High Fever in Children: Seek Medical Attention or Stay at Home?

A fever is defined as a body temperature of 38°C or higher. By itself, it is usually not a cause for concern as it is the body's natural response against an infection.

Children with high fever tend to be less energetic and more irritable. They may sleep more than usual to recover from the underlying illness. It is also normal for them to have a reduced appetite for solid food and to drink less. They may also experience shivers as their body temperature rises.

It is important to note that a higher grade fever also does not mean that your child has a more severe illness. Similarly, a low-grade fever does not necessarily mean that the illness is minor. Hence, it is more important to monitor if the child is experiencing other symptoms that may indicate an underlying infection or other serious conditions that require prompt medical attention.

Some of the warning signs that your child may need emergency medical attention include:

• Fever that reaches a temperature of 41.0°C (or 38.0°C for children less than 3 months old)

   

• Having difficulty breathing

   

• Having severe headache and/or neck stiffness or pain

   

• Having less than usual fluid intake and/or urine output

   

• Experiencing greater difficulty in awakening from sleep

   

• Interacting with you lesser than usual

   

• Feeling confused and disoriented

   

• Feeding poorly and vomiting

   

• Seizures or fit

   

• Developing new symptoms like abdominal pain or rash / purple spots

If your child's fever is accompanied by any of the warning signs listed above, it may indicate a serious condition and you should seek emergency medical attention at a hospital's A&E department. 

If your child's condition is stable and they are not experiencing any of the warning signs, you can try to reduce the fever with over-the-counter medications and keep them hydrated, and see a doctor during clinic hours if the fever persists for more than 72 hours (or 24 hours for children less than 2 years old).

When in doubt, parents or caregivers should contact the child's healthcare provider to get further advice on the available treatment options.

If your child's condition is stable and they are not experiencing any of the warning signs mentioned above, you can try to reduce the fever with over-the-counter medications such as paracetamol or ibuprofen. These medications can typically help to lower your child's body temperature by 1 - 2°C and relieve any discomfort they may be experiencing.

Do note that you will also need to know exactly how much medication to give your baby/child, which may be based on his/her weight and not age. To be safe, parents should consult a doctor or pharmacist to check the correct dosage, especially if the child’s weight has significantly changed since the last visit to the doctor.

For the first line of treatment, paracetamol can be used every 4 hours (if the temperature is above 38.5°C) to 6 hours (if the temperature is below 38.5°C). Do not use paracetamol in infants less than 3 months old.

Ibuprofen can be given every 6 hours if the temperature is persistently above 38.5°C, 1 to 2 hours after giving paracetamol.  Do not use ibuprofen in infants less than 6 months old. For infants between 6 months and less than 1 year old, ibuprofen can be given every 8 hours.

It is also important to keep your child hydrated by offering plenty of fluids, such as water, ice pops, or clear fruit juices. You should also dress your child in light clothing to allow heat exchange and keep the room cool and well ventilated. 

Check the temperature of your child every 4 hours in the day to monitor the condition.

It is not advisable to use ice/cold water to bring a high fever down as it may cause chills or shivering, further raising the baby’s temperature. Instead, use tap or lukewarm water and apply a cool compress to the forehead, nape of neck, armpits, neck and groin area, for no more than 30 minutes at one time. If your child starts to shiver, stop the sponging.

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