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Emergency department advice for the care of children with fever

What is fever?

Normal body temperature is around 37 degrees Celsius. A raised body temperature is often a sign of infection and is common in children when they are unwell.

A fever is a raised temperature of 38 degrees Celsius or higher and is best measured using a digital thermometer if possible.

Your child may feel hot and sweaty and look shivery and flushed. Fever is the body’s normal response to fighting an infection.

Infections caused by viruses are more common than bacterial infections. Viruses often also cause a runny nose, cough or sore throat. Viruses get better on their own and don’t need antibiotics.

The temperature usually returns to normal within 3 to 4 days.

Fever is common after vaccinations in the first 1 to 2 days.

What can I do to help my child?

  • Offer and encourage regular fluids
  • Do not over or under dress your child
  • Give paracetamol (if over 3 months of age) or ibuprofen (if over 6 months of age) if your child is distressed or unwell.

Do not give both paracetamol or ibuprofen at the same time but consider the other medicine if your child does not respond to the first medicine after 30 to 60 minutes.

    • Paracetamol (Calpol) can be given every 4 hours
      • Do not give more than 4 doses in 24 hours
    • Ibuprofen can be given every 6 hours
      • Do not give more than 3 doses in 24 hours
    • Follow the dosing instructions on the bottle of your medicine – the doses change as children get older, so make sure you are giving the right amount.
  • More information on paracetamol and ibuprofen can be found here: Paracetamol and Ibuprofen.
  • Keep your child away from school or nursery while unwell
  • The latest NHS guidance related to COVID-19 for children is at NHS.uk Coronavirus symptoms in children
  • Check on your child regularly

When should I worry?

If your child has any of the following:
  • becomes pale, mottled and feels abnormally cold to touch
  • is going blue around the lips
  • severe breathing difficulty – too breathless to talk, eat or drink
  • has a fit or seizure
  • becomes extremely agitated (crying inconsolably despite distraction), confused or very lethargic (difficult to wake)
  • develops a rash that does not disappear with pressure (see the Glass Test below)
  • is under 3 months of age with a temperature of 38 degrees Celsius (or 100.4 degrees Fahrenheit) or above (unless in the 48 hours after vaccinations and no other red or amber symptoms)
Information:

You need urgent help

⚠️Go to the nearest hospital emergency (A&E) department or phone 999.⚠️

If your child has any of the following:
  • is finding it hard to breathe
  • seems dehydrated (sunken eyes, drowsy or not had a wee or wet nappy for 12 hours)
  • is becoming drowsy (excessively sleepy) or irritable (unable to settle them with toys, TV, food or picking up), especially if they remain drowsy or irritable despite their fever coming down
  • has extreme shivering or complains of muscle pain
  • is 3 to 6 months of age with a temperature of 39 degrees Celsius (or 102.2 degrees Fahrenheit) or above (but fever is common in babies up to 2 days after they receive vaccinations)
  • continues to have a fever of 38.0 degrees Celsius (or 100.4 degrees Fahrenheit) or more for more than 5 days
  • seems to be getting worse or if you are worried
Information:

You need to contact a doctor or nurse today

Please ring your GP surgery or call NHS 111.

If none of the above are present:

Using the advice above you can provide the care your child needs at home.

Medical advice can be sought by calling NHS 111, seeking help from your local pharmacist (if non-urgent) or contacting your GP.

A rash that doesn’t fade when a glass is pressed firmly on the skin is more worrying. Seek medical advice urgently.

Rash shown under a glass

More advice on fever in childhood can be found here:

Fever / High Temperature :: Healthier Together (sybhealthiertogether.nhs.uk)

High temperature (fever) in children – NHS (www.nhs.uk)

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Disclaimer

Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

Resource number: ED31

Resource Type: Article

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