Fever in Children: When to Treat, When to Worry and When to Call
Few things worry parents more than a hot, flushed child. Fever is one of the most common reasons parents seek medical advice, and it is usually a sign that the body is fighting an infection, not a disease in itself. Knowing what to expect, how to care for your child and when to seek help takes much of the fear out of it.
What counts as a fever
A fever is generally a temperature of 38°C (100.4°F) or higher. Normal body temperature varies through the day and between children. A raised temperature on its own does not tell you how serious the illness is; how your child looks and behaves matters more than the number on the thermometer.
Why fever happens
The brain raises the body’s temperature set-point in response to infection, helping the immune system work better and making it harder for some germs to multiply. Most fevers in children are caused by viral infections such as colds, flu, gastroenteritis and common childhood rashes. Bacterial infections like ear infections, throat infections, urinary tract infections and pneumonia are other causes. Vaccinations often cause a mild, short-lived fever too.
How to take a temperature
- For babies and young children, use a digital thermometer under the armpit or a rectal or ear thermometer as recommended by your clinician; forehead strips are unreliable
- Follow the manufacturer’s instructions
- Take the temperature when the child is calm, not immediately after a bath or when bundled up
- Record the reading and time, along with other symptoms
Does every fever need treating?
No. The aim of treatment is to make your child comfortable, not to bring temperature to normal. If your child is playing, drinking and alert, medicine may not be needed. If they are miserable, in pain or unable to rest, paracetamol (acetaminophen) or ibuprofen can help.
Safe medicine use
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- Use only the product made for children, and measure the dose by weight and age as stated on the packet or advised by a pharmacist
- Never exceed the maximum doses in 24 hours and keep the minimum interval between doses
- Do not give aspirin to children under 16, because of the risk of Reye’s syndrome
- Avoid ibuprofen if your child is dehydrated, has persistent vomiting, asthma triggered by anti-inflammatory drugs, or kidney problems unless advised
- Do not alternate or combine medicines unless a doctor has suggested it
- Keep all medicines locked away
Fever medicines do not prevent febrile seizures.
Home care
- Offer plenty of fluids, small and frequent sips, breast milk or formula for babies
- Dress lightly; do not wrap a feverish child in heavy blankets
- Keep the room comfortably cool
- Let them rest
- Do not sponge with cold water or use alcohol rubs, which can cause shivering and discomfort
- Check on them through the night
Febrile seizures
In some children between six months and five years, a rapid rise in temperature can trigger a convulsion. It is frightening but usually harmless and lasts less than five minutes. Lay the child on their side, do not put anything in their mouth, note the time and call for medical help the first time it happens, or if it lasts more than five minutes, or if the child does not recover quickly.
When to seek urgent medical help
Call emergency services or go to the emergency department if your child:
- Is under 3 months old with a temperature of 38°C or higher
- Has a stiff neck, severe headache or dislike of bright light
- Has a rash that does not fade when a glass is pressed against it
- Is struggling to breathe, grunting or has rapid, laboured breathing
- Is unusually drowsy, floppy, hard to wake or confused
- Has a seizure
- Has cold hands and feet, pale or blotchy skin, or a blue tinge
- Shows signs of dehydration, such as no wet nappy for eight hours, dry mouth, sunken eyes or no tears
- Has severe pain or persistent vomiting, especially if green
When to book a doctor’s visit
- Fever lasting more than three days (earlier for babies aged 3 to 6 months)
- Pain when passing urine, ear pain or sore throat
- A child who seems unwell despite medicines
- Anything that is worrying you; your instinct counts
Prevention
Hand washing, keeping up to date with the vaccination schedule and keeping unwell children home from nursery reduce infections.
The takeaway
Fever is a sign that your child’s immune system is working. Focus on comfort, fluids and observation, know the red flags and never hesitate to seek help if something does not feel right.
This article is for general information and is not a substitute for professional medical advice. If you are worried about your health or have symptoms, speak to a doctor or other qualified health professional.