Fever in Children: Home Care, Paracetamol Use and When to See a Doctor

Fever is one of the most common reasons parents take children to a doctor. It is also one of the most frightening, especially at night. The reassuring fact is that a fever is a normal body response to infection and, by itself, is rarely harmful. How your child looks and behaves is usually more important than the number on the thermometer. This guide explains how to care for a child at home and which signs mean you should seek help.

What is a fever?

A fever is a body temperature of 38 °C (100.4 °F) or higher. Children's temperatures vary through the day and rise after exercise, hot weather, heavy clothing and crying, so recheck after the child has rested for 15 minutes in light clothing. Use a digital thermometer and follow its instructions.

Common causes

Most fevers are due to viral infections such as colds, influenza, throat infections and viral gastroenteritis. Others are bacterial, such as urinary tract infections, ear infections, pneumonia and tonsillitis. In Sri Lanka, dengue and sometimes leptospirosis, typhus and malaria (in travellers) must be kept in mind, especially if the fever lasts more than two days. Fever can also follow vaccination, usually within 48 hours.

Home care

1. Fluids. Offer small, frequent drinks: water, oral rehydration solution, king coconut water, breast milk or formula. Fever increases fluid loss, and dehydration is a bigger risk than the temperature.
2. Light clothing. Do not wrap a feverish child in blankets. A thin cotton layer and a comfortable room are enough.
3. Rest. Let the child play quietly or sleep. Appetite often falls, which is normal for a day or two.
4. Lukewarm sponging can help comfort if the child is very hot, but stop if they shiver or dislike it. Never use cold water, ice baths or alcohol rubs.
5. Monitor. Note the temperature, fluids taken, urine passed, and any new symptoms such as rash, vomiting or fast breathing.

Using paracetamol safely

Paracetamol is for comfort, not to "bring the number down" at any cost. Treat a child who looks miserable; a child who is playful with a temperature of 38.5 °C may not need medicine.

• Dose by weight, not age, and use the measuring device supplied with the syrup. Our paracetamol dose calculator helps, but the product label and your doctor's advice come first.
• Check the concentration (for example 120 mg per 5 mL or 250 mg per 5 mL) because different syrups give different volumes.
• Leave the minimum gap between doses stated on the label, and never exceed the maximum number of doses in 24 hours.
• Do not give other products containing paracetamol, such as cold and flu mixtures, at the same time.
• Do not give aspirin to children, because it is linked to Reye's syndrome, a rare but serious condition.
• Keep all medicines out of reach. Paracetamol overdose can seriously damage the liver, even if the child seems well at first.

See a doctor urgently or go to hospital if

• A baby under 3 months has a temperature of 38 °C or higher. This always needs same-day medical assessment.
• A baby aged 3-6 months has a temperature of 39 °C or higher, or appears unwell.
• The child is very drowsy, difficult to wake, floppy, or unusually irritable and inconsolable.
• There is a stiff neck, severe headache, or discomfort looking at light.
• There is a rash that does not fade when pressed with a glass.
• Breathing is fast, noisy or laboured, or the ribs are sucking in.
• The child has a fit (see below).
• There are signs of dehydration: dry mouth, no tears, sunken fontanelle (soft spot) in a baby, very little urine, or cold hands and feet.
• Persistent vomiting, severe abdominal pain, blood in vomit or stools, or bleeding from the nose or gums.
• The fever lasts more than 2-3 days, or comes back after improving.
• The child has a long-term illness, weakened immunity, sickle cell disease or heart disease.

Dengue season

When dengue is circulating, any child with high fever for more than two days should be seen by a doctor. The dangerous phase usually begins around days 3-7 when the fever falls. Avoid ibuprofen and aspirin and give paracetamol only. Read our guide to dengue warning signs.

Febrile convulsions

About 2-5% of young children aged roughly 6 months to 5 years may have a fit with a rapidly rising fever. It is frightening but usually brief and harmless.

• Lay the child on their side on a soft surface, away from hard objects.
• Do not put anything in the mouth and do not restrain them.
• Note the time. If it lasts more than 5 minutes, or the child has breathing difficulty or does not recover, call for an ambulance or go to hospital.
• Every child after a first fit should be seen by a doctor.

Paracetamol does not prevent febrile fits.

What the doctor may do

The doctor will examine the child, check for the cause, and may order a urine test, blood tests, a chest X-ray or a dengue test, depending on the findings. Antibiotics help only bacterial infections and are not needed for most viral fevers.

Prevention

Hand-washing, up-to-date vaccinations as per the national schedule, safe water, food hygiene, and removal of mosquito breeding sites reduce the chance of many fevers.

When to see a doctor

If you are worried, trust your instincts and get your child checked. Parents often notice subtle changes before any test does.

References

• World Health Organization: Integrated Management of Childhood Illness guidance
• NICE guideline NG143: fever in under 5s
• Sri Lanka Ministry of Health, Family Health Bureau: child health guidance