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Dr. Mohamed Eltorki, pediatric emergency department physician at McMaster Children’s Hospital, provides information on SIGNS, a new public health tool that helps caregivers recognize signs of severe illness and when to seek medical attention.
January 27, 2023

Knowing the SIGNS of severe illness

It can often be difficult to recognize the signs of severe illness in children. Dr. Mohamed Eltorki, pediatric emergency department physician at McMaster Children’s Hospital explains how using the public health tool, SIGNS, can lead to faster access in treatment and better outcomes.


SIGNS was designed for caregivers, parents, and anyone who looks after children, infants, or adolescents. It stands for Severe Illness Getting Noticed Sooner. It was developed by careful consideration of a national multi-disciplinary expert panel that included clinicians not only from multiple disciplines, but different settings and provinces as well. Plus, parent representatives actively contributed.

There are four main clinical categories of concern which are breathing, behavior, skin and fluids. Below are symptoms to for each category.


  • Breathing is noisy when resting
  • Having difficulties speaking because it is hard to breathe
  • Out of breath
  • Cannot drink
  • Long pauses between breaths or gasping breath after a pause


  • Not reacting, moving, or responding to the following: loud noises, being touched, being talked to, food or drink
  • No eye contact
  • Not noticing moving objects and staring blankly
  • Unable to stay awake
  • Unusual movements and becoming clumsy
  • Seizures, spasms or slurred speech


  • Blue lips or tongue
  • Purple blotches, or many small purple dots
  • Gray, and very pale skin that is cold and blotchy
  • Cold, clammy hands or feet
  • Infants may experience yellow skin and eyes, along with not feeding


  • Eight or more hours without peeing, wet diapers, nursing or drinking
  • Vomiting every hour for more than four hours
  • Red or very dark black vomit
  • Green or brown vomit
  • Belly is larger than normal
  • Frequent blood in stools

Another accompanying category is lack of response to usual treatments. If your child is no longer responding to medications or treatments that have been prescribed, seek medical attention.

If your child is experiencing any of the symptoms mentioned above, or has an existing health concern that is not improving with the prescribed treatment, please seek medical attention immediately.

Learn more about SIGNS and when to seek help.