Is a very high fever dangerous by itself?

The number matters much less than how the child looks. Fever from an infection does not reach the temperatures that damage the brain, because the body limits it. A child at 39.5 degrees who is drinking, alert and playing is in a better position than a child at 38.2 who is floppy, breathing fast or will not wake. Treat the child, not the thermometer, and use the danger-sign list rather than the reading to decide about hospital.

Should I sponge my child with cold water?

No. Cold water and ice make the skin blood vessels close and trigger shivering, which drives the core temperature up rather than down, and it is distressing for a sick child. If the child is hot and uncomfortable, take off extra clothes, keep the room comfortable and offer fluids. A lukewarm cloth on the forehead is fine for comfort. Never use alcohol rubs.

Can I give paracetamol and ibuprofen together?

Routinely, no. One medicine given correctly is enough for almost every child, and using two makes it far easier to lose track of timing and give too much. A doctor may occasionally advise alternating them for a child in real distress, but that should be their instruction with clear timings, not a default. Never give ibuprofen to a child who is vomiting, dehydrated or possibly has dengue.

Does teething cause fever?

Teething can make a baby irritable, dribbly and off their food, and may raise the temperature very slightly. It does not cause a fever of 38 degrees or more. If a teething baby has a real fever, look for another cause rather than assuming it is the teeth, and follow the same rules on age and danger signs as for any other fever.

My child has had fever for three days with nothing else. Do they need a blood test?

Possibly. A fever without an obvious source that continues past two to three days should be assessed, and in Pakistan that usually means considering dengue, malaria, typhoid and urine infection depending on the season and where you live. A urine test is worth doing in any small child with unexplained fever. Your doctor decides which tests are needed; a fever of five days or more should always be investigated.

How do I know if my child is dehydrated?

Look for fewer wet nappies or fewer trips to the toilet, a dry mouth and tongue, no tears when crying, sunken eyes, and unusual sleepiness or irritability. In a baby the soft spot on the head may look sunken. No urine for eight to twelve hours in a feverish child means go to hospital. Keep offering small amounts of fluid very often rather than large drinks occasionally.

Fever in Children: What to Do Tonight and When to Go to Hospital

A fever in a child means a temperature of 38.0 degrees Celsius (100.4 Fahrenheit) or above. It is the body's response to an infection, usually a virus, and the fever itself is not the illness and rarely the danger. How the child looks and behaves matters far more than the number on the thermometer. Take a baby under three months with any fever of 38 degrees or above to hospital straight away, even if the baby seems well. Go immediately at any age for a rash that does not fade when pressed with a glass, a fit, a stiff neck, fast or grunting breathing, blue or grey lips, drowsiness you cannot rouse the child from, cold mottled hands and feet with a hot body, or a child who will not drink and has not passed urine for eight to twelve hours. At home, offer fluids constantly, dress the child lightly, and use paracetamol at 10 to 15 milligrams per kilogram of body weight per dose, no more than four doses in twenty-four hours, only if the child is uncomfortable. Do not sponge with cold water, do not give aspirin to anyone under sixteen, and do not buy antibiotics or injections without a doctor. Any fever lasting five days or more needs a cause found.

Aslam Clinic Editorial Team

Health writers · Aslam Clinic

Updated 28 August 202611 min read

Illustration © VOKA (voka.io)

Go to hospital now if any of these are present

Under 3 months old with a temperature of 38 degrees or above. No exceptions and no waiting until morning.

A rash that does not fade when you press a clear glass firmly against it. Press hard enough to see the skin through the glass. If the spots stay visible, call for emergency help.

A fit or convulsion — the body stiffens or jerks and the child is not responding.

Breathing that is fast, noisy or grunting, the skin sucking in between or under the ribs, or the head nodding with each breath.

Lips, tongue, gums or nails that look blue, grey or very pale.

Drowsy, floppy, or hard to wake. A weak, high-pitched or continuous moaning cry. A child who does not recognise you.

A stiff neck, a bulging soft spot on a baby's head, or a baby who screams when the legs are bent up.

Cold, mottled or blue hands and feet while the body is hot.

Not drinking, or no urine passed for 8 to 12 hours, or no tears when crying, or a dry mouth and sunken eyes.

Constant vomiting, green vomit, or severe stomach pain.

