Fever in a child – what to do, and when to worry
Most childhood fevers are viral and settle on their own. How the child looks matters far more than the number on the thermometer.
The number is not the emergency
Fever is the body's response to infection, not the illness itself. A high temperature in a child who is drinking, responsive and playing between miserable patches is usually far less concerning than a lower temperature in a child who is floppy, unresponsive or breathing hard.
Treat how the child looks, not the reading. The goal of medicine is comfort — bringing the number down does not shorten the illness or prevent complications.
Signs that need medical attention now
In South Africa, always mention it if the child has been to a malaria area in the past year, and always mention any cough lasting more than two weeks, night sweats or weight loss, which raise the question of TB.
What to do at home
- Offer fluids often, in small amounts. Dehydration is the main practical risk of a fever and is the thing most worth staying on top of.
- Dress the child lightly. Do not wrap them up, and do not sponge with cold water or use a fan — both cause shivering, which raises the temperature.
- Give medicine for comfort if the child is miserable, not simply because the number is high.
- Let them rest and eat what they want. Appetite drops during a fever and returns afterwards.
- Check on them through the night while the fever lasts.
For comfort. Dose by the child's WEIGHT, from the packaging or the clinic — never from an adult dose or another child's:
Paracetamol — Panado, Painamol, Tylenol, Pacimol
Mild to moderate pain; fever
Ibuprofen — Nurofen, Brufen, Advil, Ibupain
Mild to moderate pain; inflammation; fever; dysmenorrhoea
Febrile convulsions
Some young children have a fit when their temperature rises quickly. It is frightening to watch and is usually harmless, but it must be seen by a clinician the first time to establish what caused it.
- Put the child on their side on the floor, away from anything hard.
- Do not hold them down, and do not put anything in their mouth.
- Note the time it started.
- Call for help if it lasts more than five minutes, if another follows, or if the child does not recover normally afterwards.
- Have them seen the same day even if it stops quickly.
Common questions
- Should I alternate paracetamol and an anti-inflammatory?
- Ask a clinician rather than doing it as a default. Alternating increases the chance of a dosing mistake at home, and the aim is comfort rather than a normal reading. If one is not making the child comfortable, that is a reason to have them seen.
- How high is too high?
- There is no single number that means danger on its own. How the child looks and behaves matters more. That said, any fever under three months of age, or a fever lasting more than three days at any age, should be seen.
- Can I sponge the child with cool water?
- It is no longer advised. Cooling the skin makes the child shiver, which raises the core temperature and makes them more uncomfortable. Light clothing and fluids are the better approach.
Sources
- Road to Health booklet and the Integrated Management of Childhood Illness approachNational Department of Health, South Africa
- Primary Healthcare Standard Treatment Guidelines and Essential Medicines ListNational Department of Health, South Africa
Last reviewed 4 August 2026.