What can I do if my child has a fever/high temperature?
A child with a fever may look flushed and irritable and they may not feel like doing very much.
- Make your child comfortable - details below.
- Check for signs of lack of fluid in the body (dehydration).
- Check for signs of serious infection.
- Keep your child off school or nursery until they are better.
In most bouts of fever that are not caused by serious illness, the temperature generally comes down quickly. It is not unusual to see a child play happily after an hour or so, when their temperature has come down and they have had a good drink. It is reassuring if a child improves with the drop in temperature.
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.
How do I manage a fever?
The important things are to try to keep your child calm, reassured and comfortable.
- 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 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. Fever caused by any illness may contribute to dehydration. This happens through evaporation of moisture from the skin as the body tries to cool itself, and through sweating.
- Cooling an over-warm room may be helpful.
- Tepid sponging is not recommended for treatment of fever. 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.
- Cold fans are not recommended, for the same reasons, although cooling an over-warm room with adequate ventilation is sensible.
- Children with fever should not be underdressed or over-wrapped.
- Medicines like paracetamol and ibuprofen should not be used for fever unless your child appears distressed. If they are not distressed it is better to let the fever do its job and run its course:
- Using paracetamol and ibuprofen does not prevent febrile convulsions and should not be used for this purpose alone.
- You can use either paracetamol or ibuprofen in children with fever who appear distressed.
- You should not use both at the same time.
- Some studies have shown that ibuprofen may increase the risk of developing skin infections when used in chickenpox. Therefore, paracetamol is usually recommended in chickenpox. For other conditions, ibuprofen is recommended only when really needed and if paracetamol has not worked.
When using paracetamol or ibuprofen in children with fever
- Continue for as long as the child appears distressed.
- Consider changing to the other agent if the child's distress is not alleviated by the first.
- Only consider alternating these two agents if the distress persists or comes back before the next dose is due.
- Do not give both simultaneously.
You can buy paracetamol and ibuprofen in liquid form, or melt-in-the-mouth tablets, for children. The dose for each age is given with the medicine packet.
Remember: paracetamol and ibuprofen do not treat the cause of the fever - they merely help to ease discomfort. They also ease headaches and aches and pains. You do not need to use these medicines if your child is comfortable and not distressed by the fever, aches or pains.
- Children known to react (have hypersensitivity) to ibuprofen.
- Children in whom attacks of asthma have been triggered by ibuprofen or similar medicines.
Further reading and references
Feverish illness in children - Assessment and initial management in children younger than 5 years; NICE Guideline (Updated August 2017)
Feverish child - risk assessment; NICE CKS, September 2013 (UK access only)
Thompson M, Van den Bruel A, Verbakel J, et al; Systematic review and validation of prediction rules for identifying children Health Technol Assess. 2012 Mar16(15):1-100.
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