When a child's fever needs the hospital tonight, and when it can wait

A fever can make a child look miserable and leave a parent unsure whether to wait, call a doctor or go straight to hospital. The temperature matters, but the child's age, breathing, alertness, drinking and other symptoms often tell you more about how urgent the situation is.

A high temperature is generally 38°C or above. Fever is a response to illness, not a diagnosis by itself. Viral infections are common, but malaria, bacterial infections and other conditions can also cause fever. In Lagos, it is safer to have a child assessed than to assume every fever is malaria or begin treatment without appropriate advice or testing.

When a fever should not wait until morning

Take your child for urgent medical assessment now if any of the following applies:

• The child is younger than three months and has a temperature of 38°C or higher.
• The child is three to six months old and has a temperature of 39°C or higher.
• Breathing is difficult, unusually fast or noisy, the ribs pull in with each breath, or the lips look blue or grey.
• The child is very sleepy, difficult to wake, confused, unusually floppy or not responding normally.
• There is a seizure, severe headache, stiff neck, persistent vomiting or strong sensitivity to light.
• A new rash does not fade when a clear glass is pressed firmly against it.
• The child cannot drink, repeatedly vomits fluids, passes much less urine, has a very dry mouth or has no tears when crying.
• The child has severe pain, looks very pale or mottled, or is getting worse quickly.

You do not need to wait for every sign on this list. A parent who feels that a child is seriously unwell should seek help, even if the thermometer reading does not look especially high.

Why age and behaviour matter so much

Young babies can become seriously unwell quickly and may show fewer obvious symptoms. That is why any temperature of 38°C or above in a baby under three months needs prompt assessment.

In an older child, look beyond the number. A child who has a fever but is alert, makes eye contact, drinks and occasionally plays is usually less concerning than a child with a lower temperature who is difficult to wake, struggling to breathe or refusing every drink.

Check the temperature with a reliable digital thermometer and write down the reading, the time and where it was measured. Tell the clinical team about medicine already given and whether the temperature changed afterwards.

What to do if your child has a seizure

Some young children have a febrile seizure during a fever. It can be frightening, but your immediate actions should focus on safety.

• Place the child on a safe surface and move hard or sharp objects away.
• Protect the head with something soft.
• Do not hold the child down and do not put a spoon, finger, medicine or anything else into the mouth.
• Note the time the seizure begins.
• After the movements stop, place the child on their side and check that breathing is comfortable.

Seek emergency help if it is the child's first seizure, it lasts more than five minutes, breathing is difficult, movements affect only one side, another seizure begins soon afterwards, or the child does not recover normally.

Safe care at home when there are no warning signs

Offer fluids regularly. Breastfed babies should continue breastfeeding. Older children can take water, oral rehydration solution or their usual suitable fluids in small, frequent amounts. Food is less important for a short period than drinking and passing urine.

Dress the child comfortably and keep the room well ventilated. Do not use ice baths, very cold water or alcohol rubs. Check the child during the night and watch for any new warning sign.

Paracetamol or ibuprofen may help when a child is distressed or uncomfortable, but the correct product and dose depend on age, weight, medical history and the strength printed on the package. Follow the label or a clinician's instruction. Do not give aspirin to a child, do not exceed the stated dose, and do not routinely alternate medicines unless a clinician has specifically advised it. If you are unsure of the dose, ask before giving it.

When to arrange a medical review even if it is not an emergency

Contact a clinician if the fever continues for five days, keeps returning, or comes with ear pain, painful urination, persistent cough, worsening sore throat, joint swelling or another symptom that concerns you. Children with sickle cell disease, immune problems, cancer treatment or another serious long-term condition may need earlier review based on their care plan.

A doctor may need to examine the child and decide whether tests for malaria, urine infection or another cause are appropriate. Antibiotics do not treat viral infections and should not be started without a clinical reason.

What to bring to the hospital

• The temperature readings and when the fever started
• Every medicine given, including the name, strength, dose and time
• The child's current weight if known
• Any recent test result, discharge note or immunisation record that may be relevant
• Details of drinking, vomiting, urine output, stool and any rash or seizure

If you are worried about a child with fever, call SkyHigh Medical Centre on 0808 974 9877. For severe symptoms, come for emergency assessment without waiting for an online consultation.