Fever in children under 5 years

Advice for parents and carers of children younger than 5 years

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If your child has any of the following:

Is under 3 months of age with a temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red or amber features)
Breathing very fast, too breathless to talk, eat or drink
Working hard to breathe, drawing in of the muscles below the ribs, or noisy breathing (grunting)
Breathing that stops or pauses
Is pale, blue, mottled or feels unusually cold to touch
Difficult to wake up, very sleepy or confused
Weak, high-pitched cry or can’t be settled
Has a fit (seizure)
Has a rash that does not disappear with pressure (the ‘Glass Test’)

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 3-6 months old with a temperature 39°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features)
Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)
Temperature less than 36°C in those over 3 months
Breathing a bit faster than normal or working a bit harder to breathe
Dry skin, lips or tongue
Not had a wee or wet nappy in last 8 hours
Poor feeding in babies (less than half of their usual amount)
Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)
Swelling of a limb or joint
Not using or putting weight on an arm, leg, hand or foot
Complaining of severe pain that is not improving with painkillers
Has had chickenpox in the past few days and is now getting worse with a high fever or spreading red rash
Getting worse or you are worried about them

You need to contact a doctor or nurse today

Please ring your GP surgery or call NHS 111 - dial 111

If none of the above features are present

Watch them closely for any change and look out for any red or amber symptoms
If your child has any other symptoms associated with their fever, you may want to look at the information on sore throat, cough, earache, diarrhoea and vomiting or tummy ache or our other pathways
Additional advice is also available to young families for coping with crying of well babies – click here
If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you

Self care

Continue providing your child’s care at home using the advice below. If you are still concerned about your child, speak to your h ealth visitor, local pharmacist or call NHS 111– dial 111. Keep monitoring your child for red and amber features and seek help if they develop

How can I look after my child?

Keep monitoring your child for red and amber features (see above). Seek help if they develop, as this may suggest a more severe illness requiring specific investigations and treatment.
Keep your baby/child as comfortable as possible. Consider giving paracetamol or ibuprofen for comfort. Paracetamol can be given to children aged two months or older for pain or fever (ibuprofen can only be used above three months of age).
Offer them simple food and regular drinks. Where a baby is breastfed, continue breast feeding.
If they are vomiting, offer small frequent drinks as this is more likely to stay down.
Do not try to control your child’s temperature with tepid sponging or fans.
If a rash appears do “the glass test” (see guidance overleaf).
Fever is common in babies up to 48 hours after receiving immunisations - consider giving regular paracetamol. If your child is due their vaccinations, postpone until after their fever has improved.
If you need to keep your child away from nursery or school while they are unwell and have a fever please notify the nursery or school – see www.what0-18.nhs.uk for advice if you are unsure.

About fever in children

Most children with a fever do get better very quickly but some children can get worse. You need to regularly check your child during the day and also through the night and follow the advice given below.

Fever is extremely common in children and usually suggests that your child has an infection.
Your child has a fever if their temperature is over 38°C. The most accurate way of measuring your child’s temperature is with a digital thermometer.
Viral infections are far more common than bacterial infections. Symptoms such as runny nose, cough, wheeze, sore throat, red eyes and diarrhoea are more suggestive of a viral infection than a bacterial infection. If a number of people are unwell in the same household, this also suggests a viral infection (because viral infections are easily spread).
Viral infections tend to get better on their own and do not need treatment with antibiotics.
During a viral illness we would expect to see ongoing temperatures for 2-3 days and then a slow and gradual improvement of symptoms. If your child becomes more unwell after a period of initial improvement, then seek medical input.

Using medicines to help

If your child is distressed you should consider giving them paracetamol or ibuprofen to help them feel more comfortable. Use one and if your child has not improved 2-3 hours later you may want to try giving the other medicine.
Carefully read the instructions on the medicine for dose and frequency.
You could ask your local pharmacist for more advice about medicines.
In general, we do not recommend cough medicines.

The Glass Test

Do the ‘glass test’ if your child has a rash. Press a glass tumbler firmly against the rash. If you can see the spots through the glass and they do not fade as you press the glass onto the skin then this is called a ‘non-blanching rash’. If you see this type of rash, seek medical advice immediately. The rash is harder to see on dark skin so check paler areas, such as palms of the hands, soles of the feet and tummy.

(Photo courtesy of the Meningitis Research Foundation 2013)

This guidance is written by healthcare professionals from across Hampshire, Dorset and the Isle of Wight.

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