Fever in Children: When Should You Bring Them In?

Bring them in immediately if

The list above. Any one of those is a reason to come to the emergency department rather than wait for an appointment — and it does not matter what the thermometer says.

Babies under three months are different

Any fever in a baby under three months needs same-day medical assessment, even if the baby seems otherwise well and even if the fever is low.

Very young babies have immature immune systems and can become seriously unwell extremely quickly, often with few outward signs. This is the one situation where "wait and see" is not appropriate. Between three and six months, be similarly cautious.

Same-day review if

• Fever lasting more than two or three days without an obvious cause
• Fever above about 39°C that is not settling with paracetamol
• Ear pain, or discharge from the ear
• A productive cough, or breathing that seems faster than usual
• Repeated vomiting, or diarrhoea with reduced fluid intake
• Pain on passing urine, or a strong-smelling urine
• Fever with a limp, or refusing to use a limb
• A child with an existing condition — asthma, heart disease, immune problems
• Fever that settled and has now returned
• Your own instinct that something is wrong. It is a legitimate reason and we take it seriously

How the child looks matters most

This is the most useful judgement a parent can make, and it is more informative than the temperature.

Reassuring: alert or easily roused, taking fluids, interested in surroundings between temperature spikes, playing at least a little, normal skin colour, crying normally.

Concerning: difficult to rouse, floppy, not interested even when the fever comes down, refusing fluids, breathing hard, pale or mottled, or crying in a way that is unusual for them.

A child of 39.5°C who is running around is generally less worrying than a child of 38.2°C who is limp and will not drink.

Care at home

• Fluids, frequently and in small amounts. This is the single most important thing. Water, oral rehydration solution, milk for infants, diluted juice — whatever they will take
• Paracetamol at the dose for their weight, not their age, at the correct spacing. Ibuprofen may also be used if advised, but not for a dehydrated child or one with vomiting
• Dress them lightly. Do not bundle a febrile child in blankets
• Do not sponge with cold water or use ice — it causes shivering, which raises the temperature
• Let them rest and eat what they want. Reduced appetite for a day or two is fine
• Recheck them regularly, including overnight, and note any new symptom

Febrile fits

A febrile convulsion — a fit triggered by fever in a young child — is frightening to watch and usually harmless. If it happens:

• Note the time it starts. Lay the child on their side on a soft surface, away from anything hard
• Do not put anything in their mouth, and do not try to restrain their movements
• Call for help. A first fit always needs assessment
• If it lasts more than a few minutes, call an ambulance

What not to do

• Do not give antibiotics you have at home. Most childhood fevers are viral and antibiotics do nothing for them
• Do not give aspirin to a child. It is associated with a rare but serious complication
• Do not combine multiple medicines that both contain paracetamol
• Do not delay for a baby under three months. See above

Our paediatrics department assesses children, and the emergency department sees acutely unwell children without an appointment.