Emergency care of the sick child can be daunting. Manifestations of infectious diseases in the pediatric population are multifaceted, which can make the exact diagnosis difficult. Pediatric emergency nurses must immediately recognize the possible infectious disease causing the child’s symptoms to prevent a potential lethal outcome. If an infectious disease is suspected, the nurse should immediately initiate isolation precautions. If indicated, interventions to maintain adequate airway, breathing, oxygenation, circulation, and hydration of the sick child should be initiated. The nurse should stabilize the child first and then identify the diagnosis and provide definitive care (Table). TableCommon signs and symptoms and possible differential diagnoses 1 Emergency Nurse Association Emergency Nursing Pediatric Course Provider Manual. 4th ed. Emergency Nurse Association, Des Plaines, IL2014 Google Scholar , 2 London ML Ladewig PW Ball JW Bindler RC Cowen KJ Maternal & Child Nursing Care. 3rd ed. Pearson, Upper Saddle River, NJ2011 Google Scholar Sign or symptom Possible differential diagnoses Fever Bacterial meningitis, malaria, otitis media, septic arthritis, sinusitis, pneumonitis, Haemophilus influenzae type B, influenza, urinary tract infections, septicemia, Ebola, mumps, rabies, Lyme disease, herpes simplex viruses Rash Bacterial meningitis, viral meningitis, chicken pox (varicella), coxsackievirus, diphtheria, erythema infectiosum (fifth disease), measles (rubeola), roseola, rubella (German measles), Rocky Mountain spotted fever, mononucleosis, community-acquired methicillin-resistant Staphylococcus aureus, toxic shock syndrome, hand-foot-and-mouth disease, group A streptococcus, sexually transmitted diseases, herpes simplex virus Soft-tissue infections Community-acquired methicillin-resistant Staphylococcus aureus, abscess, scalded skin syndrome, cellulitis, group A streptococcus, tetanus Vomiting Respiratory infection/pneumonia in children, viral or bacterial gastrointestinal infections Vomiting and diarrhea Rotavirus, gastrointestinal bacterial infections, gastrointestinal viruses, salmonella, Ebola (rare in children), norovirus Diarrhea Viral infection, bacterial infection, parasitic infection, antibiotic-associated diarrhea (Clostridium difficile), gastroenteritis, Escherichia coli, calicivirus, adenovirus Bloody diarrhea Hemolytic uremic syndrome, rotavirus, E coli, shigella, campylobacter, salmonella, other enteropathogens Respiratory distress including rapid breathing Pneumonia, bronchiolitis, respiratory syncytial virus, upper respiratory infections, enterovirus D68, other enteroviruses, epiglottitis, rhinoviruses, tuberculosis Cough Croup, pneumonia, pneumococcal infections, flu, upper respiratory infections, pertussis (whooping cough) Malaise, body aches, fatigue Mononucleosis, flu, viral syndromes, septicemia, hepatitis, poliomyelitis It should be noted that symptoms overlap in many infectious diseases. A child with chronic infections should undergo a thorough evaluation by his or her pediatrician for undiagnosed underlying conditions such as cystic fibrosis, human immunodeficiency virus, genetic disorders, or malignant disorders. Open table in a new tab It should be noted that symptoms overlap in many infectious diseases. A child with chronic infections should undergo a thorough evaluation by his or her pediatrician for undiagnosed underlying conditions such as cystic fibrosis, human immunodeficiency virus, genetic disorders, or malignant disorders. Patricia A. Normandin, Member, Massachusetts ENA Beacon Chapter, is Emergency Department Staff Nurse, Tufts Medical Center and Northeastern University, Boston, MA; Adjunct Nursing Faculty, Brigham & Women's Hospital and Massachusetts General Hospital, Institute of Health Professions, Boston, MA; and Term Lecturer, Site Clinical Instructor, Boston Children's Hospital, Boston, MA.