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.
Dealing with a fever. A fever commonly occurs with chickenpox, and may make your 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:
- You can give paracetamol to lower a temperature. You can buy paracetamol in liquid form, or melt-in-the-mouth tablets, for children. It comes in various brand names. The dose for each age is given with the medicine packet. Note: paracetamol does not treat the cause of the fever. It merely helps to ease discomfort. It also eases headaches, and aches and pains. You do not need to use paracetamol if your child is comfortable and not distressed by the fever, aches or pains.
If your child is still distressed by a fever despite paracetamol, ibuprofen may also be used. A few years ago, there were some small studies which showed ibuprofen may increase the risk of developing skin infections. The National Institute for Health and Care Excellence (NICE) decided this was not convincing evidence, and that it is safe to use ibuprofen in chickenpox. However, it does make sense to use ibuprofen only when really needed and if paracetamol has not worked. Note: Ibuprofen is sold as a medicine to ease fever and pain, but do not use ibuprofen for:
- Children known to react (have hypersensitivity) to ibuprofen.
- Children in whom attacks of asthma have been triggered by ibuprofen or similar medicines.
- Take extra layers of clothes off your child if the room is normal room temperature. 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 a lack of fluid in the body (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 first. Then, try the child with drinks half an hour or so later when his/her temperature is likely to have come down.
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.
Dr Tim Kenny
Dr Laurence Knott
Dr Helen Huins