When Your Child Has a Fever: A Guide That Keeps You Calm at 3am

Feeling a burning forehead in the middle of the night is a rite of passage for every parent. Start with this: fever isn't the enemy — it's a sign the immune system is working. What needs managing is your child's discomfort and the underlying cause.

First: what counts as fever

A rectal or ear temperature of 38°C or above (armpit runs slightly lower). Measurement method affects the reading more than you'd think — a few tenths of a degree between sites is normal, so don't agonise over decimals.

The most important principle: treat the child, not the thermometer

A child at 38.9°C who is bouncing around matters less than one at 38.2°C who is limp and won't engage. What guides you is alertness, feeding and hydration — not the number.

Fever medicine exists to make your child comfortable enough to drink and rest — not to push a number down. A child who is bright, drinking and playing may not need medication at all, even at 38.5°C.

Four hard rules on medication

Dose by weight, not age. This is the most common error and the most important rule — same-age children can differ twofold in weight
Single-ingredient antipyretics only: paracetamol, or ibuprofen (over 6 months). Don't give young children multi-symptom cold medicines — multiple regulators advise against them under 4, and they easily double-dose with your fever medicine
Don't alternate two antipyretics on your own. Unless a doctor specifically directs it, alternating raises the risk of dosing confusion and overdose
Write down every dose and time. Duplicate dosing happens most when caregivers swap overnight — keep a note on the fridge

What doesn't work (or harms)

❌ Bundling to sweat it out: blocks heat loss and can cause dangerous overheating in infants
❌ Alcohol rubs: absorbed through skin, potentially toxic
❌ Ice baths or ice packs: trigger shivering that raises core temperature
❌ Potato slices and cooling patches: brief skin cooling only, no effect on the set point

What does help: fewer layers, a well-ventilated room that isn't stuffy, lukewarm sponging (if your child finds it soothing), and plenty of fluids.

Seek care immediately if

Any fever in a baby under 3 months — no exceptions, go now
Lethargy, difficulty waking, a glazed stare
Fast or laboured breathing, flaring nostrils, chest retractions
A rash that doesn't blanch (still visible when pressed with a glass)
Seizure, neck stiffness, bulging fontanelle
Persistent refusal of fluids, much less urine, crying without tears
Fever beyond 3 days, or a child who seems worse after the fever comes down

About febrile seizures

Around 2–5% of young children have one. During it: lay them on their side, clear hard objects away, never put anything in their mouth, and time it. Most stop within 5 minutes — beyond that, or for a first episode, call emergency services.

Most febrile seizures don't damage the brain and aren't epilepsy, but every first episode needs medical assessment.

Compiled from mainstream paediatric fever guidance to help you understand the principles. Follow package instructions and your doctor for specific dosing.