What to do if your child has a fever

Nice has updated its guidelines to help parents and practitioners quickly assess the symptoms and seriousness of a child's fever using the traffic light system (below), which should help you decide when it's safe to care for your child at home or when you need to seek medical advice. The overriding advice remains, however, that if you're at all worried, get professional medical help.

The Traffic Light System:

Children who have all of the following features (Green), and none of the high (Red) or intermediate (Amber) risk features, are in a low-risk group for serious illness:

• normal colour of skin, lips and tongue
• responds normally to social cues (e.g. giggling or laughing with parents)
• content/smiles
• stays awake or awakens quickly
• strong normal cry or not crying
• normal skin and eyes
• moist mucous membranes

Children with any of the following symptoms (Amber) are in at least an intermediate-risk group for serious illness:

• pallor of skin, lips or tongue reported by parent or carer
• not responding normally to social cues
• no smile
• wakes only with prolonged stimulation
• decreased activity
• nasal flaring
• dry mucous membranes
• poor feeding in infants
• reduced urine output
• rigors.

Children with any of the following symptoms or signs (Red) are in a high-risk group for serious illness:

• pale/mottled/ashen/blue skin, lips or tongue
• no response to social cues
• appearing ill to a healthcare professional
• does not wake or if roused does not stay awake
• weak, high-pitched or continuous cry
• grunting
• respiratory rate greater than 60 breaths per minute
• moderate or severe chest indrawing
• reduced skin turgor
• bulging fontanelle.

As a parent, your view of your child's fever is considered important and should be taken seriously by healthcare professionals you speak to.

The most effective way to take the temperature of a child between 4 weeks and 5 years is an electronic themometor under the armpit. Forehead chemical thermometers are unreliable and won't normally be used by professionals.

Looking after a child with a fever at home:

• Tepid sponging is not recommended for the treatment of fever. Children with fever should not be underdressed or over-wrapped.
• Consider using either paracetamol or ibuprofen for children with fever who appear distressed. Only continue as long as the child appears distressed.
• Do not give both drugs simultaneously.
• Only consider alternating the drugs if distress continues or it recurs before the next dose is due.
• Offer regular fluids (where a baby or child is breastfed the most appropriate fluid is breast milk)
• Look for signs of dehydration: sunken fontanelle, dry mouth, sunken eyes, absence of tears

Seek further advice if you detect signs of dehydration. Check your child during the night and keep him or her away from nursery or school while the fever persists

When to seek further help

• the child has a fit
• the child develops a non-blanching rash (a rash that does not disappear when pressed)
• you feel that the child is less well than when you previously sought advice
• you are more worried than when you previously sought advice
• the fever lasts longer than 5 days