Most fevers/high temperatures in children are not serious and are due to the common infections of childhood such as coughs, colds and other viral infections. However, fever in babies aged under 3 months is rare and is a reason for seeking advice from a healthcare professional. You should seek advice if your child is aged between 3 and 6 months and has a temperature of 39°C or more. Whether or not you decide to get help, you should give the child lots to drink. It is not always necessary to give them paracetamol or ibuprofen, unless they are distressed or very unwell. Check for signs of low body fluid (dehydration) and other signs of serious illness (details below). Seek medical help if you have any concerns.
What causes a fever/high temperature?
- Infections with germs called viruses are the common cause. Viral infections cause many common illnesses such as colds, coughs, flu, diarrhoea, etc. Sometimes viral infections cause more serious illnesses.
- Infections with germs called bacteria are less common than viral infections but also cause fevers. Bacteria are more likely to cause serious illness such as pneumonia, urine and kidney infections, septicaemia and meningitis.
- Other types of infection are uncommon causes of a high temperature in the UK.
What can I do if my child has a fever/high temperature?
- Seek medical help if your child fits the rules below or if you have any concerns.
- Make your child comfortable - details below.
- Check for signs of low body fluid (dehydration) - details below.
- Check for signs of serious infection - details below.
- Keep your child off school or nursery until they are better.
Look out for signs of serious illness.
A child with a fever may look quite unwell. He or she may be flushed and irritable. However, most bouts of fever are not caused by serious illness and the temperature often comes down quickly. It is quite common to see a child happily playing an hour or so later when their temperature has come down and they have had a good drink. They will not be entirely back to normal but it is reassuring if a child improves with the drop in temperature. You should, however, consider seeking the advice of a health professional if:
- Your baby is aged under 3 months and has a temperature of 38°C or above.
- Your baby is aged between 3 and 6 months of age and has a temperature of 39°C or above.
The height of the temperature is not a good guide to how ill the child is once they are older than 6 months.
At any age, a child with a serious infection usually gets worse despite efforts to bring their temperature down. In addition, they may have other worrying symptoms. For example, breathing problems, drowsiness, convulsions, pains, or headaches which become worse. But - use your instincts. If you think a child is getting worse, get medical help, even if they don't quite fit the 'rules' described here. Note: you should check on your child 2-3 times in the night if they have a fever, to make sure they are not developing a serious infection.
Make your child comfortable
A fever can make a child feel uncomfortable and irritable. The following are things that you can do that may bring the temperature down and make your child feel more comfortable:
Give paracetamol or ibuprofen
Medicines called paracetamol or ibuprofen can lower a temperature. You can buy these medicines in liquid form for children. They come in various brand names. An alternative is to give soluble paracetamol in a drink. The dose for each age is given with the medicine packet.
Note: these medicines do not treat the cause of the fever. They merely help to ease discomfort. You do not need to use these medicines if the child is comfortable and not distressed by the fever.
Note: do not give both paracetamol and ibuprofen at the same time. However, on occasions, if a fever is difficult to control then, for each time a medicine dose is given, a doctor or nurse may advise alternating one of these medicines with the other. It is best only to do this alternating dose regime after assessment by a doctor or nurse.
Note: do not use ibuprofen for:
- Children known to react (have hypersensitivity) to ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs).
- Children in whom attacks of asthma have been triggered by an NSAID.
- Children with chickenpox. This is because some research has shown that ibuprofen or other NSAIDs may increase the risk of developing serious skin infection complications in children with chickenpox.
Take the clothes off the child
If the room is normal room temperature, remove clothes from the child. It is wrong to wrap up a feverish child. The aim is to prevent overheating or shivering.
Give lots to drink
This helps to prevent dehydration. You might find that a child is more willing to have a good drink if they are not so irritable. So, if they are not keen to drink, it may help to give some paracetamol or ibuprofen first. Then, try them with drinks half an hour or so later when their temperature is likely to have come down. If breast-feeding then keep breast-feeding, as breast milk is the best fluid. However, you can offer feeds more often to increase the amount of fluid.
Do not cold-sponge a child who has a fever. This used to be popular but it is now not advised. This is because the blood vessels under the skin become narrower (constrict) if the water is too cold. This reduces heat loss and can trap heat in deeper parts of the body. The child may then get worse. Many children also find cold-sponging uncomfortable.
Some people use a fan to cool a child. Again, this may not be a good idea if the fanned air is too cold. However, a gentle flow of air in a room which is room temperature may be helpful. Perhaps just open the window, or use a fan on the other side of the room to keep the air circulating.
Look out for signs of dehydration
A fever caused by any illness may contribute to dehydration. The fever itself can cause more sweating and some children who become irritable with a fever do not drink as much as they might need. In particular, dehydration can develop more quickly in a child who is being sick (vomiting) or has a lot of diarrhoea. Encourage your child to have plenty to drink if they have a fever. Signs of dehydration include a dry mouth, no tears, sunken eyes, drowsiness and generally becoming more unwell. Seek medical help if you suspect that your child is becoming dehydrated.