You are frightened and something is wrong. A parent's instinct that this illness is different is a recognised warning sign in every paediatric guideline. Act on it.

What counts as a fever

A fever is a body temperature of 38.0 degrees Celsius or higher. Below that is not a fever. A child who feels warm after running about, or after being wrapped in a blanket, may not have one at all.

Fever is part of how the body fights infection. Raising the temperature slows some germs and helps the immune system work. That is why bringing the number down does not treat the illness and does not shorten it. The reason to give medicine is that the child feels wretched, not that the thermometer reads high.

One myth is worth killing here. An ordinary fever from an infection does not damage the brain. Temperatures from infection almost never climb high enough to do that, because the body has its own upper limit. Brain injury from heat happens in heatstroke, which is a different thing: a child left in a closed car or working outdoors in extreme heat, who is hot, dry and not sweating, and who needs emergency cooling.

Age, temperature and what to do. Any red flag from the box above overrides this table at every age.
Age	Temperature	What to do
Under 3 months	38.0 degrees or above	Hospital now, even if the baby looks well. Babies this young hide serious infection.
3 to 6 months	39.0 degrees or above	Seen by a doctor the same day.
Any age	Any fever with any red flag	Emergency. Go to hospital.
Over 6 months	Any fever, child alert and drinking	Home care. Review if not improving in 48 hours, or if the child worsens at any point.
Any age	Fever lasting 5 days or more	See a doctor. A cause needs to be found, not more paracetamol.
Any age, August to November, or after travel to a malaria district	Any fever	See a doctor and ask about for dengue, malaria and typhoid.

How to take the temperature

Use a digital electronic thermometer. They are cheap and accurate.
For a child under five, take it in the armpit. Place the tip in the centre of a dry armpit and hold the arm gently against the body until it beeps.
For an older child, under the tongue is fine, with the mouth closed, and not within fifteen minutes of a hot or cold drink.
Ear thermometers are quick but can read falsely low in a small baby or with wax present.
Forehead strips are not reliable. Do not use one to decide anything important.
Do not use a mercury thermometer. They are being withdrawn worldwide because a broken one releases mercury.
Write down the reading and the time. A doctor will want the pattern, not one number.

What to do at home

Most fevers in children over six months settle at home in two to three days. The job at home is to keep the child comfortable and hydrated, and to keep watching for the danger signs above.

Offer fluids constantly. Small sips, every few minutes, is better than a big glass every hour. Water, milk, lassi, soup, or if the child is also losing fluid. Keep breastfeeding a baby, more often than usual.
Dress the child lightly. One thin layer. Do not wrap or cover a feverish child in blankets, and do not put on extra clothes to make them sweat it out.
Keep the room comfortable, not cold. A fan on low is fine. Do not aim it directly at the child.
Do not force food. Appetite drops with fever and returns afterwards. Fluid matters; food can wait a day or two.
Let the child rest and keep them home from school or madrasa while feverish.
Check on them through the night — feel them, look at their breathing, and see whether they wake normally.

Medicines for fever

Give an because the child is uncomfortable, miserable or cannot sleep. Do not give one simply because a number is high, and do not wake a sleeping child to give it.

Paracetamol: read the strength on the bottle

Dose: 10 to 15 mg per kilogram of the child's weight, per dose. At least four hours between doses. No more than four doses in twenty-four hours, and never more than 60 mg per kilogram in a day.

Two syrup strengths are sold in Pakistan and the bottles look almost the same: 120 mg in 5 ml and 250 mg in 5 ml. Check which one you are holding before every dose. Giving the stronger syrup at the weaker syrup's volume is a common cause of overdose here.

Use the measuring cup or syringe that came with the bottle. A kitchen teaspoon is not a measure.

Weigh the child if you can, rather than dosing by age. Children of the same age vary enormously in weight.

Check every other medicine in the house. Many cold and flu preparations already contain paracetamol, and doubling up is how children are harmed.

If a dose has been missed or repeated by mistake, or too much has been given, go to hospital. Paracetamol overdose causes no symptoms at all for the first day, and treatment works best when it is early.

