
Severe sore throat with difficulty swallowing
Eye redness with significant discharge
Limping or refusing to use an arm or leg
Abdominal pain lasting more than 6 hours
Vomiting more than 5 times in 24 hours
Diarrhea more than 8 times in 24 hours
Swollen joint — red, hot and painful
Child unusually quiet, not playing
🔴 The Glass Test — Critical Skill for Parents
A non-blanching rash can be a sign of meningococcal disease — a life-threatening emergency. Every parent must know this test.
How to do the glass test:
1. Press a clear glass firmly against the rash
2. Look through the glass while pressing
3. Does the rash fade/turn white under pressure?
If YES → Normal blanching rash. Monitor.
If NO (stays red/purple) → EMERGENCY. Go to ER NOW.
🚨 Non-blanching rash signs:
· Small red or purple spots (petechiae)
· Larger purple patches (purpura)
· Rash that does NOT fade when pressed
· Often associated with fever and stiff neck
This can be meningococcal septicemia — minutes matter. Do not wait.
What to Do During a Seizure (Convulsion)
✅ DO:
→ Lay child on their side (recovery position)
→ Keep them away from hard objects
→ Time the seizure with your phone
→ Stay calm — most febrile seizures stop within 2–3 minutes
→ After stopping, take to ER if first seizure or lasted 5+ minutes
❌ DO NOT:
→ Put anything in the child's mouth
→ Restrain the child's movements
→ Give water or medicine during seizure
→ Lay child on their back (choking risk)
→ Leave the child alone
Call emergency or go to ER immediately if: Seizure lasts more than 5 minutes · Second seizure in same illness · Child doesn't recover fully within 30 minutes · Difficulty breathing after seizure · First-ever seizure
Remember: It is always better to go to the Emergency Room and be told your child is fine than to wait at home when something serious is happening. When in doubt — go. For non-emergency questions, Dr. Wasif Iqbal is available on WhatsApp 9AM–11PM daily for under 5 minutes response.
Non-emergency concern? Ask Dr. Wasif directly
FCPS Pediatrician · Available 9AM–11PM · Response under 5 minutes