Fever in children: When to treat at home and when not to

1. What to ask

How old is the child and what do they weigh? The dose is worked out by weight, not by age.
How long have they had a fever and what was the highest temperature?
How are they when the fever comes down? Are they playing, eating and drinking, or still listless?
Do they have other symptoms: vomiting, diarrhoea, cough, difficulty breathing, a rash, earache or pain passing urine?
What have they already been given, how much and at what time? Do they have any long-term condition?

2. Refer if any of these appear

Under 3 months old with 38 °C or more: seen by a doctor or emergency department the same day, without giving an antipyretic before they are assessed.
A rash that does not fade when pressed, a stiff neck, or a child who is very listless or drowsy even when the fever comes down: emergency department.
Difficulty breathing, ribs drawing in or grunting when breathing.
Signs of dehydration: hardly any wet nappies, crying without tears, a dry mouth.
A fit, fever for more than 3 days, or a child with a long-term condition or weakened immunity.

3. If there are no red flags

Child aged 3 months or more who is otherwise well

Paracetamol 10-15 mg/kg per dose every 4-6 hours, no more than 60 mg/kg a day.
From 3 months, ibuprofen 5-10 mg/kg per dose every 6-8 hours (maximum 40 mg/kg a day), if there is no vomiting or dehydration.
The dose in mL depends on the strength of the product: it is worked out from their weight and measured with the syringe from that same pack.

If the fever does not come down with one of them

First check that the dose is right for their weight: it is the most common mistake.
Do not routinely alternate the two: it increases dosing errors and does not improve the outcome.
If they are still unwell at the right dose, they should be seen by a doctor.

What is always done

Offer fluids often.
Light clothing and no extra layers. No cold baths and no rubbing with alcohol.
The aim is for them to be comfortable, not to reach a particular number on the thermometer.

4. Adjust to who will take it

Children: Under 3 months: always seen by a doctor, the same day. For everyone else, the dose comes from their current weight, not from last time.
Asthma: If an anti-inflammatory has ever made their asthma worse, no ibuprofen: paracetamol.
Long-term conditions: With a long-term condition, weakened immunity or a treatment that lowers it, a fever is always assessed by their doctor.

What not to recommend

Aspirin in under-16s: risk of Reye syndrome.
Dosing by age, or with a kitchen spoon instead of the syringe in the pack.
Giving an antipyretic together with a children's cold remedy that contains the same active ingredient.
Metamizole without a prescription.

What to say at the counter. Work out the dose from their weight, measure it with the syringe in this pack and watch how they are when the fever comes down: if they play and drink, that is reassuring; if they are still listless, see the doctor.

Pharmacy Pills · conveniodefarmacia.com

Patient sheet: fever in children

To print and hand over. It carries only what the patient needs at home.

Give the fever medicine at the dose for their weight and measure it with the syringe in the pack.
Write down the time and dose of each one.
Offer fluids often and do not wrap them up too much.
Go to the emergency department if they are under 3 months old, have a rash that does not fade when pressed, find it hard to breathe, are very listless, are hardly passing urine or have a fit.
See the doctor if the fever lasts more than 3 days.

Fever in children

What this protocol covers