Fever in Babies: When to Worry and What to Do

It is 10 p.m., baby is fretful, their cheeks are red and their forehead feels burning. In many families, the first reflex is to put a hand on the forehead. Yet a baby’s fever cannot be guessed: it is measured. And what should guide your decisions is above all their age and general condition, far more than the number on the display.

Fever, skhana in darija, is most often the normal reaction of a body defending itself against a virus. Yet it is very frightening: in the paediatric emergency department in Rabat, 96.8% of the 264 parents questioned in a study judged it very serious, and only 3.5% knew its exact definition.

At what temperature does a baby have a fever?

A fever is defined as 38 °C or above. France’s Haute Autorité de santé (HAS), the UK’s NHS and the Canadian Paediatric Society use the same threshold, for a child normally dressed, at rest, in a room that is not overheated.

Normal temperature is around 37 °C: the French health insurance service puts it below 37.5 °C in the morning and below 37.8 °C in the evening. A baby bundled up on a chergui day, or who has just cried for a long time, can read a few tenths too high without being ill. Remove any extra clothing, leave them quietly for about twenty minutes, then measure again.

Which thermometer should you choose and how do you take the temperature?

The right tool is the electronic thermometer; mercury ones are to be avoided. As for touch, it is not reliable: in Rabat, 44.4% of the parents questioned nevertheless judged fever that way.

The Canadian Paediatric Society’s guide, method by method:

Contactless forehead thermometers are quick, but sweat or a hat throws the reading off.

Countries do not say quite the same thing: the HAS makes the rectal thermometer the reference, while the NHS rather advises underarm measurement in babies. In practice, the underarm reading is enough for monitoring; if the result is borderline or baby seems unwell, the rectal route gives the most reliable figure.

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Under 3 months: why see a doctor without delay?

In an infant under 3 months, a temperature of 38 °C or more calls for medical advice without delay, even if they look well. The HAS lists this young age among the warning signs, and the Canadian Paediatric Society speaks of an emergency. At this age, baby expresses poorly what they feel, and a serious infection can hide behind an isolated fever.

Call your paediatrician or go to the paediatric emergency department. Give no medicine without medical advice: the NHS reminds us that paracetamol is not given before 2 months without a professional’s approval.

Between 3 and 6 months, thresholds vary: the NHS asks for urgent advice from 39 °C, the Canadian Paediatric Society as soon as there is a fever before 6 months. If in doubt, call.

The right steps at home

After 3 months, if baby drinks, responds and smiles between fever peaks, most of the care happens at home. Guidance from different countries agrees:

• Offer fluids often: breastfeed on demand, more frequent bottles, water for an older child. Watch for fewer wet nappies, sunken eyes, crying without tears: these are signs of dehydration.
• Dress them lightly, with no thick blanket. Do not undress them completely: if they shiver, their temperature rises.
• Keep the room temperate, ideally between 18 and 20 °C according to the French health insurance service. Air the room, avoid space heaters in winter and an overheated bedroom in summer.
• Forget the cold bath and wet cloths: the HAS advises against them, because their effect is weak and brief, and they add to discomfort.
• Keep watching, including at night, their colour, breathing and the way they respond, and keep them quietly at home rather than at nursery.

In the Rabat study, 45.1% of parents used traditional remedies, and cloths soaked in cold water were still common. These simple steps are nevertheless enough.

Should you give medicine for fever?

Not necessarily. Treatment aims at the child’s comfort, not a number on the thermometer: that is the HAS position. A feverish baby who plays, feeds and smiles does not always need medicine; a listless, grumpy baby may be relieved by it.

If medicine is useful:

• Paracetamol is the first-choice treatment.
• One medicine at a time: do not alternate paracetamol and ibuprofen without medical advice.
• Never aspirin in children, because of the rare but serious risk of Reye’s syndrome.
• Ibuprofen is not suitable for everyone: not before 3 months, not with chickenpox, nor if the child is dehydrated.
• The dose depends on weight, not age. Ask your doctor or pharmacist for the dose suited to your child’s weight, and use the measuring device supplied with the bottle, never one from another medicine.

Antibiotics are given only on prescription, after an examination: they have no effect on viral infections, the most common in little ones. To know what to keep on hand, see our list for baby’s medicine cabinet.

Febrile seizures: what to do if baby has a convulsion

The scene is frightening, but uncommon and almost always harmless: according to the French health insurance service, 2 to 5% of children under 5 have one during a high fever, most often between 6 months and 5 years. The body is shaken by jerky movements, the eyes may roll back, the child does not respond. The seizure generally lasts 1 to 5 minutes, then gives way to drowsiness.

During the seizure:

1. Note the time.
2. Lay the child on their side, on a safe surface, without restraining their movements.
3. Put nothing in their mouth: no finger, no object, no medicine.
4. Call 141 if the seizure lasts more than 5 minutes, if it is the first, if baby is under one year old, if it affects only one side of the body or if it repeats.

Also call 141 if, after the seizure, they breathe poorly, have blue lips or do not wake up normally. In other cases, they should be seen by a doctor the same day. A febrile seizure leaves no after-effects, but recurs in about one child in three during a later fever. And contrary to a stubborn belief, bringing the fever down does not prevent it.

How long does a fever last, and when should you go back?

Most viral fevers pass in a few days. On when to go back, the guidance varies: the Canadian Paediatric Society advises seeing a doctor after 48 to 72 hours, the NHS from 5 days in a child who is otherwise well. The 48-hour rule is the most cautious.

See a doctor sooner if the fever comes with spots or rashes (see our guide to childhood rashes), if baby seems to have ear pain, if they are vomiting, or if the fever comes back after a few days of improvement. After a vaccine, a moderate fever is common: our article on reactions after vaccination explains how to monitor it.