Fever in Children: A Parent's Complete Guide

Evidence-based medical guidance for managing childhood fever safely at home

Published onMay 26, 2025
GoodUpdated 58 days ago
6 min read

Fever in Children: A Parent's Complete Guide to Recognition, Management and When to Seek Help

Fever in children (38°C+ rectally, 37.5°C+ orally) is usually caused by viral infections and resolves naturally. Most fevers can be managed at home with paracetamol, fluids, and rest. Seek immediate medical attention if your child is under 3 months with any fever, shows signs of dehydration, has difficulty breathing, or appears unusually unwell. Emergency care is needed for temperatures above 40°C, seizures, or severe symptoms. - Drterry

Quick Medical Answer

Fever in children (38°C+ rectally, 37.5°C+ orally) is usually caused by viral infections and resolves naturally. Most fevers can be managed at home with paracetamol, fluids, and rest. Seek immediate medical attention if your child is under 3 months with any fever, shows signs of dehydration, has difficulty breathing, or appears unusually unwell. Emergency care is needed for temperatures above 40°C, seizures, or severe symptoms.

Source: Drterry

In This Article

Understanding Childhood Fever: What Every Parent Should Know

Fever is one of the most common reasons parents seek medical advice, but understanding when to worry can help you respond appropriately.

Fever in children is one of the most frequent concerns that brings parents to medical consultations. While fever can be alarming, it's important to understand that fever itself is not an illness—it's actually a natural immune response that helps the body fight infection.

According to the Royal Australian College of General Practitioners (RACGP), fever is defined as a body temperature of 38°C (100.4°F) or higher when measured rectally, or 37.5°C (99.5°F) when measured orally or under the arm. Most childhood fevers are caused by viral infections and will resolve on their own with appropriate supportive care.

This comprehensive guide provides evidence-based information to help parents understand when fever requires medical attention and how to safely manage it at home, based on current RACGP and Royal Children's Hospital Melbourne guidelines.

What is Fever and Why Does it Occur?

Normal Body Temperature Ranges

Understanding normal temperature variations is crucial for parents:

  • Normal range: 36.5°C to 37.5°C (97.7°F to 99.5°F)
  • Low-grade fever: 37.5°C to 38.5°C (99.5°F to 101.3°F)
  • Moderate fever: 38.5°C to 39.5°C (101.3°F to 103.1°F)
  • High fever: Above 39.5°C (103.1°F)

The Body's Natural Defense Mechanism

Fever occurs when the body's immune system responds to infection or inflammation. The hypothalamus, acting as the body's thermostat, raises the body temperature to create an environment less favorable for bacteria and viruses while enhancing immune function.

According to Royal Children's Hospital Melbourne, fever itself rarely causes harm and can actually be beneficial in fighting infection. The focus should be on the child's overall wellbeing rather than the specific temperature reading.

Common Causes of Fever in Children

Viral Infections (Most Common)

  • Common cold and upper respiratory tract infections
  • Gastroenteritis (stomach flu)
  • Hand, foot and mouth disease
  • Roseola
  • Influenza

Bacterial Infections

  • Ear infections (otitis media)
  • Urinary tract infections
  • Pneumonia
  • Strep throat
  • Skin and soft tissue infections

Other Causes

  • Immunizations (normal response)
  • Teething (mild temperature elevation)
  • Overdressing in hot weather
  • Dehydration
  • Certain medications

Important Note: The RACGP guidelines emphasize that the pattern and associated symptoms are more important than the absolute temperature reading in determining the severity of illness.

When to Seek Medical Attention: Red Flag Symptoms

Immediate Emergency Care Required

Call 000 (emergency services) or go to the nearest emergency department if your child has:

  • Any fever in babies under 3 months old
  • Temperature above 40°C (104°F)
  • Febrile seizures (convulsions)
  • Difficulty breathing or rapid breathing
  • Severe dehydration (no wet nappies for 6+ hours, sunken eyes, no tears when crying)
  • Unusual drowsiness or difficulty waking
  • Severe headache with neck stiffness
  • Purple or red rash that doesn't fade when pressed
  • Persistent vomiting
  • Signs of severe illness (pale, mottled, or blue skin)

