Fever in children - a parents guide

Fever in Children: A Paediatrician’s Guide for Parents

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What Is a Fever?

A fever is a rise in body temperature above the normal range.

• ️ In children and adults alike, we define fever as 38.0°C (100.4°F) or higher, measured by a reliable thermometer (ear or underarm for older children; rectal for infants when advised).

• Temperature naturally fluctuates during the day, so a mild rise below 38C doesn’t always means illness.

What Does Fever Mean?

Fever feels scary for parents, but it’s usually a sign that the body is doing its job.

When your child has an infection (most commonly viral), the immune system raises the body’s temperature to fight the germs.

Think of fever as a signal that the immune system is switched on as the body activated the defence mechanisms.

What Makes a Febrile Illness Dangerous?

Fever itself is NOT harmful in otherwise healthy children!

As pediatrician, I aim to understand the underlying cause of the fever and how your child responds when unwell.

Let’s take a closer look at these aspects.

1. The cause of the fever

A fever can be trigger by many things, including:

Infections (bacterial, viral, parasitic, or fungal)
Recent vaccinations
Certain medications or toxins
Abnormal immune responses
Cancer cells

Bacterial infections are a particular worry in young children, as their immune systems are still developing and less able to contain these infections quickly.

2. The impact of the fever on the body

Children with chronic medical conditions affecting a specific organ often experience a temporary worsening of their baseline condition when they develop a fever.

For previously healthy children, a paediatrician will focus on how the fever is affecting them overall, including:

• Behavior and energy levels: are they unusual drowsy, difficult to wake, limp or particular irritable, difficult to settle or have an unusual behavior

• Appetite : are they drinking enough to pass urine at least once every 8–12 hours; do they accept solids and keep them down

• Fever pattern: more frequent, intense and less responsive to treatment

• ️ The pace of illness: rapid worsening symptoms

• Worrying associated signs: persistent mottling with cold hands and feet, purple discoloration of limbs and lips, rigors (shaking chills), or rash that does not fade when pressed

• Localised symptoms which may suggest a specific organ is under stress; breathing difficulty or persistent cough, persistent or worsening pain, purulent discharge, localised swelling and redness, bleeding, persistent vomiting

How Can I Help My Child at Home?

Keep Them Comfortable

The most important thing you can do is help your child feel as comfortable as possible while their body fights the illness.

• Offer plenty of fluids. Depending on your child’s age and preference, this might include water, breast milk, formula, diluted juice, ice lollies—almost anything they’re willing to drink. Offer small amounts regularly without forcing. The same gentle approach applies to solid foods.

• Dress lightly. Avoid wrapping them in too many layers; removing a layer may help them cool naturally.

• Encourage rest, but not strict bed-rest. They don’t need to stay in bed all day.

Gentle play, reading, or quiet activities they enjoy are perfectly fine.

Medicine

Over the years, I’ve cared for a wide range of families—some give medicine early to prevent fever, others treat the moment the thermometer reaches 38°C, and some offer medication only when the child seems uncomfortable.

Remember: fever medicine improves comfort; it does not cure the illness.

All medicines are processed by the liver and kidneys, so they should be used thoughtfully.

Healthy children can take Paracetamol (acetaminophen) or Ibuprofen.
Always follow weight-based doses, as listed on the bottle or packaging.
There is no need to alternate or combine fever medicines routinely.

Things NOT to Do

No cold baths or alcohol rubs—they’re unsafe and don’t help.
Don’t wake a sleeping child just to give fever medicine.
Don’t panic about the number on the thermometer—how your child looks and behaves is far more important!!!

Red Flags: When to Seek Medical Help

1. Fever in young babies

Any fever in a baby under 3 months old should be assessed by a doctor as soon as possible.

2. Concerning overall appearance or behaviour

Seek help if your child has:

Unusual sleepiness
Confusion or reduced responsiveness
Marked lethargy
Difficulty waking
Doesn’t recognise you

3. Rapidly worsening illness

A fast progression of symptoms or a sudden decline in your child’s condition is a reason to get medical advice promptly

4. Worrying localised symptoms

Depending on the body system involved, symptoms may suggest a specific organ is struggling

• Neurological: severe headache, seizures, unusual behavior

• Skin: rashes, especially one that does not fade when pressed

• Respiratory: persistent cough, fast breathing, or working hard to breathe

• ️ Digestive: persistent abdominal pain, repeated vomiting, inability to keep fluids down, blood in vomit or stools

• Renal/urinary: not passed urine in the last 8-12 hours, pain on urination, back pain

• Bones, joints, muscles: swelling, redness, refusal to walk or use a limb

5. Not improving as expected

Fever lasting longer than expected
Ongoing, persistent symptoms

6. Parental instinct

If you can’t quite put your finger on it but something feels wrong—especially in babies under 1 year—trust your instincts and seek medical assessment.