Fever at night: what to do and when to worry
It is two in the morning and they are hot. Here is what to do, and - more importantly - the specific things that mean you should not wait until the surgery opens.
4 min read
A fever is a temperature of 38°C or above, and it is the immune system responding rather than the illness itself. In most cases it is not dangerous and does not need treating unless your child is uncomfortable.
How your child looks and behaves matters far more than the number on the thermometer. A child with 39°C who is alert, drinking and responsive is less worrying than one with 38.2°C who is floppy, grey and difficult to rouse.
Call for advice immediately if
They are under 3 months with any temperature of 38°C or above. This is a same-day medical assessment regardless of how well they seem. Call 111 or your GP now.
They are 3 to 6 months with 39°C or above. Also needs prompt medical advice.
There is a rash that does not fade under pressure. Press a clear glass against it. If it stays visible, call 999.
Breathing is fast, laboured or grunting. Or the skin is pulling in under the ribs or at the neck.
They are difficult to rouse, floppy, or unusually stiff. Or their cry is weak, high-pitched or continuous.
A fit or seizure, blue or mottled skin, a bulging fontanelle, or a stiff neck. Any of these means emergency care now.
If none of those apply
Offer fluids frequently - this is the most important thing. Keep them lightly dressed and the room at a normal temperature. Do not cold sponge them, do not use a fan on them, and do not strip them and let them get cold; none of these help and all can make things worse.
Paracetamol or ibuprofen may be given if your child is distressed, at the dose for their age and weight. They are for comfort rather than for the number, and they should not be given simply to bring the temperature down in a child who is otherwise coping. Do not give both at once unless a clinician has told you to.
Check on them through the night. Keep them in your room while they are unwell if they are not already.
Watch the child, not the thermometer. How they look tells you more than the number does.
Sleep during it
Expect it to be poor, and expect to do whatever is needed. Extra feeds, extra holding, sleeping in your room. This is not the moment for any part of a sleep plan, and nothing you do for a few nights of illness will undo months of work.
Taking a temperature properly
Under four weeks, use an electronic thermometer in the armpit. Over four weeks, an armpit reading or an infrared thermometer in the ear is fine. Forehead strip thermometers are not reliable and are not recommended, and neither is judging by touch - a hot forehead is a poor guide and a cool one does not rule a fever out.
Note the reading and the time, and take it again after an hour or so rather than repeatedly. What matters more than any single number is the direction and how your child looks alongside it. Write both down; if you end up calling 111 or a GP, the first question will be what the temperature has been doing.
What not to do
Do not cold sponge, do not use a fan directed at them, and do not strip them and let them get cold. All three were once standard advice and none are recommended now - cooling the skin makes the body shiver, which raises the core temperature rather than lowering it.
Do not give paracetamol and ibuprofen together unless a clinician has told you to, and do not wake a comfortably sleeping child to give either. Medicine is for a child in discomfort, not for the number on the thermometer. Aspirin should never be given to a child.
When to stop troubleshooting
Any of the signs above. Also call if the fever lasts more than five days, if your child is not drinking or has had no wet nappy for many hours, if they seem to be getting worse rather than better, or if you are simply worried and cannot say why. That last one is a legitimate reason to call and clinicians would rather you did.
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