Children
Fever in children: what actually matters
Parents are taught to fear the number on the thermometer. Doctors watch the child instead — how they are drinking, how they are breathing, and whether they can be roused and settled.
The short version
- Fever is the immune system working, not the illness itself. The height of the temperature is a poor guide to how serious it is.
- How your child looks and behaves matters far more than the reading — particularly drinking, breathing, alertness and wet nappies.
- Treat the child, not the number. Paracetamol or ibuprofen are for discomfort, not for the temperature itself.
- Any fever in a baby under three months needs same-day medical assessment.
A fever in a small child is one of the most common reasons a parent rings a GP, and one of the most frightening things to sit with at two in the morning. It is worth knowing what actually matters.
What a fever is
A temperature at or above 38°C. It is the body deliberately raising its own thermostat, because most viruses and bacteria replicate less efficiently at higher temperatures. It is a sign the immune system is doing its job.
The great majority of fevers in children are caused by viruses that resolve on their own within a few days without any specific treatment.
Why the number matters less than you would expect
A child with 39.5°C who is drinking, alert between naps and grizzly but consolable is usually less concerning than a child with 38.2°C who is floppy, refusing fluids and difficult to rouse.
Doctors assess the child rather than the reading. Specifically:
- Drinking — are they taking fluids, and are nappies still getting wet?
- Breathing — is it fast, laboured, or are they using their tummy or ribs?
- Alertness — can they be roused, and do they respond normally to you?
- Colour — pale, mottled or blue is significant.
- Consolability — can they be settled at all, even briefly?
- Rash — and in particular, whether it fades when pressed.
Call 000 or go to an emergency department now if your child is difficult to wake or unusually drowsy, is working hard to breathe, has a rash that does not fade when you press a glass against it, has a stiff neck or dislikes light, has blue or very pale mottled skin, has a seizure, or is not passing urine.
Any fever in a baby under three months needs same-day assessment, regardless of how well they otherwise seem.
Treating the child, not the number
Paracetamol and ibuprofen are for making a child more comfortable — so they will drink, settle and sleep. They are not given to bring a number down for its own sake, and they do not make the illness go away any faster.
Practical points:
- Dose by weight, not age, and check the concentration on the bottle you actually have.
- Ibuprofen is best given with food and avoided if a child is dehydrated or vomiting a great deal.
- Do not give aspirin to children.
- Fluids matter more than food. A few days of poor eating is not a problem; not drinking is.
- Dress them lightly. Cold baths and sponging are not recommended — they cause shivering, which is unpleasant and counterproductive.
Febrile convulsions
Around one in twenty young children has a seizure with a fever at some point. It is terrifying to watch and is usually harmless.
If it happens: put your child on their side on the floor away from anything hard, do not put anything in their mouth, and time it. Call 000 if it lasts more than five minutes, if they do not wake properly afterwards, or if it is their first one. Any child who has had a febrile convulsion should be assessed the same day.
When to book an ordinary appointment
- Fever lasting more than two or three days
- Fever that settles and then returns
- Ear pain, a very sore throat, or pain passing urine
- A child who is drinking less than usual but still making wet nappies
- Any child under twelve months you are unsure about
- Any time your own instinct says something is not right
That last one is not a courtesy. A parent's sense that their child is not behaving like themselves is genuinely useful clinical information, and it is taken seriously here.
Getting seen
Ring when the phones open and say it is for a child with a fever. Unwell children are prioritised wherever we can. Several of our doctors have particular experience in children's health, including a Diploma of Paediatrics — mention it when you book if you would prefer one of them.
Questions we get asked
What temperature is too high?
There is no single number that means danger. A very high temperature in a child who is otherwise alert and drinking is usually less concerning than a moderate one in a child who is floppy or refusing fluids. Assess the child, and ring if you are unsure.
Should I alternate paracetamol and ibuprofen?
Sometimes, but it is easy to lose track and give too much. Ask your GP or pharmacist for specific advice for your child's weight, and write down the times if you are alternating.
Can I get a same-day appointment for my child?
We prioritise unwell children wherever we can. Ring when the phones open and tell reception the child's age and what is happening.
General information only. This article is general health information for people in the Port Stephens area. It is not advice about your individual situation and it does not replace a consultation with a doctor. If you are worried about a symptom, book an appointment or call us on (02) 4008 4400. In an emergency, call 000.
More from the journal
Women's health
Cervical screening: you can now collect the sample yourself
6 min readRead
Screening
The bowel screening kit in the drawer
5 min readRead