See Your GP Within 24 Hours

  • Fever in babies 3-6 months old
  • Fever lasting more than 3 days
  • Child appears unwell even when temperature comes down
  • Signs of ear infection (ear pain, pulling at ears)
  • Painful urination or strong-smelling urine
  • Persistent cough with fever
  • You're concerned about your child's condition

Source: Royal Children's Hospital Melbourne Clinical Practice Guidelines, 2024

Safe Home Management of Childhood Fever

Medication Management

Paracetamol (First Choice)

  • Dosage: 15mg per kg of body weight, every 4-6 hours
  • Maximum: 4 doses in 24 hours
  • Age guidelines: Safe from 1 month old (with medical advice for under 3 months)
  • Forms: Liquid, tablets, suppositories available

Ibuprofen (Alternative)

  • Dosage: 10mg per kg of body weight, every 6-8 hours
  • Age restriction: Only for children over 3 months old
  • Caution: Avoid if child has asthma, kidney problems, or is dehydrated

Non-Medication Comfort Measures

  • Fluids: Encourage frequent small sips of water, breast milk, or formula
  • Rest: Allow plenty of sleep and quiet activities
  • Clothing: Dress in light, breathable clothing
  • Environment: Keep room comfortably cool
  • Tepid sponging: Only if child is distressed (avoid cold water)

What NOT to Do

  • Don't use aspirin in children under 16 years
  • Don't alternate paracetamol and ibuprofen unless advised by a doctor
  • Don't use ice baths or alcohol rubs
  • Don't force food if child has no appetite
  • Don't overdress or underdress the child

Guidelines based on RACGP Red Book and Royal Children's Hospital protocols

How to Monitor Your Child's Fever Effectively

Temperature Measurement Methods

Most Accurate Methods by Age

  • Under 2 years: Rectal thermometer (most accurate)
  • 2-5 years: Oral or axillary (underarm) thermometer
  • Over 5 years: Oral thermometer

Digital Thermometer Guidelines

  • Wait 15 minutes after eating/drinking before oral measurement
  • For axillary measurement, hold arm firmly against body for 3-5 minutes
  • Clean thermometer before and after each use
  • Record temperature, time, and any symptoms

Fever Monitoring Chart

Keep a simple record including:

  • Date and time of temperature reading
  • Temperature measurement and method used
  • Medications given (type, dose, time)
  • Fluid intake
  • General behavior and symptoms
  • Sleep patterns

When Temperature Readings May Be Inaccurate

  • Immediately after bathing
  • After vigorous activity or crying
  • If child is bundled in heavy clothing
  • In very hot or cold environments
  • With ear thermometers if ear wax is present

Special Considerations for Different Age Groups

Newborns and Infants (0-3 months)

This age group requires special attention as their immune systems are still developing:

  • Any fever requires immediate medical assessment
  • Risk of serious bacterial infection is higher
  • May not show obvious signs of illness
  • Rectal temperature measurement is most accurate
  • Paracetamol can be used but only under medical supervision

Infants (3-12 months)

  • Fever tolerance is better than newborns
  • Watch for signs of dehydration more carefully
  • Teething may cause mild temperature elevation (usually under 38.5°C)
  • Both paracetamol and ibuprofen can be used (ibuprofen after 3 months)

Toddlers and Preschoolers (1-5 years)

  • May have higher fevers with viral infections
  • Risk of febrile seizures is highest in this age group
  • Can usually tolerate oral medications
  • May be more resistant to taking fluids

School-age Children (5+ years)

  • Can communicate symptoms more clearly
  • Generally handle fever well
  • May return to school 24 hours after fever breaks
  • Can participate in monitoring their own symptoms

Age-specific guidelines adapted from Royal Children's Hospital Melbourne Fever Management Protocol

Understanding and Managing Febrile Seizures

What are Febrile Seizures?

Febrile seizures are convulsions that occur in children aged 6 months to 6 years during fever episodes. They affect approximately 3-4% of children and are usually harmless, though frightening for parents.

