Our 10-month-old son had a sudden onset

Answer

I'll work through this carefully. A 10-month-old with episodic screaming, knees-to-chest, pallor, then limp/drowsy between spells, vomiting, no bowel movement — this is a time-critical surgical emergency pattern. Let me pull the relevant clinical cards before drafting.

I have all I need. This is an unambiguous C-level match for intussusception — episodic screaming with knees drawn up + pallor + limp/lethargy between spasms + vomiting + no BM since morning, in a 10-month-old. The RCH intussusception row is a near-textbook description. Let me confirm the location ask pattern and run the linter pipeline.

Confirmed: empty lookup (no place named). I'll structure the reply to put the go-now action first, include NPO and what to bring, briefly address the three clinical questions, and ask for the country/city in the same breath. Let me write the draft and run the linter.

The linter correctly flagged the four example phone numbers I included (even with caveats) — per the skill, EMS digits only come from a `lookup_ems.py` hit, and there was no hit. Let me remove them and tighten the diagnostic boundary.

PASS — no BLOCKs. Let me read back the final draft and ship it in full.

Go to a pediatric emergency department now — by ambulance if it is faster than driving, or by the fastest safe vehicle you have. Do not wait for another spell, do not wait for "redcurrant jelly" stool, and do not let a relative's "it's just gas or teething" delay you. A 10-month-old with sudden screaming spells every 15–20 minutes, knees drawn up, pallor, clenched fists, who then goes limp, pale and almost asleep between attacks, with vomiting and no stool since morning, matches the Royal Children's Hospital intussusception red-flag pattern almost word for word. This is a time-critical surgical emergency — bowel that has telescoped inside itself loses its blood supply within hours, and the "quiet, smiling between spells" look is part of the disease, not a sign against it.

Right now, all of these in parallel:

- Call your local emergency number, or drive straight to the nearest pediatric emergency department. Tell the team: 10-month-old; sudden onset 3 hours ago; screaming every 15–20 min for 3–5 min with knees drawn up, pallor, clenched fists; limp, pale, drowsy between spells; vomited once (yellow, not yet green); no stool since morning; no fever.
- Tell me which country or city you are in, in the same message. I will not pull a number from language alone — once I have a place, I can give you the right local emergency number and the nearest pediatric ED door. Until then, please use your own phone's emergency dialer or your local pediatric hospital's number from a recent bill or their website — do not take a number from a forum, a chatbot, or memory.
- Nothing by mouth. No milk, formula, water, juice, gripe water, gripe drops, herbal teething or colic remedy, oral rehydration, teething gel, homeopathic drops, or any other liquid or food. He may need urgent ultrasound and possibly sedation, an air or contrast enema, or surgery — anything in his stomach makes that harder and riskier.
- No fever reducer or painkiller "to see if the pain settles." No laxative. No warm compress or hot-water bottle on the belly. None of these tests the diagnosis safely, and each can make the picture harder to read at the ED.
- Keep him with you, on his side if he has just vomited, and watch his breathing. The limp-drowsy intervals look like sleep but are the moment the trapped bowel is compromising its blood supply. A spell where he does not rouse to you is a reason to call emergency services immediately rather than drive.

Why this is not colic, gas, or teething:

- The Royal Children's Hospital intussusception guideline is explicit: do not take a pause in crying, or a smile between spasms, as excluding intussusception. The well-between-spells look is the textbook course of this disease, because the bowel telescopes and partially reduces in cycles.
- The classic teaching triad — intermittent pain, palpable abdominal lump, and redcurrant jelly stool — appears in fewer than 15% of children at presentation. Its absence means nothing here, and rectal bleeding is a late sign of bowel ischemia, not an early screening test.
- The peak age for intussusception is 4–9 months; boys are over-represented; about one in three children have had a recent viral illness beforehand. Your son is right in the window.
- Pallor with episodic pain and unexplained lethargy between attacks is the named red-flag pattern in this age band; "just gas" and "just teething" are the documented misroutes that cost hours. The fact that you are seeing him go limp and pale between screams is the part of the story that places this above ordinary colic.

What the team is likely to do tonight, so you can follow it:

- Examine him, secure IV access, and do an urgent abdominal ultrasound. On ultrasound, intussusception shows the classic "target" or "doughnut" sign on cross-section — one loop of bowel telescoped inside another — and the "pseudokidney" sign on the longitudinal view. Ultrasound is fast, non-invasive, and the first imaging of choice.
- If confirmed, the first treatment is usually a non-operative air or contrast enema under fluoroscopy or ultrasound guidance. In experienced pediatric centers this reduces the intussusception without surgery in roughly 80–90% of cases. It works best when it is done early, before the trapped loop loses its blood supply.
- Surgery is reserved for cases that fail to reduce, that have perforation, or that already show a dead segment of bowel. The reason the enema is "first and urgent" is exactly that delay past the ischemic window is what turns a 5-minute enema into an open operation and a possible bowel resection. Currant-jelly stool and a hard, swollen belly are the late signs you are trying to outrun, not the ones you wait for.

Bring to the ED:

- A nappy with the most recent stool, or a clear photo of it — especially any pink, red, jelly-like, or mucus streak.
- The time each spell started, how long it lasted, and how he looked between them.
- The time and colour of the vomit, the last wet nappy, his last known weight, and any medicine given today.
- His immunization history, any prior abdominal surgery, and any recent viral illness in the family.

One question worth asking the team before you leave the ED: what specific change — more frequent spells, green vomit, blood or mucus in the stool, a hard or swollen belly, or a limp spell where he does not rouse to you — should bring you back faster than you came in tonight.

If it helps, say the word and I will turn the above into a one-page visit sheet you can hand to triage.

I am not diagnosing your son. The picture matches the intussusception red-flag pattern in the Royal Children's Hospital guideline closely enough that the safe move is to be at a pediatric emergency department within the next hour, not to wait at home. What the team finds on examination and on ultrasound — and only they can do that — will tell you what is actually happening and what the treatment is.