Fever in children: when to lower temperature and when to see a doctor
Fever in children can be alarming for parents. When is it still safe to let the body fight on its own, when should you start lowering the temperature, which home methods are effective, and when is it time to contact a doctor? This practical guide explains everything you need to know about fever in children – from proper temperature measurement to the use of paracetamol and ibuprofen.
Every parent knows it: your child is cheerful, everything is fine, and then suddenly they sit down, they’re tired, they start shaking, their eyes look glassy, their cheeks turn red — and even without a thermometer it’s usually clear that you’re dealing with a fever.
Fever in children: stay calm and understand what’s happening
The important thing is to stay calm and not panic. Fever itself is not an illness, but a sign that the body is fighting disease, infection, or inflammation. Most often it signals that bacteria or viruses have entered the body, and the body responds by raising the temperature — this slows their multiplication and activates the immune system. Because some “bugs” multiply very quickly, the body can raise the temperature just as quickly, and within a few hours a healthy child can become a miserable little patient with fevers reaching 40 °C. But there’s a solution to everything.
When to lower a child’s fever: general principles
General principles for fever include the following:
We lower the temperature only when it reaches 38 °C–38.5 °C. Opinions differ on which threshold is correct. That’s why it’s recommended to be guided primarily by your child’s overall condition and common sense. Up to this threshold we do not lower the fever, so we give the body enough space to fight the illness.
We never reduce the temperature abruptly. We want to bring it down, but we must do it gradually, otherwise febrile seizures may occur.
Febrile seizures: what they look like and what to do
Febrile seizures can also occur when the temperature shoots up rapidly. They are most common in children from six months to five years of age, at the moment when the temperature is so high that it irritates brain tissue. The brain then begins sending uncoordinated impulses to nerves and muscles. Symptoms include trembling, uncontrollable jerking of the whole body and impaired consciousness; the child may also arch their back and roll their eyes upward. If you have no previous experience with febrile seizures, place the child on the floor so they don’t injure themselves, do not physically restrain the convulsions, and always call emergency medical services.
We never use wraps/tepid sponging when the skin is mottled and the limbs are cold.
When to see a doctor: warning signs
There are also situations when an immediate visit to a doctor is necessary, for example an emergency pediatric clinic. Especially if:
The child has a rash in addition to fever, is apathetic, very sleepy, limp, behaves unusually for them, or is pale.
The child cannot bend their head forward and has a stiff neck.
It is a baby under one month of age (a doctor’s check is always needed), or a baby under three months with a temperature over 39 °C.
In children under two years of age with fever of unclear cause (without cough, runny nose and other symptoms) lasting more than 24 hours.
In older children, if the fever lasts longer than three days and we still don’t know the cause, it’s a good idea to visit a pediatrician.
How to lower fever at home: shower, bath, wrap
If you already know you want to reduce the fever at home, let’s do it.
Options for reducing fever are as follows:
A lukewarm shower around 25 °C for one to two minutes. Dry the child thoroughly afterwards and keep them warm; after fifteen minutes check how much the temperature has dropped.
If your child doesn’t tolerate such a cold shower, you can choose a ten-minute bath in water around 35 °C. This is more pleasant and can still cool the body. Again, dry, settle them, and after a while check the temperature.
A wrap — spread a blanket on the bed and put a towel on top to prevent soaking; the child lies on this layer. Place a towel soaked in cool water (about 18 °C) on the chest and belly and let the child rest like this for about 10 minutes. Then dry again, keep warm, and after fifteen minutes check the temperature drop.
“Vinegar socks” — some consider it nonsense, others swear by it. If you want to try this method, add six tablespoons of vinegar to half a liter of water, soak socks in the mixture and wring them slightly. Put them on the child’s feet, add another pair of dry socks over them, and put the child to bed for twenty minutes, for example with a favorite cartoon.
“Body-to-body” treatment — very popular especially with small children. It works on the principle of heat transfer: mom gets into bed with the child and they cuddle skin-to-skin. Besides lowering the temperature, this method also has a positive effect on the emotional well-being of both. You can also try this method when carrying a little patient in a baby carrier.
Clothing and fluids during fever
In the room where the child is staying, it’s necessary to keep a comfortable temperature and dress the child appropriately — not overdress them unnecessarily. A child with fever will feel better in looser clothing made of pleasant materials. If they sweat, change them into dry pajamas and give them something to drink to replenish fluids.
