When Your Child Has a Fever: When to Watch, When to Call a Doctor and When to Get Help

Few things make a parent reach for the thermometer faster than a child who suddenly feels hot, tired and miserable.

Fever is extremely common in children and, in many cases, is simply a sign that the immune system is responding to an infection.

But when you’re standing beside a sick child at 2am, knowing what’s normal — and what isn’t — can feel far less straightforward.

As August marks Child Health Month in South Africa, it’s a good opportunity for parents and caregivers to understand what a fever means, which warning signs deserve attention and when it’s time to speak to a healthcare professional.

What Is a Fever?

A fever is an increase in body temperature, usually occurring when the immune system is responding to an infection.

Viruses are a very common cause, but bacterial infections and other conditions can also cause fever.

A fever itself isn’t necessarily the illness. It’s a symptom.

That distinction is important because the number on the thermometer is only one part of assessing a sick child.

How your child is behaving, breathing, drinking and responding to you can be equally important.

Look at the Child, Not Only the Temperature

It’s easy to become fixated on a temperature reading.

But two children with the same temperature can look very different.

One might be miserable while the fever is high but perk up, drink something and start chatting once they’re more comfortable.

Another may be unusually sleepy, difficult to wake or struggling to breathe.

The second situation deserves much more urgent attention.

When your child is sick, consider:

• Are they alert and responding normally?
• Are they drinking fluids?
• Are they urinating?
• Is their breathing comfortable?
• Is their skin colour normal?
• Can they be comforted?
• Are they becoming better, worse or staying the same?

Your observations can give a healthcare professional valuable information.

Babies Under Three Months Need Special Attention

Very young babies are different from older children.

According to UNICEF South Africa, any fever in a baby younger than three months can potentially be serious and should be discussed with a healthcare professional.

Don’t simply give medication and wait to see whether it disappears.

Young babies can become unwell quickly, and infections that might cause relatively mild illness in an older child can be more significant in a newborn or young infant.

If your baby is under three months old and has a fever, seek medical advice promptly.

Red Flags Parents Shouldn’t Ignore

Regardless of your child’s exact temperature, certain symptoms should prompt urgent medical assessment.

Difficulty Breathing

Seek urgent medical help if your child:

• Appears to be struggling to breathe
• Is breathing unusually fast
• Is pulling in around the ribs when breathing
• Is using the stomach or shoulders noticeably to breathe
• Develops blue or greyish lips or skin
• Cannot speak, drink or feed normally because of breathing difficulty

UNICEF highlights rapid or laboured breathing as an important warning sign in babies and children.

Breathing difficulty should never simply be monitored at home to see whether it improves.

Your Child Is Very Drowsy or Difficult to Wake

Children with fever are often tired and may sleep more than usual.

What is concerning is a child who:

• Is unusually difficult to wake
• Seems confused
• Doesn’t respond normally
• Appears floppy or extremely weak
• Is noticeably different from their normal behaviour

Parents often know immediately when their child seems “not right”.

That observation matters.

Signs of Dehydration

Children can lose fluid quickly when they’re sick, particularly if fever is accompanied by vomiting or diarrhoea.

Possible signs of dehydration include:

• A dry mouth
• Very little urine
• Fewer wet nappies than usual
• No tears when crying
• Sunken eyes
• Unusual sleepiness
• Refusing fluids

UNICEF South Africa advises that fewer wet nappies, crying without tears and sunken eyes can be signs that a young child needs medical attention.

Encourage regular fluids while your child is ill.

A Seizure

Some young children can experience a seizure associated with fever.

Watching this happen can understandably be frightening.

If your child has a seizure — particularly if it is their first seizure, lasts several minutes, recurs or the child does not recover normally afterwards — seek urgent medical care.

During a seizure, keep the child away from objects that could injure them and do not place anything inside their mouth.

A Concerning Rash

Many childhood viral illnesses cause harmless rashes.

However, a fever combined with a rash can sometimes require urgent medical assessment.

Get medical help if your child looks very unwell or develops a rash together with symptoms such as:

• Difficulty breathing
• Extreme lethargy
• Severe headache
• Neck stiffness
• Confusion
• Rapid deterioration

If you’re uncertain about a new rash in a feverish child, contact a healthcare professional rather than trying to diagnose it from pictures online.

What About Vomiting and Diarrhoea?

Stomach bugs are common in children.

Often the biggest concern isn’t the vomiting or diarrhoea itself — it’s whether your child can replace the fluid they’re losing.

