Fever and Infections in Children: When to Treat at Home and When to Go to Hospital

A child's fever is one of the most common causes of parental anxiety and calls to the paediatrician. Most cases are ordinary viral infections that resolve on their own. But some situations require urgent medical attention. This article will help you understand: when you can monitor at home, when you need a doctor, and when to call an ambulance.

Fever in children: normal temperatures by age

Normal body temperature depends on the method of measurement and the child's age. This is important for correctly interpreting thermometer readings.

Rectal temperature — the most accurate method for children under 3 years. Normal: up to 38.0°C. A temperature of 38.0°C or above is a fever.
Axillary (underarm) temperature — the most common method. Normal: up to 37.2°C (up to 37.5°C in children under 3 months). This method is less accurate: the reading may be 0.5–1°C lower than the true body temperature.
Ear (tympanic) temperature — normal up to 38.0°C. Requires correct technique; less reliable in children under 6 months.
Oral temperature — normal up to 37.8°C.

Important: in children in the first 3 months of life, even a slight rise in temperature (38.0°C rectally) is a reason to see a doctor immediately. In newborns, infection can develop very quickly and without obvious symptoms.

When to bring down a fever

Fever is the body's protective response. It helps fight infection. The reason to bring it down is not because "high temperature is dangerous in itself," but to relieve the child's discomfort.

Guidance on reducing fever:

Temperature below 38.5°C (axillary) in a child over 3 months who feels well — antipyretics are not necessary. Monitor the child and ensure adequate fluids.
Temperature of 38.5°C or above — give an antipyretic if the child feels unwell (lethargic, crying, refusing to drink).
Any temperature in a child with a history of febrile seizures — bring down from 37.5°C.

Safe antipyretics for children: paracetamol (from birth) and ibuprofen (from 3 months). Aspirin in children under 18 is absolutely contraindicated (risk of Reye's syndrome).

Physical cooling methods (sponging with lukewarm water) can be used as a supplement, not a replacement for antipyretics. Sponging with alcohol or vinegar is dangerous, especially for children.

Respiratory infections in children: treat at home or see a doctor

Upper respiratory tract infections (URTIs) are the most common cause of fever in children. Runny nose, cough, sore throat, temperature of 38–39°C — a typical picture. In most cases, URTIs resolve on their own within 7–10 days.

What helps with a URTI:

plenty of fluids (water, fruit drinks, warm tea) — the most important measure for any infection;
antipyretics when needed;
nasal saline rinses;
ventilating and humidifying the room.

What is not needed for a URTI:

antibiotics — URTIs are caused by viruses; antibiotics have no effect on them;
antiviral medications — most lack proven effectiveness;
immune stimulants — their effectiveness is not proven.

When a URTI requires a doctor:

fever persists for more than 5 days;
fever returns after a period of improvement;
ear pain develops, or severe sore throat (possible tonsillitis);
difficulty breathing or rapid breathing;
the child refuses to drink;
a rash appears alongside the fever.

Gastrointestinal infection and rotavirus

Gastrointestinal infection in children presents with vomiting, diarrhoea, abdominal pain, and sometimes fever. The most common cause in children under 5 is rotavirus. Rotavirus infection typically starts suddenly: vomiting, then diarrhoea (watery, without blood), temperature of 38–39°C. It lasts 5–7 days.

The main danger with gastrointestinal infection is dehydration. Signs of dehydration in a child:

dry mouth, no tears when crying;
infrequent urination (less than once every 6–8 hours in a child under 1 year);
sunken fontanelle in infants;
lethargy, weakness, refusing food and drink;
dry skin, reduced skin turgor (skin is slow to return after pinching).

Home treatment:

Oral rehydration — replacing fluids and salts. Specialist rehydration solutions (Dioralyte, Pedialyte) are better than water or sweet drinks. Give small amounts (5–10 mL) every 5–10 minutes.
Don't stop breastfeeding (if the child is breastfed).
Antibiotics are not needed for viral gastrointestinal infections.

When to call an ambulance for gastrointestinal infection:

the child cannot drink due to persistent vomiting;
signs of dehydration (see above);
blood in the stool;
severe abdominal pain;
a child under 6 months with vomiting and diarrhoea.

When to call an ambulance immediately

Some symptoms in a child require immediate medical attention — not "see the paediatrician tomorrow," but right now:

Breathing difficulty: rapid breathing (more than 60 breaths/min in children under 2 months; more than 50 in children 2–12 months; more than 40 in children 1–5 years); intercostal recession; flaring nostrils; blue lips or fingertips.
Seizures — any, especially a first episode.
Loss of consciousness or sudden severe lethargy — the child does not respond to being spoken to.
Fever in a child under 3 months of 38.0°C or above (rectal).
Petechial rash — small pinpoint haemorrhages that do not fade when pressed (the glass test). This may be a sign of meningococcal infection.
Severe headache with neck stiffness (the child cannot touch their chin to their chest) — a sign of meningitis.
Signs of dehydration when it is impossible to give the child fluids.

If you're unsure how urgent the situation is, describe the symptoms to our assistant. It will help assess whether urgent help is needed.

Frequently asked questions

Should I bring down a temperature of 37.5°C in a child?

Generally, no. A temperature below 38.5°C (axillary) in a child over 3 months who is active and drinking does not require an antipyretic. Exception: children with a history of febrile seizures — for them, temperature should be brought down from 37.5°C. The key is to monitor how the child feels, not just the number on the thermometer.

Why does my child get so many colds?

Children under 5–6 years old get respiratory infections on average 6–8 times a year — this is normal, not a sign of a weak immune system. The child's immune system is still developing and learning to recognise viruses. Children who have started nursery or daycare are particularly prone. Frequent uncomplicated colds are not a reason for immune stimulants or investigations.

How do you tell tonsillitis from a cold?

Tonsillitis (acute tonsillitis) is a bacterial infection of the tonsils. Signs: severe sore throat, high fever (38.5–40°C), white or purulent coating on the tonsils, enlarged lymph nodes in the neck. With tonsillitis there is no runny nose or cough — this is an important distinction from a cold. Tonsillitis requires a doctor's examination and, if streptococcal, antibiotic treatment.

Is the rotavirus vaccine recommended?

Yes. The rotavirus vaccine is included in national immunisation schedules in many countries and effectively prevents severe rotavirus infection. It is given between 6 and 32 weeks of age (depending on the vaccine). Discuss with your paediatrician.

My child has been coughing for 3 weeks. Is that normal?

A cough after a respiratory infection can persist for up to 3–4 weeks — this is normal if the child feels well and has no other symptoms. But a cough lasting more than 4 weeks, a night cough, a cough with breathlessness or wheezing, or a cough with blood all require a doctor's assessment to rule out asthma, whooping cough, or other causes.

Can I bathe a child with a fever?

Yes, and it can be helpful: a warm bath (not hot, around 37°C) helps reduce temperature and improve wellbeing. Don't bathe in cold water — this causes vascular spasm and can worsen the condition. Dress the child warmly afterwards.

Symptomatica is an informational reference service. Not a medical service; does not diagnose or prescribe treatment. For any symptoms, please consult a doctor.

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