Sepsis in Children: Warning Signs Every Parent Should Know

An infection in a child can start out looking like something familiar. A fever, cough, stomach bug, urinary tract infection, skin infection or wound infection may seem manageable at first. While most childhood infections improve without complications, some can trigger a serious medical emergency called sepsis.

Sepsis happens when the body's response to an infection becomes extreme and starts damaging its own tissues and organs. It can affect children of any age, but newborns, premature infants and children with weakened immune systems face a higher risk of developing serious infections that can lead to sepsis.

Although most children recover from infections without complications, sepsis remains one of the most serious medical emergencies affecting children. It is estimated to lead to more than 18,000 pediatric hospitalizations and more than 1,800 deaths annually in the United States.

What Is Sepsis?

Sepsis is a life-threatening medical emergency that can happen when the child’s body has an extreme response to an infection.

Sepsis begins with an infection. The infection may be caused by bacteria, viruses, fungi or other germs. Most childhood infections do not lead to sepsis, but almost any infection has the potential to become serious.

When sepsis develops, the immune system’s response becomes overwhelming. Instead of only fighting the infection, the body’s response can interfere with normal organ function. This is why sepsis requires urgent medical evaluation and treatment. 

Sepsis can be difficult for families to recognize because early symptoms can look like many common childhood illnesses. Parents know their child best. If your infant or child seems significantly sicker than expected or symptoms are worsening quickly, it is important to seek medical care right away. 

What Causes Sepsis in Children?

Sepsis can develop from many types of infections, including infections in the lungs, urinary tract, skin, abdomen, bloodstream or nervous system.

Many parents associate sepsis with a bloodstream infection, but sepsis can begin with infections in different parts of the body. 

Common infections that may lead to sepsis include:

• Pneumonia or other serious lung infections
• Urinary tract infections
• Skin infections or infected wounds
• Appendicitis or other abdominal infections
• Meningitis
• Influenza or other viral infections
• Infections that occur after surgery or medical procedures

Sepsis is not contagious in the same way a cold or flu can be contagious. However, the infection that leads to sepsis may be contagious, depending on the cause.

The goal is not for parents to worry about every fever or infection. Instead, it is important to watch for signs that an illness is becoming more severe or that a child is not improving as expected.

How Can I Tell if My Child Has Sepsis?

Sepsis symptoms can be hard to spot because they may look like other childhood illnesses at first. A combination of concerning symptoms, especially if they worsen quickly, should be taken seriously. 

There is not one single symptom that always means a child has sepsis. Instead, parents should look at the full picture: how the child is breathing, behaving, drinking, urinating, responding and whether symptoms are getting better or worse.

Signs of Sepsis in Infants, Adolescents and Teens

Newborns and young infants are especially vulnerable because their immune systems are still developing. Any fever in a very young infant should be discussed with a health care provider promptly. It's important to note that babies and young infants may not be able to show illness in obvious ways, and older children may be able to describe how they feel, but sepsis can still be difficult to recognize early.

Parents should seek medical guidance right away if a child has concerning symptoms such as:

How Quickly Can Sepsis Develop?

Sepsis can develop over hours or days, depending on the infection and the child. Some children may seem mildly ill at first before symptoms worsen rapidly. This is why it is important to monitor a child closely and seek medical care if symptoms are getting worse or a child appears significantly more ill than expected.

When Should Parents Seek Emergency Care?

Seek emergency care immediately if your child has symptoms that suggest severe illness, trouble breathing, confusion, color changes, dehydration or a rapidly worsening infection. 

Sepsis can progress quickly. When in doubt, it is better to seek emergency care and be told your child is safe than to delay care for a serious infection.

Call 911 or go to the nearest emergency department if your child: 

• Has trouble breathing
• Is difficult to wake
• Seems confused, disoriented or unusually weak
• Has blue, gray, pale, blotchy or mottled skin
• Has a seizure
• Has signs of shock, such as extreme weakness, cold skin or a weak pulse

Parents are encouraged to communicate concern clearly with the care team when a child appears much sicker than expected.

