Overview
A fever is a temperature of 38C or more. It is not an illness in itself but the body turning up its own thermostat while it fights an infection. In children that is usually a common virus, and the temperature settles within one to four days.
The height of the reading does not tell you how serious the illness is. A child at 39C who is drinking and playing a little is often less worrying than a quiet child at 38C who will not feed.
Symptoms
A feverish child feels hot to touch on the forehead, back or tummy, may look flushed or sweaty, and often seems tired, clingy and off their food. Shivering and chills can come first.
The other symptoms depend on the infection behind it: a runny nose and cough, sore throat, earache, a rash, loose motions, vomiting, or pain on passing urine. Some young children have a febrile seizure, going stiff, twitching or jerking, and may lose consciousness briefly.
When to see a doctor
See a doctor within a day or two if a baby of three to six months has a temperature of 39C or more, if the fever lasts five days or longer, if there is a rash with it, or if there are fewer wet nappies and dark urine. Trust your own sense that a child is not right.
Causes
Most fevers in children come from infections the body clears on its own: colds, influenza, throat and ear infections, and the usual stomach bugs. These need fluids, rest and time rather than .
Some come from infections that do need treatment, such as pneumonia, a urine infection, typhoid, malaria, dengue and, less often, meningitis or sepsis. A fever can also follow a vaccination for a day or so.
Risk factors
- Age under three months, when any fever is treated as urgent
- Being born early
- A long-term heart, lung, kidney or liver condition
- A weakened immune system, or medicines that lower immunity
- Vaccinations not up to date
- Close contact with others who are ill, at home, creche or school
- Living in or travelling to places where malaria, dengue or typhoid are common
Complications
Most fevers pass without trouble. Difficulties come from the infection behind the fever, or from a child who stops drinking.
- Dehydration, from sweating, poor drinking, vomiting or loose motions
- Febrile seizures in young children
- An infection that spreads or deepens, such as a chest or urine infection
- Rarely, meningitis or sepsis, which are emergencies
Prevention
- Keeping vaccinations up to date
- Washing hands with soap before food and after the toilet
- Keeping a sick child at home while they are unwell
- Mosquito nets, screens and repellents where dengue and malaria occur
- Safe drinking water and freshly cooked food
- Not sharing bottles, spoons, cups or towels when someone at home is ill
Diagnosis
The doctor measures the temperature and then examines the child from head to toe: throat, ears, chest, tummy, neck and skin, along with how the child is breathing and responding.
Many children need no tests at all. Where the source of the fever is not clear, or the child is very young or seems unwell, blood tests, a urine test, a chest X-ray, or tests for malaria, dengue or typhoid may be arranged.
Treatment
Most fevers need comfort rather than medicine. Offer fluids often, in small amounts if the child is vomiting, keep them in light clothing and let them rest. Food can wait a day or two; drinking cannot.
Paracetamol or ibuprofen can be given if the fever is making the child miserable, at the dose advised for their age and weight. They make a child more comfortable rather than treat the infection. Aspirin should not be given to anyone under sixteen. Paracetamol is not used under two months of age, and ibuprofen not under three months, without a doctor's advice.
work only against bacterial infections and do nothing for the viruses behind most childhood fevers. Where a bacterial infection, malaria or dengue is found, that is treated on its own terms.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“A high fever will damage my child's brain.”What is true?
Fact
Fever is part of the body's defence against infection, and a fever caused by infection rarely climbs to the level at which heat itself can harm the brain. What matters is the illness behind the fever, which is why doctors watch a child's breathing, alertness and drinking far more closely than the number on the thermometer.
Myth“A fit during a fever means my child has epilepsy.”What is true?
Fact
Febrile seizures happen in some young children, usually between six months and six years old, and they are not the same thing as epilepsy. Most are over quickly and do not cause lasting harm. A first fit, one lasting more than five minutes, or more than one fit in a day still needs emergency care so the cause can be checked.
Myth“Cover the child with blankets so the fever sweats out.”What is true?
Fact
Extra blankets trap heat and can push the temperature higher. Light clothing, a single light cover and plenty of fluids are what help. NHS advice for a feverish child is not to overdress them.
Myth“Sponge the child with cold water, or rub spirit on the skin, to bring the fever down.”What is true?
Fact
Cold baths, ice and alcohol rubs cool the skin but often make things worse, because they cause shivering, which drives the body temperature back up. Offering fluids, keeping the child lightly dressed and, if the fever is making them miserable, giving paracetamol or ibuprofen at the dose advised for their age is the usual approach.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How should I take my child's temperature?
A digital thermometer is the usual way. Under the arm suits babies and young children, and older children who can hold it still can have it in the mouth. Write down the reading and the time, and tell the doctor which method you used, because the same child reads slightly differently under the arm and in the mouth.
The fever comes down with medicine and then goes back up. Is that normal?
Yes. Paracetamol and ibuprofen lower the temperature for a few hours, and it rises again while the infection is still there. That is expected and does not mean the medicine has failed. What matters is how the child is between doses: one who perks up, drinks and plays a little is usually doing well.
Should I ask for antibiotics just to be safe?
No. Most childhood fevers are caused by viruses, and antibiotics do not work against viruses. They are prescribed when a doctor finds a bacterial infection, and then the course is finished as directed.
What should I do if my child has another febrile seizure?
Stay with them, move anything hard or sharp out of the way and cushion the head. Do not hold them down and do not put anything in the mouth. Once the movements stop, turn them on their side. Call for emergency help if it is the first fit, if it lasts more than five minutes, if breathing is difficult, if only one side of the body is twitching, or if there is more than one fit in a day.
