Fever in Children: What to Know Before Giving a Fever Reducer

When your child develops a fever, the first question that usually comes to mind is “what should I give?” But there are other questions worth answering before a fever reducer is given: where and how was the temperature taken, what does the child look like in general, and how long has the fever been present? This post looks at common mistakes made around fever in children, how to measure temperature correctly, and the situations in which a doctor should see your child.

The first distinction is this: what matters is not the fever itself but how the fever is affecting the child. Fever is part of the body’s response to an infection; a rise in temperature signals that something is going on. The goal is therefore not to force the reading back to normal, but to make your child more comfortable.

What is fever, and why does it rise?

In children, fever means the body temperature has risen above the normal range. Infections are the most common cause: throat, ear, urinary tract, lung or the stomach and bowel. Sometimes the fever is not the illness itself but the body’s reaction to it. The height of the fever does not tell you on its own how serious the illness is; what matters is the child’s alertness, how much they are drinking and eating, their breathing and their overall appearance.

In everyday paediatric practice the usual threshold is a reading of 38 °C or above when taken under the arm. Readings taken in the ear or on the forehead can differ from underarm readings; an underarm reading usually comes out slightly lower. That is why the question “is there a fever?” should always be followed by “where did I measure it?”

Measuring temperature correctly

A thermometer measures the place it is designed to measure. A thermometer intended for the armpit should not be placed in the ear canal, and one intended for the ear should not be used on the forehead. A reading taken from the wrong site either causes unnecessary worry or hides a genuine rise.

The child needs to be settled while you measure; a crying child usually gives a falsely high reading. Glass mercury thermometers are no longer recommended, because they can break and expose the child to mercury; a digital thermometer is the better choice. With a digital thermometer the child stays under the arm until the reading locks on, and with an ear thermometer the correct angle has to be maintained while the child is held still. Writing the number down makes the whole story much easier to describe when you see a doctor.

When should a fever reducer be given?

A fever reducer is used to improve a child’s comfort, not to bring the temperature down. When there is pain, restlessness, poor sleep or general discomfort, medicine may be given in the way your doctor has advised. The choice of preparation, the amount and the interval between doses are all matters for your doctor to decide.

Two points deserve particular emphasis. First, a sleeping child should not be woken. Waking a child whose fever has come down and who looks settled causes distress, and once you have woken them you cannot tell whether they would have needed anything at all. Second, treatment should not simply be continued once the fever has settled, because the decision to give another dose belongs to the doctor who has set the plan.

Four mistakes that come up again and again

• Waking a settled, sleeping child: If the child is asleep and comfortable there is no need to wake them. The question comes up again when they wake crying, restless or unwell.
• Alternating between two different fever reducers: Using paracetamol and ibuprofen preparations in turn can lead to confusion over which medicine was given when, and to too much medicine being given by mistake. Alternating them should not be done without asking your doctor.
• Giving medicine without measuring: Measuring is better than guessing from how the child feels; it protects against both unnecessary medicine and the wrong conclusion. Recording the site you used matters for the same reason.
• Cooling the child down: Cold compresses, cold sponging and alcohol wipes do not bring the fever down and only make the child uncomfortable.

What you can do at home

There is a great deal you can do without medicine, and it is often enough. Offer fluids regularly, offer the foods your child likes rather than pushing new ones, keep clothing light and comfortable, keep the room calm and make sure there is plenty of rest. Keeping the room from becoming too warm, removing clothing when the child sweats and taking off extra bedding all add to everyday comfort.

If your child is vomiting, ask a doctor whether an oral preparation can be given at all. None of these measures replaces a fever reducer; when one is used, it is still a tool aimed at making your child comfortable.

When it is urgent

Some situations are not a matter of watching to see whether the temperature climbs. If any of the following is present, call 112 or go to the nearest emergency department immediately:

• Loss of consciousness, a child who cannot be roused, or who does not respond when woken
• Severe difficulty breathing, pulling in of the chest, or bluish colouring
• A seizure (fit), a stiff neck, or a severe headache
• A red or purple rash that does not fade when pressed

If a baby under three months has a temperature of 38 °C or above, see a doctor or go to an emergency department without delay, even if the baby seems well.

In the following situations, your child should be seen by a doctor the same day:

• Vomiting or diarrhoea that prevents an oral preparation being kept down
• Clearly reduced urine output, dry mouth and lips, or sunken eyes
• A fever lasting longer than three days, or one that returns repeatedly during the day
• Restlessness, drowsiness, fast breathing, or a child who simply cannot express themselves

A fever that appears in a child taking antibiotics, a severe reaction that has not happened before and recurs, or similar symptoms in other family members should all be reported to a doctor.

In brief

• Fever is a defensive response; the aim is comfort, not a reading of zero.
• Measure with the site the thermometer is designed for, and write the number down.
• Do not wake a settled, sleeping child to give a fever reducer.
• Do not alternate between paracetamol and ibuprofen preparations.
• The preparation, the amount and the interval should follow your doctor’s instruction.
• If there is loss of consciousness, severe breathing difficulty, a seizure or bluish colouring, call 112 or go to the nearest emergency department immediately.

This information is written for parents; the choice of fever reducer, the amount and the interval can only be settled by a doctor who has seen your child. If you are unsure about anything, you can book an appointment at our practice in Florya and have the situation assessed face to face.