Fever is the single most common reason children are brought to a doctor, and the anxiety it produces is often out of proportion to the danger. Fever itself does not damage the brain, and the height of the temperature correlates poorly with how serious the illness is.
What matters far more is how your child looks and behaves.
What Fever Actually Is
Fever is the body deliberately raising its temperature as part of the immune response. It slows the replication of many viruses and bacteria and improves immune cell function. It is a useful mechanism, not a malfunction.
A temperature of 38 degrees or above measured rectally, or 37.5 measured in the armpit, counts as fever. Digital thermometers are accurate and safe. Forehead strips are unreliable, and mercury thermometers should no longer be used.
The purpose of treating fever is comfort, not the number. A child with a temperature of 39 who is drinking, alert and playing is less concerning than a child with 38 who is limp and unresponsive.
Age Changes Everything
The threshold for concern depends heavily on age, and this is the most important principle.
- Under 3 months: any fever of 38 degrees or above is a medical emergency requiring immediate assessment. Newborn immune systems are immature and serious infection can present with very few signs
- 3 to 6 months: fever needs same day medical review
- Over 6 months: assessment is guided by how the child looks rather than the temperature alone
Do not give paracetamol to a baby under three months and wait to see if the fever settles. That baby needs to be seen. Our paediatric emergency service assesses young infants promptly for this reason.
The Red Flags
These features indicate a child needs urgent assessment regardless of the temperature reading.
- Difficulty breathing, fast breathing, or the ribs drawing in with each breath
- A rash that does not fade when pressed with a glass
- Unusual drowsiness, difficulty waking, or floppiness
- A weak, high pitched or continuous cry
- Neck stiffness, or a bulging soft spot on a baby's head
- A seizure
- Signs of dehydration: no wet nappy for eight hours, no tears, sunken eyes, dry mouth
- Persistent vomiting, or inability to keep fluids down
- Cold, mottled or blue hands and feet, or very pale skin
- Fever lasting more than five days
- A child who simply looks much more unwell than usual, which parental instinct detects reliably
Parental instinct deserves respect. If you feel something is seriously wrong, act on that even without a specific red flag.
Managing Fever at Home
For a child over six months who is otherwise well, home management is appropriate.
- Offer fluids frequently in small amounts, more important than food
- Dress lightly. Do not bundle a feverish child in blankets
- Paracetamol for discomfort, dosed by weight rather than by age
- Ibuprofen is an alternative, though avoid it in dehydration or suspected dengue
- Do not alternate the two routinely without medical advice, since dosing errors become likely
- Never give aspirin to a child
- Tepid sponging is not recommended and often distresses the child
- Do not use ice water or alcohol rubs
Dose by weight. A large proportion of paracetamol errors come from dosing by age when a child is small or large for their years.
Febrile Seizures Are Frightening and Usually Harmless
Around one in twenty children between six months and five years has a seizure with fever. It is terrifying to witness and is usually benign.
During a seizure: place the child on their side on a safe flat surface, remove anything nearby they could strike, do not put anything in their mouth, do not restrain them, and note the time it starts.
Call for emergency help if the seizure lasts more than five minutes, if a second occurs in the same illness, if the child does not recover normally afterwards, if it affects only one side of the body, or if it is the first seizure the child has had.
Simple febrile seizures do not cause brain damage and do not usually lead to epilepsy. Giving paracetamol does not prevent them.
Why Antibiotics Are Usually Not the Answer
The great majority of childhood fevers are viral, and antibiotics do nothing for viruses. Prescribing them anyway contributes to resistance and causes side effects without benefit.
Features suggesting a bacterial cause include very high fever with a toxic looking child, ear pain with discharge, painful swallowing with pus on the tonsils, a productive cough with fast breathing, or burning on passing urine.
A doctor examining the child and, where needed, testing is what distinguishes these. Pressing for antibiotics for a three day viral fever is understandable and rarely in the child's interest.
Fevers Specific to Our Region
Chennai has seasonal patterns that change what fever might mean, particularly after the monsoon.
- Dengue: high fever with severe body aches, headache behind the eyes and a rash. Warning signs are persistent vomiting, abdominal pain, bleeding gums and lethargy as the fever falls
- Typhoid: fever rising in a stepwise pattern over days with abdominal discomfort
- Malaria: fever with chills and rigors in a cyclical pattern
- Chikungunya: fever with prominent joint pain
- Scrub typhus: fever with a characteristic eschar, a small dark scab
In suspected dengue, avoid ibuprofen and aspirin because of bleeding risk, and use paracetamol only. Any fever lasting beyond three days during dengue season warrants a blood test.
When to Return After Being Seen
Being assessed once does not settle the matter for the whole illness. Return if the child develops any red flag, if fever persists beyond five days, if they become progressively less alert or are drinking less, if a rash appears, or if you remain worried.
Illnesses evolve. A child who looked well on day two can look different on day four, and no consultation predicts that. Coming back is not overreacting.
Treat the child rather than the thermometer. A child who is drinking, alert between fever spikes and interacting with you is usually safe to manage at home. The features that matter are breathing, alertness, hydration, rash and age.
Our paediatrics department at T. Nagar provides outpatient and round the clock emergency assessment for children.
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