High temperature (fever) in children

Children react to pathogens with a high temperature more often and quicker than adults. They are classed as having a high temperature from a body temperature of 38.5 degrees Celsius – infants up to 3 months from 38 degrees Celsius.

Many parents become concerned about their children when their temperature rises. High temperatures are one of the most common reasons for children being taken to a medical practice or emergency department. But most children simply have a harmless viral infection. They can be cared for at home and return to full health within 3 days: their body fights off the viruses of its own accord.

Only about 1 in 100 children with a high temperature has a serious condition that requires medical treatment. This is usually caused by a bacterial infection, for example of the lungs.

You can often see if children have a high temperature. Typical signs are:

• reddened face
• glazed eyes
• pale skin
• hot forehead and/or neck 
• loss of appetite

A visit to a medical practice or emergency department is advisable if:

• the high temperature exceeds 39 degrees Celsius (or 38 degrees Celsius in the case of infants).
• the high temperature recurs periodically or repeatedly.
• the high temperature lasts for more than 3 days.
• the child has a febrile seizure.
• the child has a stiff neck or seems apathetic, restless or confused.
• the child vomits or has diarrhea or abdominal pain.
• the child has a rash.
• the child refuses to drink anything for a prolonged period.
• the child’s condition has deteriorated since last visiting the doctor.

Several things can cause a child to feel hot despite not actually having a high temperature and being ill. For example, being particularly upset, running around a lot or being very warmly dressed. One reason for this is that children sweat less and later when warm than adults. A baby can also get a high temperature when teething.

A high temperature is usually caused by pathogens though and is a sign that certain metabolic and immune system processes are working at a higher speed than usual. This is the body’s way of fending off pathogens. In other words, a high temperature is not an illness.

There are several things that can cause a high temperature:

• Viruses or bacteria: these can lead to a common cold, middle ear infection, a urinary tract infection or gastroenteritis. They can also cause typical childhood diseases such as mumps, measles, rubella, scarlet fever or chickenpox.
• A vaccination: because the child’s immune system is developing antibodies.
• Dehydration: children get a high temperature because they have not drunk enough. This can also happen if a child suffers from a severe bout of vomiting or has diarrhea.
• Sunburn, sunstroke or skin conditions such as urticaria (hives).

Severe conditions like pneumonia, meningitis, appendicitis or an infection of joints or bone marrow are rarely the cause.

Very rarely, high temperatures are caused by metabolic disorders, rheumatic disorders or allergic reactions to food or medication.

If a child gets a high temperature after traveling to a far-flung destination, even if it was several weeks ago, it is important to notify a doctor. Targeted testing can be used to determine if the child could have become infected with a pathogen while traveling and if so, with which one.

Parents often worry that high temperatures can be dangerous. However, high temperatures only cause damage on real exceptions and rarely exceed 41 degrees Celsius. Higher temperatures can be dangerous but are rare.

Children with a high temperature sweat more. This can lead to dehydration. Medical attention is needed if the child refuses to drink. It may also be required if the following symptoms of dehydration persist:

• sunken fontanelle in infants
• dry mouth and lips
• sunken eyes
• no tears 
• child looks generally unwell

Febrile seizures are sometimes possible and most commonly affect children between the ages of 3 months and 5 years. A simple febrile seizure can be frightening but is usually harmless and only lasts for a few minutes. Despite this, it is still advisable to visit a doctor following a febrile seizure.

Healthy children have a body temperature of between 36.5 and 37.5 degrees Celsius. This changes over the course of the day: in the evening, the temperature is usually 0.5 degrees Celsius higher than in the morning. An elevated temperature can vary between 37.5 and 38.5 degrees Celsius.

A high temperature is anything over 38.5 Celsius or over 38 degrees Celsius in the case of babies under 3 months.

There are several ways to measure body temperature. The most important thing in relation to young children is that their temperature is measured quickly and with as little dressing, undressing and restraint as possible. Often, parents start by placing a hand on their child’s forehead or neck to see if it feels hot.

The body temperature can be precisely measured with a thermometer – ideally three times a day. Rectal measurements using a digital thermometer are the most reliable. Many parents also use an ear or forehead thermometer. Measurements should only be taken in the mouth or under the armpits once the child is at least 4 years old. How long a measurement takes depends on where the temperature is being measured and with what kind of thermometer. The product instructions will provide more precise information.

Further information on topics relating to high temperatures in children, such as how to correctly measure a child’s temperature, can be found at gesundheitsinformation.de.

It is not usually necessary to use anything to lower a high temperature.

However, treatment with antipyretic drugs such as paracetamol or ibuprofen in suppository or liquid form can be useful:

• in the case of a high temperature above 39.5 degrees Celsius.
• if the child feels extremely unwell.

Dosage information can be found on the package insert. The dosage depends on the child’s age and weight. If the child’s temperature does not fall within one to four hours despite medication, a doctor should be consulted.

Home remedies such as cold compresses or tepid baths are popular but only cool the exterior of the body. If these make the child feel better, there is no harm in using them but it is unclear whether they actually help reduce a high temperature.

A child with a high temperature should not be dressed too warmly. Otherwise, the heat may be unable to escape from the body.

Most children with a high temperature can be well-cared-for at home. There is no reason not to do this if:

• there are no signs of a serious condition
• a doctor has diagnosed the child with a harmless infection

Children with a high temperature need plenty of fluid. It is therefore important for them to drink regularly – even if still being breastfed. Children have a great feel of what is good for them. It therefore helps to focus on their needs and ask them things like what they would like to eat or drink.

Children may play all day despite having a high temperature. As long as they are not running around wildly, this is absolutely fine. However, children with a high temperature cannot go to playgroups, nursery or school. This also applies to children who appear otherwise healthy as they could infect other children.

Children with a high temperature almost always recover of their own accord. The best remedies are usually time, rest and loving care.