Watch how well they’re drinking and how frequently they’re urinating.

Seek medical advice if:

• Your child cannot keep fluids down
• Vomiting is persistent
• There is blood in vomit or stool
• The child is becoming increasingly sleepy
• Urination becomes very infrequent
• There are signs of significant dehydration
• Severe abdominal pain develops

Babies and very young children can become dehydrated more rapidly than adults.

Should You Give Medicine for a Fever?

Fever-reducing medicine can help a child who is uncomfortable, in pain or distressed.

However, the goal shouldn’t necessarily be to force their temperature back to a perfectly normal number.

Always use medication that is appropriate for your child’s age and weight, and follow the recommended dosing instructions carefully.

Never guess a child’s dose.

If you’re unsure which medication is appropriate, how much to give or whether it can be combined with another medicine your child is already taking, ask a doctor or pharmacist.

Also remember that medication may temporarily lower a fever without treating the underlying cause.

If your child continues becoming more unwell, a lower temperature after medication doesn’t mean they no longer need medical attention.

Keep Your Child Comfortable

For a child who has a fever but otherwise appears reasonably well, simple supportive care can make a big difference.

Encourage Fluids

Offer small amounts regularly.

Depending on the child’s age, this may include breastmilk, formula, water or an appropriate oral rehydration solution when advised.

Don’t wait until a thirsty child asks for a large drink.

Frequent small amounts can sometimes be easier to manage, especially when nausea is present.

Avoid Overdressing

Bundling a feverish child in multiple heavy blankets can make them uncomfortable.

Dress them comfortably and keep the room at a reasonable temperature.

Let Them Rest

A sick child doesn’t need to maintain their normal routine.

Let them sleep and rest, while periodically checking that they are responding normally and taking fluids.

When a Fever Keeps Coming Back

A fever associated with a straightforward viral infection will often settle as the child recovers.

But recurring or persistent fever deserves medical assessment.

Speak to a healthcare professional if:

• The fever persists longer than expected
• It disappears and then repeatedly returns
• New symptoms develop
• Your child’s condition is worsening rather than improving
• Your child has ongoing pain
• They are repeatedly becoming ill
• You are simply concerned about how they look or behave

There may be a need to check for infections involving the ears, throat, lungs, urinary tract or another part of the body.

Antibiotics Aren’t Needed for Every Fever

A fever does not automatically mean your child needs an antibiotic.

Many childhood infections are caused by viruses, and antibiotics do not treat viral infections.

Using antibiotics when they aren’t necessary can contribute to antibiotic resistance and may expose a child to unnecessary side effects.

A healthcare professional can assess whether the symptoms suggest a bacterial infection and whether antibiotics or further testing may be appropriate.

Don’t use antibiotics left over from a previous illness or medication prescribed for somebody else.

When Telemedicine Can Help

Not every sick child needs an immediate trip to an emergency department.

Sometimes parents simply need professional guidance about what they’re seeing.

A virtual consultation can be particularly useful when your child has symptoms such as:

• Fever
• Cough
• Cold or flu-like symptoms
• Mild rashes
• Sore throat
• Ear discomfort
• Stomach complaints
• Vomiting or diarrhoea without emergency warning signs

A healthcare professional can ask about your child’s age, temperature, symptoms, fluid intake, behaviour and medical history and advise you on the appropriate next step.

However, telemedicine has limits.

If your child has difficulty breathing, a seizure, severe dehydration, reduced consciousness, a serious injury or another medical emergency, they need urgent in-person medical care.

Trust Your Instincts

Parents and caregivers see their children every day.

You know how energetic they usually are, how they communicate and what their normal behaviour looks like.

If you feel something is significantly different — even if you can’t quite explain why — it’s reasonable to ask for medical advice.

You don’t need to wait until a situation becomes an emergency before speaking to someone.

Child Health Starts With Knowing When to Ask

Most childhood fevers will pass without serious complications.

But knowing the warning signs means you can confidently manage the minor illnesses while recognising the situations that deserve medical attention.

This Child Health Month, remember:

Watch your child, not just the thermometer.

Keep them hydrated.

Pay attention to their breathing and responsiveness.

And if you’re worried, ask.

TruMD gives South African families convenient access to qualified healthcare professionals through online consultations, helping parents get trusted medical guidance when their children are unwell.

Worried about your child’s symptoms? Talk to a doctor with TruMD.