🌡️ Children's Health

All ages

Fever in Children

When to treat at home, when to worry, and when to go to hospital.

Fever is the most common reason parents bring a child to a doctor in Nigeria. Most childhood fevers are caused by viral infections that resolve on their own. But some fevers signal serious infections that need immediate treatment. Knowing the difference could save your child's life.

⚠️ Go to Hospital IMMEDIATELY if your child has:

🚨 Any fever in a baby UNDER 3 MONTHS — go to hospital immediately, no exceptions

🚨 Child is unresponsive, very difficult to wake, or floppy

🚨 Convulsion (seizure) — call for help immediately

🚨 Rash that does not fade when pressed (glass test for meningococcal disease)

🚨 Very rapid breathing or difficulty breathing

🚨 Blue, pale, or mottled skin

🚨 Crying inconsolably for more than 2 hours

🚨 Fever above 40°C (104°F) in any child

🚨 Bulging soft spot (fontanelle) on head — in infants

🚨 Stiff neck and light sensitivity — possible meningitis

💚 Most childhood fevers in children over 3 months, who are alert and drinking, are caused by viral infections that resolve on their own. Fever itself is not dangerous — it is the body's immune response. The child's behaviour and alertness are more important than the exact temperature.

Signs Parents Notice

• Temperature above 38°C (100.4°F) — measured in the armpit, rectally, or via ear

• The child feels hot to touch

• Child is irritable, not eating, and clingy

• Restless or difficult to settle

• Mild fever with cold symptoms — runny nose, sneezing — usually viral

• Fever with rash — needs assessment (some rashes are harmless, others are serious)

• Fever with ear pain — possible ear infection

• Fever with urinary symptoms — possible UTI

Home Care — What You Can Do

Paracetamol or Ibuprofen

Paracetamol (Panadol, Emzolyn) every 4–6 hours OR ibuprofen every 6–8 hours for children over 3 months and over 5 kg. Dose by WEIGHT, not age. Check the packet. Do not alternate both routinely.

Keep the child hydrated

Fluids are essential — breast milk for infants, water and oral rehydration salts for older children. Fever increases fluid loss. Small, frequent sips if vomiting.

Light clothing and cool environment

Do not bundle up a feverish child — this raises temperature further. Light clothing and a comfortable room temperature (not cold). Lukewarm sponging can provide temporary relief.

Monitor closely

Check temperature every 4 hours. Watch for the emergency signs listed above. A child who responds to paracetamol and seems more comfortable between doses is generally reassuring.

Rest and observation

Keep the child at home and observe. Most viral fevers in children over 3 months old who are otherwise alert and drinking are manageable at home initially.

When to Seek Medical Help

NowAny of the emergency signs listed above — especially baby under 3 months with any fever, seizure, difficulty breathing, or not responding normally.

SoonFever lasting more than 3 days in any child, or more than 24 hours in a child under 2 years.

SoonChild refuses to drink anything for more than 6–8 hours, has no wet nappies for 8+ hours, or appears increasingly unwell despite paracetamol.

RoutineFever with mild cold symptoms in a child over 3 months who is drinking and otherwise alert — manage at home initially and seek assessment if not improving within 3 days.

Common Mistakes to Avoid

🚫 Do not give aspirin to children under 16 — risk of Reye's syndrome (rare but life-threatening)
🚫 Do not wrap or bundle a feverish child in heavy blankets
🚫 Do not use very cold water or ice baths for fever reduction
🚫 Do not give adult medications or doses
🚫 Do not wait if a baby under 3 months has ANY fever — even a temperature of 38°C in a newborn is an emergency
🚫 Do not assume every fever is malaria — test before treating

Tests Your Doctor May Order

Malaria RDT

A malaria rapid diagnostic test is recommended for any febrile child in Nigeria — malaria is the most common serious cause of childhood fever.

Full Blood Count

Helps distinguish bacterial from viral infection — neutrophilia suggests bacterial; lymphocytosis suggests viral.

Urine Dipstick and Culture

If no other focus of infection is found — UTI is a common occult cause of fever in children.

Chest X-ray

If respiratory symptoms or clinical signs suggest pneumonia.

How It Is Treated

Antipyretics for Comfort

Paracetamol or ibuprofen reduce fever and discomfort but do not treat the underlying cause. They do not prevent febrile seizures. Their purpose is to make the child comfortable.

Treat the Underlying Cause

Viral infections: supportive care only. Malaria: ACT (Coartem). Bacterial infection (ear infection, pneumonia, UTI): appropriate antibiotic under medical supervision.

Oral Rehydration

Ensure adequate fluid intake throughout the febrile illness. ORS (oral rehydration salts) for children with associated diarrhoea or vomiting.

IV Treatment in Hospital

For severe malaria, bacterial meningitis, sepsis, or very young infants with fever — hospitalisation with intravenous medications may be needed.

Frequently Asked Questions

What temperature counts as a fever?

Any temperature above 38°C (100.4°F). Measured under the arm is the easiest — armpit temperature above 37.5°C is borderline; above 38°C is fever. Rectal temperature is most accurate in young infants.

Should I be worried if my baby has a febrile convulsion?

Febrile seizures (convulsions from fever) are frightening but usually brief and harmless. They occur in 2–4% of children aged 6 months to 5 years. Lay the child on their side, time the seizure, do not put anything in their mouth, and call for help if it lasts more than 5 minutes. Most febrile seizures stop within 2 minutes without treatment.

Should I alternate paracetamol and ibuprofen?

This is sometimes recommended for persistent high fever, but for most fevers, one medication given regularly is sufficient. If alternating, give ibuprofen first as it has anti-inflammatory properties; give paracetamol 3 hours later if needed. Do not give both at the same time.

Does malaria always cause fever?

Malaria typically causes fever — but the classic "cyclical" fever pattern is not always present in children. Any Nigerian child with a significant fever should have a malaria RDT, regardless of other symptoms.

When can my child return to school after a fever?

When the child is fever-free (without antipyretics) for at least 24 hours and well enough to participate in school activities.