Few things worry parents more than a hot, miserable child at two in the morning. Fever itself is rarely the danger: it is the body’s normal response to an infection, and most childhood fevers come from viruses that pass on their own. What matters is how your child looks and behaves, and a short list of signs that mean the fever needs a doctor rather than a cool drink and a cuddle.
What a temperature tells you
A temperature of 38°C or more, measured under the arm, in the ear or on the forehead, is a fever. Older children can have it measured by mouth. How high the fever goes says surprisingly little about how serious the illness is: a cheerful child with 39.5°C is usually less of a concern than a limp, quiet child with 38.2°C.
Watch the child rather than the thermometer. Is your child drinking? Passing urine? Interested in anything, even briefly, when the medicine has taken effect? Those answers guide what to do next.
Keeping your child comfortable
For most fevers, the job at home is comfort and fluids:
- Offer drinks often, in small amounts. Water, milk, diluted juice, or an oral rehydration solution if there is vomiting or diarrhoea. Breastfed babies should feed more often.
- Dress lightly and keep the room comfortable. Do not wrap a feverish child in blankets, and do not strip or sponge them with cold water, which makes them shiver and feel worse.
- Let them rest without insisting on bed. A sofa with a screen is fine. So is sleep.
- Keep them home from nursery or school until the fever has been gone for a day and they are eating and playing normally.
Medicines
Paracetamol or ibuprofen can be given if your child is uncomfortable, in the dose for their weight on the packet or as the pharmacist or doctor advises. A few points parents often ask about:
| Question | Answer |
|---|---|
| Do I have to treat the fever? | No. If your child is comfortable, the fever can be left alone. |
| Can I alternate the two medicines? | Only if a doctor has advised it, and keep a written note of times and doses. |
| What about aspirin? | Not for children, unless a specialist has prescribed it. |
| My child vomited the dose | Do not repeat it straight away. Wait for the next due time, and ask if unsure. |
Antibiotics do nothing for the viral infections behind most fevers. When a bacterial infection is found, such as an ear or urine infection, the doctor will prescribe them.
When to see a doctor the same day
Book an appointment, or come to the clinic, the same day if:
- Your baby is under three months and has a fever of 38°C or more.
- The fever has lasted more than three days, or it went away and came back.
- Your child is drinking much less than usual, or has had fewer than three wet nappies, or passed little urine, in a day.
- There is ear pain, a sore throat with difficulty swallowing, pain passing urine, or any pain that worries you.
- Your child has a long-term condition, such as a heart or kidney problem, or takes medicines that affect immunity.
- You are worried. Parents notice things a checklist cannot. That is a good enough reason.
When to seek urgent care
Go to an emergency department, or call the emergency number, if your child:
- Is breathing fast or with effort, with the skin pulling in between the ribs, or with a grunting sound.
- Has a rash that does not fade when you press a glass against it.
- Is unusually drowsy, hard to wake, or limp, or cries in a weak or high-pitched way.
- Has a stiff neck, cannot bear bright light, or has a bulging soft spot on the head.
- Has a seizure, even a short one.
- Has lips, tongue or skin that look blue, grey or very pale.
The parents I worry about least are the ones who call and say “I know it’s probably a virus, but something isn’t right”. Trust that instinct. We would always rather see a child who turns out to be fine.
Febrile seizures
A small number of children between about six months and five years have a brief seizure as a fever rises. It is frightening to watch and usually harmless, but every first febrile seizure should be assessed by a doctor the same day. During a seizure, lay your child on their side on a safe surface, do not put anything in the mouth, and note the time. If it lasts more than five minutes, call the emergency number.
After the fever
Most children bounce back within a day or two of the fever settling. A lingering cough or a tired, clingy week afterwards is common with viral illnesses. If a new fever starts after a few clear days, or if your child is not back to their usual self within a week, book a visit so we can take a look.
This article is general information, not medical advice. For your own situation, talk to a doctor.