Ibuprofen is the alternative. The usual dose is 5 to 10 mg per kilogram per dose, every six to eight hours, given with or after food. It should not be used in a baby under three months, in a child who is vomiting, dehydrated, passing little urine, or has stomach pain, or in a child with asthma that worsens with medicines. In the dengue season, from roughly August to November, do not give ibuprofen or any other anti-inflammatory painkiller to a child with fever unless a doctor has excluded dengue. These drugs affect and can worsen bleeding. Paracetamol is the safe choice when dengue is possible.

Do not give both medicines at the same time as a routine. Alternating them is not usually needed and makes overdose more likely by confusing the timing.
Never give aspirin to anyone under sixteen. It is linked to Reye's syndrome, a rare but severe brain and liver illness.
Do not give an adult tablet broken into pieces for a child.
Write down what you gave and at what time. At three in the morning nobody remembers.

What causes fever in children here

Most fevers are caused by a — a cold, flu, a throat infection, a stomach bug, or one of the many childhood viral rashes. These need fluids and time, not . But in Pakistan several important causes are common enough that a fever should not be dismissed as viral without thought.

Dengue, mainly August to November in cities, with high fever, severe body and eye pain, and sometimes a rash. Warning signs come as the fever falls.
Malaria, in endemic districts of Sindh, Balochistan and Khyber Pakhtunkhwa, and after the monsoon. Fever with rigors and shivering.
Typhoid, spread by contaminated water and food, with a fever that climbs over days and does not swing. Drug-resistant typhoid is a serious problem in Pakistan, so treatment must be guided by a doctor and a blood culture.
Pneumonia, suggested by fast breathing, chest indrawing and grunting. This is one of the leading causes of child death here and the breathing rate is the key sign.
Urine infection, which is easy to miss because there may be no other at all in a small child. Any unexplained fever deserves a .
Measles, which still causes outbreaks where coverage is low, with fever, red eyes, cough and a rash spreading from the face downwards.
Ear and throat infections, common and usually mild.
Tuberculosis, where fever has gone on for weeks with weight loss or a long cough.

Keeping the child's up to date under the national EPI schedule prevents several of these outright. Measles vaccine is given at nine and fifteen months, typhoid conjugate vaccine at nine months, and pneumococcal vaccine in the first months of life. Take the vaccination card to every appointment.

Fits caused by fever

About one child in twenty to thirty has a febrile convulsion at some point between six months and five years. The child stiffens, jerks, may go blue around the mouth, and is not responsive. It is terrifying to watch. Most last less than two or three minutes and cause no lasting harm.

Put the child on the floor, on their side, away from furniture and hard objects.
Do not put anything in the mouth. Not a spoon, not a finger, not water. The tongue cannot be swallowed.
Do not hold the child down or try to stop the movements.
Look at a clock and time it.
Once it stops, keep the child on their side until they wake properly.
Call for emergency help if the fit lasts more than five minutes, if another one starts, if the child does not wake up afterwards, if breathing is difficult, or if this is the first fit the child has ever had.

A child who has had a first febrile fit should be seen the same day, to check what is causing the fever. Febrile fits are not epilepsy and the large majority of children who have one never develop it. Giving paracetamol has not been shown to prevent them.

Things that do more harm than good

Cold water, ice or alcohol sponging. Cold on the skin makes the body shiver, which raises the core temperature and distresses the child. Lukewarm water on the forehead is comforting; a cold bath is not treatment.
Wrapping up to sweat the fever out. This traps heat.
Antibiotics bought without a prescription. They do nothing for a , cause diarrhoea and rashes, and are the reason typhoid in Pakistan has become so difficult to treat.
Injections from a medical store. An injection is not stronger than a syrup. It carries a real risk of infection and reaction, and it removes the doctor from the decision.
Steroid or unlabelled syrups given to bring a fever down quickly. They can mask a serious infection while it worsens.
Waiting for morning when a danger sign is present.

When to see a doctor

Go to hospital immediately for any red flag in the box near the top of this page, and for any fever at all in a baby under three months. See a doctor the same day for a baby of three to six months with a temperature of 39 degrees or above, for a first febrile fit, for fast or laboured breathing, or if you are worried and cannot say why. Book an appointment for a fever that is still there after 48 hours without improving, a fever lasting five days or more, a fever with a rash, a fever with vomiting or diarrhoea that is not settling, or a fever in a child who is not fully immunised. If your child also has diarrhoea, our article on diarrhoea in children covers rehydration in detail.

Common questions

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