Treating fevers in children
Fevers are very common in young children with around 20 to 40% of parents reporting a child with a raised temperature each year in the UK. Fever is probably the most common reason for a child to be taken to the doctor.
Self-care at home
The three goals of home care for a child with a fever are to reduce the temperature,prevent dehydration, and assess/monitor for serious or life-threatening illness.
One goal is to make the child comfortable by monitoring and reducing the fever to under 38C (100.4°F). This is done using an appropriate thermometer and medicationand dressing the child appropriately.
To check your child's temperature, you will need a thermometer. Digital thermometers are inexpensive and obtain a reading in seconds. In children aged 4 weeks to 5 years use an electronic thermometer in the armpit (axilla) or an infra-red eardrum (tympanic) thermometer. Under 4 weeks old only use an electronic thermometer in the armpit. Whatever device you use, follow the instructions carefully and take a few readings to make sure each time.
You can give children’s paracetamol or ibuprofen to ease discomfort. Most recent advice is not to give them both at the same time but if one doesn't work you could try the other later. Paracetamol is licensed in the UK for use in children over the age of two months, and ibuprofen for use in children over three months of age. In younger children advice on fever management should be sought if there is any doubt.
Always follow the dosage and frequency printed on the packaging or information leaflet.
Do not use aspirin to treat fever in children under 16 years old. It has been linked to Reye's syndrome, which causes liver failure.
Children should not be overdressed indoors, even in the winter.
Overdressing prevents the body from cooling using evaporation, radiation, conduction, or convection.
Most practical is to dress the child in a single layer of clothing and cover the child with a sheet or light blanket. Duvets can be inadvisable as they are much more difficult to kick off in the night if the temperature rises.
A sponge bath in warm water has been advised in the past to help reduce fever. However, it is no longer recommended by experts.
Another goal is to keep the child from becoming dehydrated. Humans lose extra water from the skin and lungs during a fever.
Encourage the child to drink clear fluids such as juice or non-carbonated drinks without caffeine. Not just water because water does not contain the necessaryelectrolytes and glucose. Other clear fluids include chicken soup and there are re-hydrating drinks available at your supermarket or pharmacy. However, remember that your pharmacist is equipped to give you advice as well as supply the appropriate rehydration compounds.
Tea or other caffeine-containing products should be avoided. They can act asdiuretics and may increase urination and fluid loss. This is not the effect you want.
Your child should urinate light-coloured urine at least every 4 hours if well hydrated.
If a child is still breastfeeding then this should be encouraged to continue as normal.
Another goal is to be able to assess and monitor the child for signs of serious or life-threatening illness.
Your clinician, this website, your local pharmacy and other NHS resources can give you some pointers on observing and monitoring your child.
Look for signs of dehydration:
Absence of tears - dry eyes
In younger children - sunken fontanelles (the two soft spots on your child’s scalp - ask your doctor, health visitor or pharmacist to show you where these are
Sunken eyes - can be a later sign of more severe dehydration
Look for a rash - a non-blanching rash. You can use the 'tumbler test'. Press a clear drinks glass against the rash. If the rash doesn’t fade under pressure this could be a more serious rash needing urgent medical attention.
Observation at regular intervals through the night is an essential part of parenthood when your child has a fever.
Guidance from the National Institute of Health and Care Excellence on managing fevers in children under five suggests you should seek advice from a doctor if:
Your child has a fit
There is a non-blanching rash - see above
Your child has a raised heart rate
The situation is getting worse
Since last receiving advice you are more worried
There is a fever that last for more than five days
You are not sure what is happening and your concern and distress is affecting your ability to care for your child