Fever in children: when to wait, and when to come in.
A hot, miserable child at 2 a.m. is worrying for any parent. Most fevers are the body fighting an ordinary virus. Here’s how to help at home, and the signs that mean your child should be seen today.
A fever is a sign, not the illness.
A temperature of 38 °C or higher is a fever. It’s one of the body’s ways of fighting infection, and in children it’s usually caused by a virus, like a cold or flu, that gets better on its own within a few days.
How high the number goes doesn’t tell you much about how sick your child is. A child with 39.5 °C who is playing and drinking between doses of medicine is often less worrying than a child with 38.5 °C who is floppy and won’t drink.
So look at the whole child: are they drinking, passing urine, waking up properly and breathing comfortably? Those answers matter more than the thermometer. The one exception is young babies, where any fever needs a doctor.
Watch the child, not just the thermometer.
Comfort first, at home.
The aim isn’t to bring the number down to normal. It’s to keep your child comfortable and well hydrated while their body does its work.
- 01
Fluids, little and often
Fever uses up fluid quickly. Keep breastfeeding or offering milk, and give water or diluted rehydration solution between feeds.
Try small sips every few minutes if they won’t drink much at once.
- 02
Dress them lightly
Don’t bundle a feverish child in blankets, and don’t strip them bare either. Cold baths and sponging with cold water make children shiver and aren’t advised.
Try one light layer and a sheet, with the room comfortably cool.
- 03
Medicine by weight
Paracetamol can ease the aches and help a child drink and sleep. Give the dose for your child’s weight, not age, using the syringe that comes with the medicine, and no more than four doses in 24 hours.
Try writing down the time of each dose so no one doubles up.
- 04
Ibuprofen, with care
Ibuprofen can be used from six months, if your child is drinking well. Most ibuprofen syrups in South Africa are only registered from one year, so check the label or ask your pharmacist. Avoid it if they’re dehydrated or have chickenpox. Don’t give paracetamol and ibuprofen together unless your doctor says so.
Try checking the label on every medicine for hidden paracetamol.
- 05
No aspirin
Children under 16 shouldn’t be given aspirin, including in cold and flu powders. It’s linked to Reye’s syndrome, a rare but serious illness.
Try keeping adult remedies out of the children’s medicine box.
- 06
Let them rest
Sleep helps. If your child is sleeping peacefully and breathing comfortably, you don’t need to wake them to give medicine or take their temperature.
Try checking on them at night, without waking them, if you’re worried.
When to come in.
Most fevers settle within two or three days. These signs mean your child should be checked by a doctor, and some mean you should go now.
A baby under three months with a fever of 38 °C or higher must see a doctor straight away.
Book a same-day visit if
- Your baby is 3 to 6 months old and has a fever of 39 °C or higher
- The fever has lasted more than 2 days in a child under 2, or more than 3 days in an older child
- They’re drinking less than usual, or have fewer wet nappies
- They have ear pain, a sore throat without a cough, or pain or burning when passing urine
- The fever went away and then came back
- They’ve been in a malaria area, like the Lowveld or Mozambique, in the past few months: tell us where
- You’re worried. You know your child best
Get emergency care now if
- Your baby is under 3 months old and has a fever of 38 °C or higher
- They have a fit (seizure), even if it stops by itself
- A rash doesn’t fade when you press a glass against it
- They’re very drowsy, floppy or hard to wake
- They’re breathing fast or struggling to breathe, or the skin below the ribs sucks in with each breath
- They can’t drink or breastfeed, or vomit everything
- They have a stiff neck, or pale, blue or blotchy skin
Priority patients: straight to Dr. Madri, after hours.
Fevers have a habit of starting at night. Dr. Madri’s priority patients don’t have to wait for the practice to open to find out whether their child needs to be seen.
It works on the same WhatsApp number you already use to book.
How it works
Message us after hours
Send a WhatsApp to the practice number as usual. For priority patients, your message goes straight to Dr. Madri instead of an after-hours reply.
Dr. Madri decides the next step
She reads what you’ve sent and comes back to you: a video consult, an appointment first thing, or a referral to an emergency unit.
A video consult when it helps
If she needs to see your child, she sends a private video link that opens in your browser. There’s nothing to install.
How to become a priority patient
- 01
Ask us
Ask at your next visit, or send us a WhatsApp saying you’d like priority access.
- 02
Give your consent
We’ll send you short consent wording for care over WhatsApp and video consults. Reply to agree, for yourself and for each child.
- 03
Dr. Madri confirms
Dr. Madri accepts priority patients herself. We’ll let you know as soon as you’re set up.
Priority access isn’t an emergency service. If your child shows any of the emergency signs above, go to your nearest emergency unit straight away.
Before your appointment.
A few simple things that help us help your child faster when we see them.
- 01
Measure it properly
Use a digital thermometer under the arm for children under five. Forehead strips and a hand on the forehead aren’t reliable.
- 02
Write it down
Note the temperature, the time, and any medicine you gave, with the dose.
- 03
Count the nappies
How much your child is drinking and how often they pass urine tells us a lot about dehydration.
- 04
Book an appointment
Book a visit in person, or a video consult, on WhatsApp or online. We keep same-day appointments for children who need to be seen.
Fever is one of the most common reasons parents bring their children to us, and it’s nearly always something that passes. You don’t need to wait until you’re sure it’s serious. If something doesn’t feel right, book an appointment, in person or by video, and we’ll see your child.
Dr. Madri Verster
Book on WhatsAppSources: Integrated Management of Childhood Illness (IMCI) danger signs, National Department of Health; NICE guideline NG143, fever in under 5s; National Institute for Communicable Diseases (NICD) malaria guidance.