Types of Febrile Seizures

Simple Febrile Seizures (95% of cases)

  • Last less than 15 minutes (usually 1-2 minutes)
  • Generalized (whole body) seizure
  • Do not recur within 24 hours
  • Child recovers completely

Complex Febrile Seizures (5% of cases)

  • Last longer than 15 minutes
  • Focal (partial) seizure
  • Recur within 24 hours
  • May require further investigation

What to Do During a Febrile Seizure

  1. Stay calm and time the seizure
  2. Place child on their side on a soft surface
  3. Clear the area of hard objects
  4. Do not put anything in the child's mouth
  5. Do not try to restrain the child
  6. Call 000 if seizure lasts more than 5 minutes
  7. Seek medical attention after any first febrile seizure

Prevention and Management

  • Controlling fever may reduce risk but doesn't prevent all seizures
  • Most children who have one febrile seizure never have another
  • Risk of epilepsy is only slightly increased (2-3% vs 1% in general population)
  • Family history increases risk

Information based on RACGP guidelines and Royal Children's Hospital Neurology Department protocols

Prevention and Building Immunity

Vaccination: The Best Prevention

Following the Australian National Immunisation Program schedule is the most effective way to prevent serious infections that cause fever:

  • Routine childhood vaccinations prevent many serious bacterial and viral infections
  • Influenza vaccination annually for children over 6 months
  • COVID-19 vaccination as per current guidelines
  • Discuss any concerns about vaccines with your healthcare provider

General Health Measures

Hygiene Practices

  • Regular handwashing with soap and water
  • Teaching children to cover coughs and sneezes
  • Avoiding close contact with sick individuals when possible
  • Cleaning and disinfecting frequently touched surfaces

Lifestyle Factors

  • Adequate sleep for age (10-14 hours for toddlers, 9-11 hours for school-age)
  • Balanced nutrition with plenty of fruits and vegetables
  • Regular physical activity
  • Stress management and emotional wellbeing
  • Avoiding exposure to cigarette smoke

When to Keep Children Home

  • Any fever present
  • 24 hours after fever breaks
  • If child appears unwell or unable to participate in activities
  • Vomiting or diarrhea
  • Contagious conditions (as advised by healthcare provider)

Key Takeaways for Parents

Remember the Essentials

  • Fever is usually helpful: It's the body's natural response to infection
  • Focus on the child, not the thermometer: How your child looks and acts is more important than the exact temperature
  • Most fevers resolve on their own: With appropriate supportive care at home
  • Trust your instincts: If you're concerned, seek medical advice
  • Know the warning signs: When to seek immediate medical attention

When in Doubt, Seek Professional Advice

Healthcare professionals are available to help guide you through managing your child's fever. Don't hesitate to contact your GP, call Healthdirect (1800 022 222), or visit your local emergency department if you're concerned about your child's condition.

For non-urgent questions about fever management, consider booking a telemedicine consultation for convenient, professional medical advice from the comfort of your home.

Professional Medical Support

Dr Terry Nguyen provides comprehensive pediatric consultations including fever management guidance, both in-person and via telemedicine. With expertise in emergency medicine and family practice, Dr Nguyen can help parents navigate childhood illnesses with confidence.

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Frequently Asked Questions About Childhood Fever

Common concerns answered by medical professionals

At what temperature should I be concerned about my child's fever?

Any fever in babies under 3 months requires immediate medical attention. For older children, focus on how unwell they appear rather than the exact temperature. Seek medical care for temperatures above 40°C (104°F) or if your child appears very unwell.

Should I wake my child to give fever medication?

Generally, no. Sleep is important for recovery. Only wake a sleeping child for medication if they appear very unwell or if specifically advised by a healthcare professional. A sleeping child with fever is usually not in immediate danger.

Can teething cause fever in babies?

Teething may cause a slight temperature elevation (usually under 38.5°C), but high fevers are not typically caused by teething alone. If your teething baby has a significant fever, consider other causes and consult your healthcare provider.

How long should I wait before seeing a doctor for my child's fever?

For babies under 3 months, see a doctor immediately. For older children, see a GP if fever lasts more than 3 days, if your child appears unwell even when the fever comes down, or if you have any concerns about their condition.

Is it safe to give both paracetamol and ibuprofen together?

Only give both medications if specifically advised by a healthcare professional. Generally, start with one medication (paracetamol is usually first choice) and use the other only if the first is not effective or if advised by your doctor.

When can my child return to school or daycare after having a fever?

Children should stay home while they have a fever and for 24 hours after the fever breaks. They should also be well enough to participate in normal activities before returning to school or daycare.