Introduction

 Photo of an adult's hand being held to a sleeping child's forehead (PantherMedia / ruttapum2) "My child has a high temperature" – not an unlikely event in the lives of parents with young children. Fever is one of the most common reasons for children being brought to the doctor or to the hospital for after-hours medical advice. Most parents will be familiar with this situation.

As a child's temperature increases, so does parents’ concern for their child. But it may help to know that, compared to adults, children's bodies are more likely to react to germs with a fever. Most children with a fever have a harmless virus. They can then easily be cared for at home and feel better again within two or three days. Their bodies can fight off the viruses without any extra help.

Only about 1 out of 100 children with fever have a serious medical problem that needs to be treated by a doctor. Then the cause is usually a bacterial infection such as pneumonia or meningitis.

Symptoms

You can often tell that a child has a fever just by looking at them. Typical signs include a red face, tired-looking or glazed eyes and otherwise pale skin. A hot forehead or neck can also be a sign of fever.

If the fever is very high, the child needs to be taken to the doctor or children's clinic, or to use after-hours services if necessary. This is particularly important if the child has other symptoms too, such as a stiff neck, vomiting, listlessness, restlessness or confusion. You may also need to seek medical advice if the child:

  • has had a febrile seizure,
  • has had a fever for several days,
  • has a rash, or
  • has started feeling worse since the last visit to the doctor.

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Causes

Children are prone to fever. Even things like running around, excitement or very warm clothing can make children’s body temperature rise, although they are not ill. One reason for this is that children don't sweat as much or as easily as adults do when they get warm.

But fever is usually caused by an infection. Fever is a sign that your body is trying to fight germs. So it isn't a medical condition, but part of your body's immune response.

Possible causes of fever include the following:

  • A common viral or bacterial infection – for instance, a common cold, middle ear infection or gastroenteritis. Or typical childhood diseases such as mumps, measles, German measles (rubella), scarlet fever, chickenpox and sixth disease (roseola).
  • A vaccine.
  • Teeth coming in.
  • Dehydration: The child has a fever because they haven’t had enough to drink and their body is dehydrated. This kind of fever due to dehydration can also be caused by severe vomiting and diarrhea.
  • Sunburn, sunstroke or skin conditions such as hives (urticaria).
  • Rare serious infections caused by bacteria, viruses, or other germs, including pneumonia, meningitis, appendicitis or infections of the joints or bone marrow.
  • In rare cases also metabolic or rheumatic diseases.
  • Very rarely, allergic reactions to foods or medications.

If your child has recently been to a foreign country, it is important to tell the doctor about this. Special tests can be done to find out whether the child picked up an infection while traveling and, if so, what kind.

Effects

Many parents worry that a high fever might damage their child’s internal organs or could even be life-threatening. But fever in itself is only very rarely harmful and usually stays below 41°C (about 106°F). Higher temperatures can be dangerous, but they are rare.

Fever can sometimes lead to a febrile seizure. When children have a febrile seizure, their muscles contract, making their arms and legs twitch. Their body may become unnaturally stiff and rigid. Their eyes often roll back, or they may have dilated pupils or a fixed gaze. Sometimes their lips or face turn blue. Their arms and legs might relax quite suddenly again. Febrile seizures usually last just a few minutes and are most common in children between three months and five years of age. Although they can be alarming, they are usually harmless.

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Diagnosis

The body temperature of healthy children lies between 36.5 and 37.5°C. Temperatures between 37.6 and 38.5°C are referred to as an elevated body temperature. Body temperatures of 38.5°C (101.3°F) or above are considered to be fever. In some children, though, temperatures above 38.0°C (100.4°F) may already be a sign of illness. Babies under three months old are considered to have a fever if their body temperature is above 38.0°C. Your body temperature changes throughout the day: It is usually about 0.5°C lower in the evening than it is in the morning.

Body temperature can be measured in different ways. With small children it is particularly important that it can be done quickly and with as little effort as possible – such as dressing and undressing or keeping still.

Many parents who suspect that their child has a fever first place their hand on the child’s forehead. If the child's forehead or the back of their neck feel hot, he or she may have a fever.

It is quite easy to take someone’s temperature with a thermometer. The temperature can either be measured in the mouth (under the tongue), in the bottom (rectally), under the arm, in the ear or on the forehead. The length of time needed to take the temperature depends on where it is measured and what kind of thermometer is used – you will find further information in the instructions that come with the thermometer. Nowadays battery-operated digital thermometers (contact thermometers) are the most commonly used kind of thermometer.

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Treatment

If a child has a fever, you don’t necessarily have to try to lower it with medication. It isn’t always clear whether their symptoms are being caused by the fever or by the underlying illness. But it may be a good idea to treat the fever if the child is feeling very unwell.

There are basically two ways to lower a fever:

  • Taking medication like acetaminophen (paracetamol) or ibuprofen
  • Cooling from the outside with wraps or baths

There is a lack of good research on whether medications that reduce fever can prevent febrile seizures.

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Everyday life

Most children with a fever can be well cared for at home. If your child doesn’t have any of the signs of a serious illness described above, or if the doctor has diagnosed a harmless infection, there is no reason not to care for him or her at home. However, it is still a good idea to continue keeping an eye on the child and perhaps check up on him or her at night. Children who have a fever need to get enough fluid. That is why it is important to make sure that children, including breastfed children, get enough to drink. Medical help is needed if the child refuses to drink or shows signs of dehydration, such as the following:

  • A sunken fontanel in small children – in other words, the soft spot on the upper front part of their head is larger than usual.
  • A dry mouth and dry lips.
  • Sunken eyes.
  • Lack of tears.
  • The child generally looks ill.

Children have a pretty good feel for what is good for them. So it is a good idea to ask them what they need – for instance, what they feel like eating or drinking. You can remove or put on extra layers of clothing to make sure that they are neither too hot nor too cold. Children may play all day long despite having a fever. As long as they do not run around too much, that is perfectly fine.

Children who have a fever are ill and shouldn’t go to daycare, kindergarten or school. This is also true if your child doesn’t appear to be especially weak or listless. Being in a group with other children is always tiring: they have to communicate with and react to each other. Children who have a fever are also more susceptible to infection. And if the child has an infection, he or she might pass it on to other children.

In most cases the fever will go away again without treatment. Time, rest and loving care are usually the best remedies.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?”

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