Which Children Are at Higher Risk for Sepsis?

Any child can develop sepsis, but some children face a higher risk and may be more vulnerable to severe infection.

Children at higher risk may include:

• Newborns and young infants
• Premature babies
• Children with weakened immune systems
• Children receiving chemotherapy or other immune-suppressing treatments
• Children with complex medical conditions; such as chronic lung, heart, kidney or neurologic conditions
• Children with central lines or other medical devices
• Children recovering from surgery
• Children with infected wounds or serious skin infections

Families of children with complex medical needs should talk with their child’s care team about when to seek urgent care for fever or infection symptoms.

How Is Sepsis Diagnosed in Children?

Sepsis is diagnosed through a medical evaluation that may include a physical exam, vital signs, lab tests and other studies to identify infection and organ stress.

Depending on the child’s condition, testing may include:

• Blood tests
• Urine tests
• Blood cultures or other cultures to identify infection
• Imaging, such as an X-ray or ultrasound
• Tests to assess breathing, circulation and organ function

The care team may begin treatment while test results are pending if sepsis is suspected.

How Is Sepsis Treated?

Sepsis is treated in the hospital with urgent medical care. Treatment often begins as soon as sepsis is suspected and may include:

• Antibiotics or other medicines to treat the infection
• IV fluids
• Oxygen or breathing support
• Medicines to support blood pressure, if needed
• Careful monitoring of vital signs and organ function
• Treatment in a pediatric intensive care unit for children who are critically ill

Treatment depends on the child’s age, symptoms, possible source of infection and how sick the child is.

Not every child with sepsis requires treatment in an intensive care unit. Children who receive prompt treatment, remain stable and do not develop severe complications may be cared for on a general pediatric inpatient unit. However, children with severe sepsis, septic shock or signs of organ dysfunction may require intensive monitoring and treatment in a pediatric intensive care unit.  

At Miller Children's & Women's Hospital, children with severe sepsis or septic shock who require intensive care receive specialized treatment from pediatric critical care physicians and a multidisciplinary team in the Cherese Mari Laulhere Pediatric Intensive Care Unit. Miller Children's & Women's is home to a Level I Pediatric Intensive Care Unit, the highest level of pediatric critical care recognized by the American Academy of Pediatrics. The unit is equipped to care for children with the most complex and life-threatening illnesses and injuries. 

Many children recover completely, especially when sepsis is recognized and treated early. Some children who experience severe sepsis may require additional follow-up care and monitoring after leaving the hospital.

Can Sepsis Be Prevented?

Not every case of sepsis can be prevented, but reducing the risk of infection can lower a child’s risk.

Preventing infections is one of the best ways to help reduce the risk of sepsis.

Parents and caregivers can help by:

• Keeping children up to date on recommended vaccines
• Encouraging regular handwashing
• Cleaning cuts and scrapes properly
• Keeping wounds covered until healed
• Seeking care for infections that are worsening or not improving
• Following instructions for prescribed antibiotics
• Managing chronic medical conditions with the child’s care team

Vaccines can help prevent infections that may lead to sepsis, including influenza, pneumococcal disease and certain types of meningitis. Keeping children up to date on recommended vaccinations is an important part of prevention.

If a child is prescribed antibiotics, give them exactly as directed. Do not stop early unless the child’s doctor tells you to.

What Should Parents Do if They Are Worried About Sepsis?

Trust your instincts. If your child seems seriously ill, is worsening quickly or something feels wrong, seek medical care right away.

Before seeking care, it can help to note:

• When symptoms started
• Whether symptoms are getting worse
• The child’s temperature
• How much the child has been drinking
• How often the child has urinated or had wet diapers
• Any recent infection, injury, surgery or medical procedure
• Any medical conditions or medications
• Whether your child seems different from their usual self

If you are concerned, tell the medical team clearly: “I am worried this could be sepsis.” Sharing that concern can help the team understand the urgency of what you are seeing at home.