What to expect if you contact a healthcare professional
If you telephone your GP or out of hours service the healthcare professional will try to work out why your child has a fever. This will usually include asking about your child's health and symptoms. Your child may need to be examined (a 'face-to-face' consultation). In this case it is most likely that your child's temperature, pulse and breathing will be checked. Your child will be checked for low body fluid (dehydration) and their blood pressure may be taken. A urine sample may be tested. Rarely, an ambulance may be called. This does not necessarily mean your child is very ill, only that they need to be assessed quickly in hospital.
It may be decided that you can carry on looking after your child at home; you may be given a number to contact if you need more advice or you may be asked to take the child for a check-up ithe next day.
Meningitis and septicaemia - what to look out for
Two of the most serious infections are meningitis and septicaemia (blood infection). These are uncommon and the vast majority of children with a fever do not have these infections (or other serious infections). However, meningitis and septicaemia need urgent treatment if they develop. Therefore, the following gives a guide as to symptoms to look out for.
Common early warning symptoms of meningitis and/or septicaemia
Many children (and adults) who develop meningitis or septicaemia have 'nonspecific' symptoms at first. Thay may, for example, just feel unwell or look generally unwell. However, three symptoms that commonly develop early on - often before the more classic symptoms listed later - are:
- Leg pains - which can become severe and make it hurt to stand or walk.
- Cold hands or feet - even if there is a fever.
- Pale or mottled skin. In particular, pale, dusky or blue skin colour around the lips.
Rash - may occur with meningitis or septicaemia but not always
The rash that may occur is red or purple. Small spots develop at first and may occur in groups anywhere on the body. They often grow to become blotchy and look like little bruises. One or two may develop at first but many may then appear in different parts of the body. The spots/blotches do not fade when pressed (unlike many other rashes). To check for this, do the tumbler test. Place a clear glass (tumbler) firmly on one of the spots or blotches. If the spot/blotch does not fade and you can still see it through the glass, get medical help immediately. (Note: a rash does not occur in all cases of meningitis and septicaemia but can be quite characteristic when it does occur.)
Other symptoms that may occur in babies with meningitis or septicaemia
- Excessive crying - often high-pitched or moaning and different to their usual cry.
- Fast breathing, or unusual patterns of breathing.
- Fever - but the baby may not look hot and the skin may look pale or blotchy, or turn blue. The hands and feet may feel cold. The baby may shiver.
- Will not take feeds - sometimes repeatedly being sick (vomiting).
- Being irritable - especially when picked up and handled. Normally a baby will be happier when picked up and held.
- Drowsiness or sleepiness - does not wake easily.
- The 'soft spot' on the baby's head may bulge out, instead of being indented. This is called a 'bulging fontanelle'.
- Jerky movements may occur and the body may appear stiff. Sometimes the opposite occurs and the body appears floppy. Fits (convulsions) sometimes develop.
Other possible symptoms in older children or adults with meningitis or septicaemia
- Fever and shivering - however, the hands and feet often feel cold.
- Stiff neck - cannot bend the neck forward.
- Headache - which can become severe.
- Fast breathing.
- Aches and pains in muscles or joints - the pains can become quite severe.
- Dislike of bright lights - will shut eyes and turn away from the light.
- Drowsiness, confusion or odd behaviour - may appear 'vacant'.
- Repeated vomiting. Sometimes, tummy (abdominal) pain and diarrhoea.
The course of symptoms of meningitis or septicaemia
The symptoms often develop quickly, over a few hours or so. They can occur in any order and not all may occur. Sometimes symptoms develop more slowly, over a few days. The symptoms may suggest a less serious illness at first such as flu. But, even if you think it was flu to start with, if symptoms become worse then it may be meningitis or septicaemia.
Most fevers are due to infections that are not serious and do not last long. But, see a doctor if a child does not improve within a few days, or has any worrying symptom.
Further reading & references
- Feverish illness in children - Assessment and initial management in children younger than 5 years; NICE Guideline (May 2013)
- Feverish child - risk assessment; NICE CKS, September 2013
- Doan Q, Enarson P, Kissoon N, et al; Rapid viral diagnosis for acute febrile respiratory illness in children in the Cochrane Database Syst Rev. 2012 May 16;5:CD006452.
- Thompson M, Van den Bruel A, Verbakel J, et al; Systematic review and validation of prediction rules for identifying children Health Technol Assess. 2012 Mar;16(15):1-100.
- No authors listed; Varicella, herpes zoster and nonsteroidal anti-inflammatory drugs: serious Prescrire Int. 2010 Apr;19(106):72-3.
- Mikaeloff Y, Kezouh A, Suissa S; Nonsteroidal anti-inflammatory drug use and the risk of severe skin and soft Br J Clin Pharmacol. 2008 Feb;65(2):203-9.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Laurence Knott
Dr Helen Huins