Fever FAQ

Your child has been cranky all evening and doesn't want to eat. You check their temperature and you hear an ominous long beeping sound accompanied by an alarming flashing red screen. You try not to panic, but your mind starts to race... How high is too high? Do they need antibiotics? Is their brain going to boil? What about seizures? When do they need to see a doctor?

Let's set the record straight about fever in kids. 

• A fever is a normal, healthy part of a functioning immune system in response to an infection. It means their bodies are hard at work fighting off the germs that are making them sick!

• The most common cause of fever in a child is a viral infection, like the common cold or flu. 

• Although some children with a fever do need to be seen by a doctor urgently (outlined below), most of the time they just need rest and plenty of fluids.

• Fever medicines (ibuprofen and acetaminophen/paracetamol) do not help your child get better any faster (nor do they hinder recovery), but may help them feel better temporarily so that your child (and you!) can get some rest. They are not necessary if your child is clearly comfortable (e.g. sleeping or resting comfortably, playing, etc.). If you choose to give fever medications, follow the product instructions carefully. Expect the fever to return in 3-4 hours. 

When does my child with a fever need to go to the Emergency Room?

You should take your child with a fever to the Emergency Room if they have any of the following RED FLAGS*:

Risk factors: immunocompromised, unvaccinated, complex medical conditions, or recent travel to a malaria-endemic region

Energy/behaviour: extremely irritable (e.g., crying inconsolably), severe pain, unusually sleepy, confused, or having a seizure

Dehydration: not drinking fluids, dry lips or mouth, urinating much less than usual

Fast breathing, noisy breathing, or trouble breathing

Long duration: fever lasting 5 days or more

Age: less than 3 months

Gut feeling: caregiver intuition that your child needs medical attention now

Skin changes: pale, purple, blue, or cool skin

*This is not an exhaustive list!

You should take your child with a fever to see a doctor or nurse practitioner urgently (within 24 hours) at a clinic or urgent care centre if they have any of the following*:  

1. A fever lasting 48 hours or more without other symptoms (may indicate the need for specific tests, such as a urine test)

2. A fever plus a new rash

3. A fever plus ear pain

4. A fever plus throat pain without other viral symptoms (may indicate the need to evaluate for strep throat)

5. A fever that initially improves, then recurs several days later (may signal a secondary bacterial infection, such as pneumonia or an ear infection)

6. Caregiver intuition (you feel your child should be seen urgently—trust your gut!)

*This is not an exhaustive list!

Fever FAQ

Q: What is a fever? 

A: A temperature of at least 38°C or 100.4°F is a fever. Some consider 37.5°C to be a fever if measured in the axilla (armpit). 

Q: What is the best way to measure my child’s temperature?

A: Underarm, oral, or rectal temperature measurements are generally more accurate than forehead or ear thermometers. However, it can be much easier for parents to use forehead or ear thermometers, especially with young children.

Q: How high is too high?

A: A high fever does not necessarily mean your child has a more serious illness or needs antibiotics. It simply means your child has mounted a strong immune response to an infection. As outlined above, your child’s symptoms and behaviour, as well as the duration of the fever, are the most important indicators when assessing whether they need medical attention.

Q: If my child’s fever gets too high, won’t they be at risk for a seizure?

A: A small number of children (2–4%) have a genetic predisposition to febrile seizures. These are generally considered benign and cannot be prevented with fever medications.

Q: My child’s fever doesn’t get better after giving them fever medication. Should I worry?

A: Remember that the goal of fever medications is to make your child more comfortable so they can rest and rehydrate, and that the effects typically last about four hours. So, if your child is more comfortable for a few hours, regardless of what the thermometer says, the medicine is working. If your child does not seem any more comfortable or shows any of the RED FLAGS outlined above, they should be evaluated right away by a qualified healthcare provider.

Q: Does my child need antibiotics?

A: Viral illnesses, such as the common cold or flu, do not need antibiotics or other medicines, vitamins, or herbal remedies. They get better with rest, fluids, and most importantly, time. If you are concerned your child may have a bacterial infection, such as pneumonia, an ear infection, or strep throat, see your healthcare provider to determine if antibiotics are needed. If your child shows any of the RED FLAGS outlined above, they should be evaluated right away.

Q: Should I give my child over-the-counter cough and cold medicines? 

A: No. These have not been proven to help your child recover any sooner, and several serious safety concerns have been reported with these medications.

Q: How do I get my child with a fever to eat?

A: Children typically have a poor appetite when they are sick. This will resolve when they are feeling better. Don’t push them to eat. Instead, offer fluids such as commercially available oral rehydration solutions or a 50:50 mix of apple juice and water. If your child doesn’t want to drink fluids, offer small sips frequently (e.g., every 5–10 minutes). 

Q: How do I get my child to sleep when they are sick?

A: It is normal for young children to sleep poorly when they are ill. If they have a fever, you can try fever medications to see if this helps them rest. Most of the time, however, young children just need extra snuggles (and caregivers need extra coffee!) until they recover. 

Q: Should I wake my sleeping child to give them fever medicine?

A: No! Your child (and you!) need rest more than they need fever medicine. If they are sleeping, it means they are comfortable and do not require fever medicine. Waking them may also make it harder for them to settle back to sleep.