When to call the doctor: a tier guide for the first year

A tiered guide to 999, 111, same-day GP, and 'can wait' — covering fever, breathing, rash, dehydration, head injury, and more. Includes the glass test for meningitis.

One of the hardest decisions in the first year is knowing whether a symptom needs emergency action, a same-day call, or patient monitoring. The tiers below are based on NHS and AAP guidance. Use them as a framework — and remember that if your instinct says something is significantly wrong, call regardless of which tier a symptom appears to fall in. Trusting your instinct is part of the guidance, not separate from it.

If in any doubt in the UK: call 111. They will triage your baby and direct you to the right level of care.

Tier 1: Call 999 or go to A&E immediately

These signs require emergency services. If your baby is unresponsive, not breathing, or deteriorating rapidly, do not drive yourself — call 999 and let them come to you.

Worth a doctor call

Call 999 immediately if your baby has:

Blue, purple, or grey lips, tongue, or fingernails (cyanosis)¹
Breathing that has stopped, or pauses lasting more than 20 seconds
Severe breathing difficulty: skin visibly pulling in between the ribs with each breath, nostrils flaring widely, grunting sound with every exhale
Cannot be woken — completely limp, unresponsive, or very floppy when picked up
A rash that does not fade when you press a clear glass against it (see below)²
A seizure / fit (unless your baby has a known seizure condition with a care plan)
Suspected serious head injury

The glass test for meningitis

A non-blanching rash — one that stays visible under pressure — can be a sign of meningococcal disease (meningitis or septicaemia), which can be rapidly fatal without immediate treatment.² Every parent should know this test.

How to do it: Press a clean, clear drinking glass firmly against the rash. Watch through the glass. If the spots or blotches fade (blanch) under pressure, they are most likely caused by small blood vessel irritation — still worth a GP call, but not an emergency by itself. If the rash stays visible through the glass and does not fade — treat it as a medical emergency and call 999.²³

The rash often begins as small red or purple pinprick spots and can spread to larger blotches or bruise-like patches. It can appear anywhere on the body. Critically, a non-blanching rash may not be present in the early stages of meningitis — do not wait for a rash if other signs below are present.

Other signs of meningitis requiring immediate 999:

High-pitched, unusual cry unlike any you have heard before
Stiff neck (difficult to assess in young babies — assess alongside other signs)
Dislike of bright light (photophobia)
Bulging fontanelle — the soft spot on top of the head is visibly raised or tense
Extreme inconsolable distress
Vomiting combined with any of the above²³

Tier 2: Call 111 or seek urgent care today

These symptoms don't require an ambulance but cannot wait for a routine appointment.

Good to know

Call 111 or seek same-day urgent care if your baby has:

Any temperature ≥38°C (100.4°F) and is under 3 months old — any fever, any time¹
Temperature above 39°C at age 3–6 months
Fever that isn't coming down with paracetamol and your baby seems to be getting worse
Signs of dehydration: sunken fontanelle, no wet nappies for 8+ hours, very dry mouth or lips, no tears when crying (after the first few weeks)¹
Projectile vomiting — forceful enough to arc across a room, especially in a baby under 2 months (possible pyloric stenosis)
Bile-stained vomiting — yellow-green colour at any age
Blood in vomit or stool
A rash that is spreading rapidly
Head injury with any loss of consciousness, vomiting more than once after impact, or unusual drowsiness afterwards
A fontanelle that appears either bulging (tense, raised) or sunken when your baby is calm and upright
Breathing that is faster or harder than usual, without the Tier 1 emergency signs
Your baby seems unusually quiet, limp, or hard to engage — but can be roused
Any situation where your instinct says your baby is significantly unwell

Tier 3: Same-day GP appointment

Call your GP surgery when it opens, but this is not emergency-level:

Temperature 38.0–39.0°C in a baby aged 3–6 months, with no other concerning signs¹
Possible ear infection: baby pulling at one ear, combined with fever or clear distress
Persistent crying for more than 2–3 hours with no obvious cause
Refusal of two or more consecutive feeds
A new, spreading, or unfamiliar rash without the emergency features above
Prolonged jaundice: beyond 2 weeks in a formula-fed baby, or 3 weeks in a breastfed baby, without a previous medical review
A fontanelle that looks or feels different from normal — slightly more pulsating, or a little sunken in an otherwise well-hydrated baby

Tier 4: Watch at home, call if worsens

Mild cold or viral symptoms with temperature below 38.5°C in an alert, feeding baby over 3 months old
Runny nose and mild cough with no other symptoms
One or two loose stools without fever, blood, or dehydration signs
Minor spit-up (not projectile, not bile-stained) not affecting weight gain
Teething symptoms — drooling, increased chewing, gum redness — without fever

For any Tier 4 situation, set a clear mental threshold before you start monitoring: for example, "If the temperature goes above 38.5°C, or if they refuse the next two feeds, I'll call." Having the threshold defined in advance prevents both under-reacting in the moment and calling repeatedly without a clear trigger.

Dehydration: what to watch for

Dehydration develops quickly in small babies with fever, diarrhoea, or vomiting. Signs to monitor:¹

Wet nappies: fewer than 6 per day after the first week, or fewer than 1 per 8 hours, is concerning
Fontanelle: should feel flat or very slightly soft when your baby is calm and upright; sunken is a dehydration sign
Mouth: lips and gums should be moist; dry, sticky, or pale indicates dehydration
Skin: gently pinch the skin on the abdomen or back of the hand — it should spring back immediately; slow return suggests dehydration
Tears: absent when crying (after the first few weeks of life) is a later sign of significant dehydration

Two or more of these signs together: call 111.

The overarching rule

No list covers every possible symptom. The practical rule:

If your baby is acting like their usual self, and what you're seeing is a recognisable variant of their normal — watch and wait, with a defined threshold.
If your baby is different from how they usually are in a way you cannot account for — call.
If your baby has any Tier 1 sign — call 999 immediately.

No healthcare professional will think less of you for calling when you weren't sure. The call exists for exactly that reason.

← Back to the complete guide: Baby health basics

Also in this cluster: Fever: when to worry · Newborn jaundice

Sources

NHS. "High temperature (fever) in children." NHS, 2024. https://www.nhs.uk/conditions/high-temperature/
NHS. "Meningitis." NHS, 2024. https://www.nhs.uk/conditions/meningitis/
American Academy of Pediatrics. "Warning Signs of Meningitis." HealthyChildren.org. https://www.healthychildren.org/English/health-issues/conditions/head-neck-nervous-system/Pages/Warning-Signs-of-Meningitis.aspx

Footnotes

NHS. "High temperature (fever) in children." NHS, 2024. https://www.nhs.uk/conditions/high-temperature/ ↩ ↩² ↩³ ↩⁴ ↩⁵
NHS. "Meningitis." NHS, 2024. https://www.nhs.uk/conditions/meningitis/ ↩ ↩² ↩³ ↩⁴
American Academy of Pediatrics. "Warning Signs of Meningitis." HealthyChildren.org. https://www.healthychildren.org/English/health-issues/conditions/head-neck-nervous-system/Pages/Warning-Signs-of-Meningitis.aspx ↩ ↩²