Go through these in order and stop at the first one that applies. If you are reading this for someone else, answer for them.
1
Is any of this happening now?
Call 911
Call emergency services for:
Severe trouble breathing, gasping, or long breathing pauses
Blue, grey, or unusually pale lips or skin
Unresponsiveness or difficulty waking
A first seizure, a seizure lasting more than five minutes, or repeated seizures without recovery
Sudden collapse or another change covered by the child's emergency plan
If your child has an individualized emergency or comfort-care plan, keep it available and follow the instructions in that plan.
Other emergency signs, for anyone
Someone who is struggling to breathe, gasping, choking, or cannot get words out
Someone who has chest pain, tightness or pressure lasting more than a few minutes
Someone who has sudden weakness or drooping on one side of the face or body, slurred speech, or sudden confusion
Someone who is unconscious, or cannot be woken
Someone who is bleeding heavily and it will not stop with firm pressure
Someone who has had a seizure that will not stop, or does not wake up afterwards
Someone who has lips or skin that look pale, blue, grey or blotchy
Someone who you believe has taken an overdose or swallowed something poisonous
2
Is any of this happening?
Be seen today
Seek prompt medical advice if your child has more coughing or choking during feeds, fewer wet diapers, repeated vomiting, a fever, increasing sleepiness, new swelling, or a noticeable change in breathing.
3
Does any of this apply?
Book an appointment
Arrange routine follow-up if feeding is becoming harder, weight gain slows, constipation or reflux persists, or equipment no longer fits.
New changes in movement, hearing, vision, sleep, or alertness also deserve assessment.
Every sign above is quoted from the sofidex article on Trisomy 18 syndrome. If you are not sure, err upward — it is always reasonable to be checked.