The child is crying inconsolably or whimpering. The child cries when moved or touched by a parent. The child is hard to wake up. The neck is stiff. Any purple spots are present on the skin.
Breathing is difficult and no better after the nose is cleared.
The child is drooling saliva and is unable to swallow anything. A convulsion has occurred. The child acts or looks very sick. The fever has gone 24 hours without an obvious source of infection. The fever went away for 24 hours and then returned.