spot severe illness in infants children & adolescents

Severe Illness Getting Noticed Sooner (SIGNS)

This resource helps parents and caregivers identify the signs and symptoms of severe illness in infants, children and adolescents.

In this section :

  • Severe Illness Getting Noticed Sooner (SIGNS)
If you notice any of these SIGNS, seek medical attention immediately.

SIGNS helps parents and caregivers recognize signs of serious illness. Developed by a team of experts, including parents and healthcare professionals, it equips you to identify and understand crucial signs that indicate your child might be seriously sick.

Want to view the PDF? Download the SIGNS resource

Additional languages

The SIGNS resource is available in the following languages:  

This resource is provided “as is” and is for informational and educational purposes only. It is not intended to provide specific medical advice or replace the judgment of a healthcare professional.

What to look for

Behaviour change

  • Not reacting, not moving, not responding to things such as:
    • Loud noise
    • Touch
    • Being talked to
    • Food or drink
  • No eye contact which can include:
    • Not watching moving objects
    • Staring
    • Looking blank
  • Unable to stay awake
  • Unusual movements, clumsy, slurred speech:
    • Seizure: repeated jerky movements of arms, legs, lips, or eyes
    • Floppy: limp body, arms or legs
    • Spasm: stiff body, arms or legs
    • Speech: jumbled or unclear

Breathing change

  • Difficult breathing which could include:
    • With each breath ribcage sucks in or neck or belly pulls in
    • Breathing is... noisy when resting and/or very fast
    • Difficult to speak
    • Child says it’s hard to breathe
    • Is out of breath
    • Cannot drink
  • Long pauses between breaths
    • >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

  • Throwing up every hour for more than 4 hours
  • Red or very dark/black vomit
  • Green or brown vomit and belly that is bigger than normal


  • Red blood
  • Medium amount (streaks) that keeps happening or large amount (blobs or more)

Skin change

  • New skin tone or colour which can include:
    • Blue lips/tongue with crying, feeding or at rest
    • Purple blotches or many small purple dots
    • Gray/very pale/cold/blotchy
    • Cold/clammy hands or feet

Infant less than one month old

  • Yellow skin and eyes
  • Sleepy
  • Not feeding

Not getting better with treatment

  • If a known long-term health issue is not getting better with things that usually help and any SIGNS are present: seek medical attention immediately.
  • These conditions include asthma, seizure disorders, diabetes and many others.

Download the resource

Who developed this 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, 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.