Paracetamol and ibuprofen: lowering fever with medicine
Options for lowering fever with medicines are as follows:
Medicines containing paracetamol (acetaminophen) — effective dose for children from three months is 10–15 mg/kg per dose. With suppositories, follow the dosing on the package; with syrups the package dosing may not always be precise, so it’s better to calculate the amount according to the child’s weight.
Medicines containing ibuprofen — 7–10 mg/kg per dose. Again, it’s better to calculate the dose, because some syrups are labeled with the lower end and for many children the higher end works better. These medicines also have an anti-inflammatory effect, so if we suspect inflammation in the body and we have a choice, we prefer medicines containing ibuprofen.
General rules for giving medicines
General rules for giving medicines:
If you give any medicine containing one active ingredient, you can give another medicine from the same group, i.e., with the same active ingredient, after 6 hours.
When we see that the fever climbs again after 3–4 hours, we try to keep at least a 4-hour interval and then give a medicine from the other group of active ingredients.
If the child is vomiting or feels sick to their stomach, give suppositories. Once they vomit up the syrup, it’s hard to estimate how much has already been absorbed and how much hasn’t.
If you’re not sure about dosing, you can call a hospital pediatric ward for advice. They won’t bite your head off — they have huge experience.
It’s good to have syrups with both active ingredients at home. When fever comes in the evening or at night, it’s useful.
Example syrup dose calculation (15 kg)
Example calculation of a syrup dose for a child weighing 15 kg.
Paracetamol syrup: 24 mg active ingredient in 1 ml of syrup Effective dose: 15 mg/kg per dose. Lower limit: 15 (kg) * 10 (mg) / 24 (mg active ingredient)= 6.3 ml of syrup Upper limit: 15 (kg) * 15 (mg) / 24 (mg active ingredient)= 9.4 ml of syrup
Ibuprofen syrup: 20 mg active ingredient in 1 ml of syrup Effective dose 7–10 mg/kg per dose. Lower limit: 15 (kg) * 7 (mg) / 20 (mg active ingredient)= 5.3 ml of syrup Upper limit: 15 (kg) * 10 (mg) / 20 (mg active ingredient)= 7.5 ml of syrup
How to measure temperature in children
In this article we’ll also say something about measuring temperature. Because this article is often found by moms in the highest distress, we deliberately prioritize the topic of lowering temperature and only now move on to measuring.
We can use several types of thermometers; among the most common are digital and non-contact thermometers.
With a digital thermometer we can measure temperature in the armpit, mainly in older children who can hold it and stay still for a moment.
In smaller children we choose rectal measurement, where we subtract 0.5 °C from the reading. If a child has 39.5 °C rectally, their real temperature is 39 °C.
With non-contact thermometers it’s more complicated. For accurate measurement, a high-quality non-contact thermometer and sufficient acclimatization of both the child and the thermometer in the room are recommended. If the child runs from the living room to the bedroom and we grab the thermometer in the kitchen on the way, we almost certainly won’t measure correctly. But if the children sleep at night in the room where the thermometer also is, and we measure them quietly, we can be almost sure we’ll get the right value. Still, it’s recommended to take three measurements at different spots on the forehead and follow the highest one. If the number is very high, wake the children to be safe and recheck with a digital thermometer.
For fans of smart solutions there are small temperature sensors that are stuck onto the sick child’s body with a patch; they then send temperature data to an app at regular intervals. Once it rises above a set threshold, the app sends a notification to the parent’s phone.
If we already know we have a little patient at home, there are also forehead patches that change color depending on the child’s temperature. This is an approximate measurement, but if we don’t want to keep taking out the thermometer, it can serve us well.
Fluids during fever
It’s always necessary to ensure the child has enough fluids. If the child doesn’t want to eat, we don’t have to force them, but they must drink at least in small sips. You can offer cooled black tea, water, fruit tea. Juices and milk can trigger vomiting in combination with fever, so at high temperatures it’s better not to give them.
We believe this article was helpful and that you now know how to deal with fevers. Still, we wish you’ll need this advice as little as possible, because a healthy child is the most important thing any mom could wish for.
And because you’re reading this article on the Jožánek website, a Czech brand not only of children’s clothing, you might find it useful to take a look at our clothing selection. For rainy autumn weather, softshell clothing will definitely come in handy — it will keep your children warm and dry even in damp, chilly conditions.
