Fever in children: when to worry
Few things frighten a parent like a child who is burning hot. The child is clingy, they will not eat, they are restless and then drowsy, and the number on the thermometer climbs. You feel you should be doing something, and every hour that passes without the fever breaking feels like an hour wasted.
Here is the reassuring part first. Fever is the body's normal response to infection, and in most children it means the immune system is doing its job. It is a signal, not a disease. The great majority of fevers in children come from ordinary viral illnesses that settle on their own within a few days.
But you are right to take it seriously. A small number of fevers do point to something more dangerous, and there are certain ages and certain signs where waiting at home is the wrong choice. This article explains what a fever is, how to look after a child who has one, and the specific features that mean you should seek care today or immediately.
What counts as a fever
A temperature of 38 degrees Celsius or above is usually taken as a fever. Measured under the armpit in a young child is the simplest and most reliable method at home; forehead and ear devices can be inaccurate in small children.
The number itself matters less than how the child looks and behaves. A child with a temperature of 38.5 who is drinking, playing and annoyed about being checked is very different from a child with the same temperature who is limp, not responding, or breathing fast. Parents are often told to trust their instinct, and there is good reason for that. A child who seems "not themselves" deserves a look even if the temperature is modest.
The common causes
Most fevers in children come from infections, and most infections are viral. Colds, flu, sore throats and stomach bugs are the usual culprits. These fevers tend to settle over three or four days, though a cough or a runny nose may linger longer than the temperature does.
In Nigeria, malaria is an important cause of fever in children and should be considered whenever a child has a fever with chills, sweating, headache, or body aches. Malaria in a child can worsen quickly, which is why a fever in a child who lives in or has travelled to a malaria area should be tested rather than simply watched. Typhoid is another local cause and often presents with a fever that climbs slowly over several days, along with abdominal discomfort and sometimes constipation or diarrhoea.
Other causes include ear infections, urine infections, throat infections and chest infections such as pneumonia. A urine infection in a baby can be surprisingly quiet, presenting with fever and poor feeding and nothing else obvious.
Fever can also follow vaccination. A mild temperature in the day or two after a routine immunisation is expected and not a reason to skip the next one. If your child is unwell in a way that does not fit the usual post-vaccine pattern, have them seen.
Caring for a feverish child at home
For a child over three months who is drinking, alert and otherwise well, the main job is comfort and fluids.
Encourage your child to drink. Offer water, breast milk or oral rehydration solution often, in small amounts. Do not worry about food for a day or two; fluids matter far more, and appetite usually returns once the fever settles. Dress the child lightly, keep the room comfortable, and let them rest.
Paracetamol, given at the dose on the product leaflet for your child's age or weight, can ease discomfort and bring the temperature down. Ibuprofen is an option for children over three months. Follow the leaflet; do not stack extra doses because the fever persists, and do not give both medicines together unless a doctor or pharmacist has advised it. The aim is not to force the number to normal, but to make the child more comfortable.
Do not sponge a child with cold water and do not wrap them to "sweat out" the fever. Both can make things worse. Cold sponging causes shivering, which can push the temperature up again.
Do not start antibiotics on your own. Leftover antibiotics do not treat viral fevers, and using them blindly can hide a serious infection and delay the right treatment. If malaria or a bacterial infection is possible, the child needs testing.
When to worry
Most fevers are manageable at home. Some need a doctor today, even if not in an emergency. Arrange a same-day review if your child:
- is drinking much less than usual, or refusing fluids
- is passing less urine than normal, or has fewer wet nappies
- has a dry mouth, or cries without tears
- is unusually drowsy, or more irritable than you can settle
- has a fever that has lasted five days or more
- has had a fever that settled and then returned
- seems to be getting worse rather than better
- has fast breathing, or is working harder to breathe
- has a fever of 39 degrees or more and is aged three to six months
Go to an emergency department or call for help immediately if your child has any of these:
- Any fever in a baby under three months old. This is always urgent, without exception.
- A fever with a rash that does not fade when you press a clear glass against it.
- A fever with a stiff neck, a bulging soft spot on the head, or pain on looking at bright light.
- Confusion, extreme drowsiness, or difficulty waking.
- A seizure (fit).
- Very pale, mottled, or blue-tinged skin, or skin that feels cold and clammy.
- Breathing that is very fast, or so laboured that the child cannot talk, eat or drink.
- Signs of severe dehydration: sunken eyes, a very dry mouth, no urine for many hours, or a drowsy, floppy child.
- A child with sickle cell disease, HIV, diabetes, or on immunosuppressant medication who develops a fever. For these children a fever can be an emergency, because their defences against serious infection are weaker.
Children who need a lower threshold for care
Age matters a great deal. The younger the child, the less able they are to show you what is wrong and the faster a serious infection can move. A fever in any baby under three months should be assessed urgently, not observed at home.
Children on cancer treatment, children with sickle cell disease, and children whose immune system is suppressed need urgent assessment for fever, because the usual signs of serious infection may be blunted.
Premature babies and those with heart or lung conditions also sit in a higher-risk group. For these children, treat a fever as an emergency rather than waiting to see how the night goes.
Frequently asked questions
Should I bring the temperature down, or let the fever run?
Comfort is what matters. If the child is miserable, paracetamol can help. There is no need to force the number down purely for its own sake.
How long should a fever last?
A simple viral fever usually settles within three to four days. A fever lasting five days or more, or one that recurs, should be reviewed.
Can a high fever cause brain damage?
In an ordinary infection, the fever itself does not damage the brain. The danger lies in the illness causing the fever. That is why the child's behaviour and other signs matter more than the temperature.
My child had a fit with the fever. What now?
A fever fit is frightening but usually brief and not harmful in itself. Your child still needs to be seen, both to check the cause of the fever and to confirm the fit was the simple type. Read our article on febrile convulsions for what to do during and after.
Next steps
If your child has any warning sign above, do not wait for morning; get care now. If the fever is mild and your child is drinking and alert, you can watch at home, but keep checking through the night. Any fever in a baby under three months, a fever that lasts five days, or a child who seems to be getting worse should be seen. A fever is a clue, and finding out what it is pointing to is what keeps your child safe.
Related articles
- Febrile convulsions (fever fits) in children
- Cough in children: causes and when to see a doctor
- Diarrhoea and dehydration in children
- Vomiting in children: causes and red flags
- Poor feeding in babies and children