Fever in children

A raised temperature is considered to be a fever at 38.5°C (101.3°F) or more in children, and at 38.0°C (100.4°F) or more in babies under three months old.

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. Some children lose their appetite or cry a lot.

You should take the child to see a doctor or to the emergency room if

• they are under three months old and have a temperature of 38°C (100.4°F) or higher.
• the fever has lasted for longer than three days.
• the child has a febrile seizure.
• they have a stiff neck.
• the child has an unusually shrill cry or is in a lot of pain.
• they are unresponsive, restless or confused.
• the child is struggling to breathe or is breathing very quickly.
• the child has a skin rash that doesn't fade if you press against it – for example, with a clear glass while looking through it.
• they are a young baby and repeatedly refuse to be breastfed or fed.
• their symptoms have got worse since they were last seen by a doctor.

Things like running around, excitement or very warm clothing can make children feel hot to the touch even if they don't have a fever and aren't ill. One reason for this is that it takes longer for children to start sweating compared to adults.

Teething can cause a child's body temperature to go up too.

But fever is usually caused by germs. The body reacts to the germs by speeding up certain metabolic and immune system processes, generating more warmth. So fever isn't an illness, but a normal bodily response.

Fever can be caused by the following:

• Viruses or bacteria: for instance, a common cold, middle ear infection, urinary tract infection (UTI like cystitis) or gastroenteritis (tummy bug). Or typical childhood diseases such as mumps, measles, German measles (rubella), scarlet fever, chickenpox and sixth disease (roseola).
• A vaccination: because the child's immune system is developing antibodies to fight the germs that the vaccine aims to protect them from.
• Dehydration: The child has a fever because they haven’t had enough to drink and their body is dehydrated (doesn't have enough water and other fluids in it). This kind of dehydration-related fever can also be caused by severe vomiting or diarrhea.
• Sunburn and sunstroke.
• Skin conditions such as hives (urticaria).
• In rare cases: serious illnesses such as pneumonia, meningitis, appendicitis or an infection of the joints or bone marrow.
• In very rare cases: metabolic diseases, rheumatic diseases or allergic reactions to foods or medications.

If a fever develops after traveling to a faraway place – even several weeks after returning – it's important to tell your doctor about your travels. Special tests can be done to find out whether the child picked up an infection (for example, a virus) while traveling.

Many parents worry that a high fever could become dangerous. But fever alone isn't harmful for otherwise healthy children and rarely goes above 41°C (105.8°F).

Children who have a fever sweat more. That can lead to dehydration. It is important to see a doctor if the child refuses to drink, has not peed in the last twelve hours, or if they show signs of dehydration over a longer period of time. Signs of dehydration include:

• A sunken fontanel (soft spot on the top of a baby's head)
• A dry mouth and dry lips
• Sunken eyes
• Lack of tears
• The child generally looks unwell

Fever can sometimes lead to a febrile seizure (also known as a febrile convulsion) – particularly in children between the ages of three months and five years. Although simple febrile seizures can be very alarming, they usually only last a few minutes and are normally not dangerous. But it is still a good idea to take the child to see a doctor afterwards.

Healthy children have a body temperature between 36.5°C (97.7°F) and 37.5°C (99.5°F). This temperature changes over the course of the day: It is usually about 0.5°C higher in the evening than it is in the morning. Temperatures between 37.5°C (99.5°F) and 38.5°C (101.3°F) are referred to as an elevated body temperature. It is considered to be a fever at temperatures of 38.5°C (101.3°F) or more in children, and at temperatures of 38.0°C (100.4°F) or more in babies under three months old.

Body temperature can be measured in different ways. For young 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 first place their hand on their child's forehead or neck to check whether it feels hot.

They can then use a thermometer to measure the child's temperature properly – ideally three times a day, if possible. The best way to get reliable readings is by inserting a digital thermometer into the child's bottom (rectal temperature). In children over the age of one year, ear thermometers provide similarly accurate readings. Measuring a child's temperature in their mouth is less reliable because they usually find it difficult to keep their mouth closed and their tongue still.

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.

Children who have a fever usually don't need to take medication to lower their temperature.

But treatment with fever-reducing medication such as acetaminophen (paracetamol) or ibuprofen can help if the child is in pain too or is feeling very unwell. This medication can be used in the form of a syrup or a suppository. The correct dose will depend on the child's age and body weight, as described in the package insert. If the child's condition worsens after taking acetaminophen (paracetamol) or ibuprofen, you should seek medical advice.

Some home remedies cool the outside of the child's body. These include wrapping their lower legs in lukewarm wet towels or giving them a lukewarm bath. It is not clear whether this actually helps to reduce the fever, though. You should only use these home remedies if the child has warm feet and finds the wraps or baths pleasant.

It is more important to be there for the child and make sure that they feel comfortable. If they're feeling cold, you can cover them with a warm blanket or give them warmer clothes. If they're feeling warm, cover them with a lighter blanket or sheet. You should also make sure they drink enough because children who have a fever need plenty of fluids.

Children have a pretty good feel for what's good for them. So it can be helpful to ask them what they need – for instance, what they feel like eating or drinking.

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's no reason not to care for him or her at home.

Children may play all day long despite having a fever. As long as they don't run around too much, that's perfectly fine. But they shouldn't go to playgroups, childcare or school if they have a fever. They could still infect others. This is true even if they seem to be fine otherwise.

When children have a fever, it nearly always goes away again on its own. Time, rest and loving care are usually the best remedies.

When people are ill or need medical advice, they usually go to see their family doctor or pediatrician first. Information about health care in Germany can help you to navigate the German health care system and find a suitable doctor. You can use this list of questions to prepare for your appointment.