Parents are usually told a number, and the number becomes the thing they watch. But a child of 39°C who is drinking, alert and grumbling about being bored is in a very different position from one at 38.2°C who is floppy, will not drink and is hard to rouse. Fever is a symptom. What matters is what it is telling you.
A fever is generally a temperature of 38°C or above. It is the immune system deliberately raising body temperature to fight infection — not something that needs eliminating for its own sake. Most fevers in children come from ordinary viral infections and settle within three to five days.
The height of the temperature is a poor guide to how serious the illness is, with one important exception: any fever of 38°C or above in a baby under three months, or 39°C or above in a baby aged three to six months, needs urgent medical assessment regardless of how well they seem.
Use a digital thermometer under the arm for children under five. Forehead strip thermometers are unreliable. Ear thermometers can be accurate but need correct positioning.
Paracetamol or ibuprofen are for a child who is distressed or uncomfortable — not for the number alone, and not to prevent febrile convulsions, which they do not do.
Use one or the other first. If the child is still distressed before the next dose is due, you can alternate them, but do not give both at the same time as a routine. Check the dose against your child’s age and weight on the bottle, and never exceed the daily maximum. Ibuprofen should be given with food and avoided if the child is dehydrated, has chickenpox, or has a history of stomach problems or asthma made worse by it.
Do not sponge a child with tepid water or strip them cold — both are unhelpful. Dress them in normal clothing, keep the room comfortable, and offer fluids regularly and in small amounts.
Call 999 for a non-fading rash, difficulty breathing, a fit, or a child who is unresponsive.
Around one in twenty young children has a febrile convulsion at some point. They are frightening and usually harmless. Put the child on their side somewhere safe, do not put anything in their mouth, and time it. Call 999 if it lasts more than five minutes, if it is their first one, or if they do not recover properly afterwards.
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