My Best Advice for Parents

Parents should watch for a child who looks much sicker than expected, is not acting like themselves or is getting worse quickly.

Most childhood infections improve with time, rest and the right care. But when an infection becomes serious, a child’s condition can change quickly. 

Pay attention to your child’s breathing, alertness, skin color, fluid intake and urination. Watch for behavior changes that feel unusual. If your child is difficult to wake, struggling to breathe, confused, severely dehydrated or rapidly worsening, seek emergency care. 

You know your child best. If something does not feel right, it is always appropriate to ask for help.

Frequently Asked Questions About Sepsis in Children

Q: What is sepsis in children?
A: Sepsis is a life-threatening medical emergency that can happen when the body has an extreme response to an infection.

Q: Can healthy children develop sepsis?
A: Yes. While premature infants and children with weakened immune systems face a higher risk, sepsis can develop in otherwise healthy children.

Q: Can any infection lead to sepsis?
A: Yes. Almost any infection can lead to sepsis, although most childhood infections do not. Sepsis can begin with infections such as pneumonia, urinary tract infections, skin infections, abdominal infections or meningitis.

Q: What are the first signs of sepsis in children? Can a fever turn into sepsis?
A: A fever itself does not cause sepsis. However, the infection causing the fever can, in rare cases, progress to sepsis. Parents should seek medical attention if a child develops concerning symptoms or appears significantly more ill than expected.

Q: What are the first signs of sepsis in children?
A: Early signs may include fever or low temperature, fast breathing, fast heart rate, extreme sleepiness, confusion, severe discomfort, color changes, poor feeding or decreased urination.

Q: What are signs of sepsis in babies?
A: In babies, warning signs may include poor feeding, fewer wet diapers, trouble breathing, unusual sleepiness, fever or low temperature, pale or mottled skin, seizures or a baby who does not seem like themselves.

Q: How quickly can sepsis become serious?
A: Sepsis can progress over hours or days, depending on the child and the infection. Some children may appear mildly ill before symptoms worsen quickly, which is why prompt medical attention is important.

Q: When should I take my child to the ER for a possible infection?
A: Seek emergency care if your child has trouble breathing, is difficult to wake, appears confused, has blue or gray skin, has a seizure, is severely dehydrated or is getting worse quickly.

Q: Is sepsis contagious?
A: Sepsis itself is not contagious. However, some infections that may lead to sepsis, such as influenza or certain bacterial infections, can spread from person to person.

Q: How is sepsis treated in children?
A: Sepsis is treated in the hospital with urgent medical care, which may include antibiotics, IV fluids, oxygen, close monitoring and intensive care support if needed.

Q: Can children recover from sepsis?
A: Many children recover, especially when sepsis is recognized and treated early. Some children may need follow-up care after a severe illness.

Q: Can sepsis be prevented?
A: Not every case can be prevented, but parents can reduce the risk of infections by keeping children up to date on vaccines, practicing good hand hygiene, caring for wounds properly and seeking care when infections worsen.

Q: What should I say if I am worried my child has sepsis?
A: Tell the care team clearly, “I am worried this could be sepsis.” Then explain what has changed, including breathing, behavior, fever, fluid intake, urination and how quickly symptoms are worsening.

Medically Reviewed By: 

Christopher J. Babbitt, M.D., medical director, Cherese Mari Laulhere Pediatric Intensive Care Unit, Miller Children’s & Women’s Hospital

About the Author:

Christopher J. Babbitt, M.D., is the medical director of the Cherese Mari Laulhere Pediatric Intensive Care Unit (PICU) at Miller Children’s & Women’s Hospital. Board certified in pediatrics with a subspecialty in pediatric critical care, Dr. Babbitt specializes in caring for critically ill infants, children and adolescents. He earned his medical degree from Tulane University School of Medicine and completed his residency and fellowship training at UCLA Mattel Children’s Hospital.