Fever is the reason children are brought to casualty and OPD more often than anything else, and in most of those visits the body temperature is doing its job against an ordinary infection. The number on the thermometer is not what tells you how sick the child is. How the child looks, drinks, breathes and responds is — with one clear exception.

The exception: under three months old

A baby under three months with a temperature of 38°C or above is seen the same day, every time, whether the baby seems fine or not. A young infant can be seriously infected while looking remarkably well, and the examination and blood and urine tests that rule it out are not available at home. Do not wait for the fever to break, do not wait until morning, and do not use a previous illness as the reason to wait.

What to watch instead of the thermometer

Fluids and wet nappies. Drinking normally and passing urine at the usual frequency is one of the more reassuring signs there is. No wet nappy for eight hours, or a dry older child, is dehydration and needs assessment.
Breathing. Fast breathing, the chest or the skin under the ribcage pulling in, flaring nostrils, grunting, or any blue or grey tinge around the lips — those are not “wait and see” signs at any age.
Responsiveness. A feverish child who is miserable but consoleable, who makes eye contact and settles on you, is behaving differently from one who is floppy, hard to wake, will not look at you, or is inconsolable with a high-pitched or unusual cry.
The glass test. A rash with fever that does not fade when a glass is pressed firmly against it needs urgent assessment, whatever the child otherwise looks like.
Stiff neck, light hurting the eyes, a fit. Any of these with fever: come in.
Pain with a place. Fever with an ear that hurts only at night is one thing; fever with a painful, swollen, unusable limb or joint, or pain passing urine, is another and needs to be examined.

Making the child comfortable at home

Treat the child, not the number. A feverish child who is playing and drinking does not need to be kept fever-free; one in discomfort does.
A fever medicine dosed for this child’s weight, on the schedule your paediatrician or the packet label for that preparation gives. Weight, not age, is what a dose is worked from — and if you have been given a dose before, bring the bottle so the strength on it is read rather than remembered.
Never give aspirin to a child or teenager with a fever. This is settled and not a matter of degree.
Light clothing, room temperature, and extra fluids offered often rather than in one large drink.
Do not sponge a shivering child with cold water, and do not bundle them in blankets to “sweat it out”. Both fight the body rather than help it.
Antibiotics are not a fever medicine. A viral illness will not respond to one, and a course started from a previous illness’ leftover strips is how a real infection gets partially treated and harder to read.

Coming in tonight

Fever with any of the breathing, responsiveness or rash signs above; a fit; fever in a child under one year who has not been immunised on schedule; fever returning after it had settled for a day or two; fever for more than about three days without a clear source; fever with a stiff or painful joint, or with passing no urine; any fever in a child on chemotherapy, with a heart condition, or with a condition that affects their immunity: casualty, now, rather than the next OPD slot. If you are the parent of a small feverish child and your instinct is that this is different from previous illnesses, bring that instinct to be examined. It has been right before.

A febrile fit — a convulsion in a febrile child, usually brief, usually in the first year or two of fever — is frightening out of proportion to what it usually means. Lay the child on their side on a soft surface, do not put anything in the mouth, do not restrain the limbs, note the time, and get the child seen afterwards even if they recover within a minute.

Published by R.R. Healthcare as general patient information. It is not advice about your own condition, and it cannot replace being examined — see the medical disclaimer. To be seen: book a consultation or contact the hospital.