Fever in children: when to worry

Fever is a normal response to infection, most often a viral one. The question is rarely “how high is it” but “how is the child?”

Measuring it properly

Use a digital thermometer. A temperature of 38°C or above is generally considered a fever. Avoid judging by touch alone, and do not rely on forehead strips for decisions.

Caring for a feverish child at home

• Offer fluids frequently: breast milk, water or oral rehydration solution depending on age.
• Dress them in light clothing. Do not wrap them tightly or sponge with cold water.
• Give paracetamol if they are uncomfortable, dosed by weight and not more often than the label allows. The aim is comfort, not a normal thermometer reading.
• Let them rest and keep them off school or nursery while unwell.
• Check on them through the night if the fever is high.

Get medical help the same day if

• Your child is under three months old and has any fever
• They are drinking very little, or passing much less urine
• The fever lasts more than three days
• They have a rash
• They are unusually sleepy, floppy or hard to wake
• They are not improving, or you are simply worried

Emergency signs

• Difficulty breathing, fast breathing, grunting, or the chest pulling in
• A rash that does not fade when pressed with a glass
• A seizure
• A stiff neck, severe headache or discomfort looking at light
• Blue or very pale lips or skin
• Repeated vomiting with inability to keep fluids down
• No wet nappies for many hours, no tears, or sunken eyes

Go to hospital immediately for any of these. In malaria-risk areas, a child with fever should be tested the same day.

Febrile convulsions

Some young children have a seizure with fever. It is frightening to watch. Put the child on their side on a safe surface, do not put anything in their mouth, and time the seizure. Call for emergency help if it lasts more than five minutes, if they do not recover properly afterwards, or if it is their first.

What not to do

Do not give aspirin to children. Do not give adult medicines or a sibling’s prescription. Do not give antibiotics left over from a previous illness: most childhood fevers are viral and antibiotics will not help.

Parental instinct is a genuinely useful signal. If something feels wrong, have your child seen, even if the thermometer reading seems reassuring.