If your child has a fever, the most important first step is checking their temperature accurately and then matching your response to their age and how they look and act. A fever is a rectal, ear, or forehead temperature of 100.4°F (38°C) or higher. Most childhood fevers are caused by common viral infections, last three to five days, and resolve on their own with basic comfort care at home.
That said, certain ages and certain symptoms turn a routine fever into something that needs medical attention right away. Here’s how to handle it from start to finish.
How to Take an Accurate Temperature
The method you use matters. A rectal thermometer is the most accurate option for babies and toddlers. For older children, an oral reading of 100°F (37.8°C) or higher also counts as a fever. Armpit readings register a fever at 99°F (37.2°C), but they’re the least reliable. If an armpit reading seems off, confirm it with a different method.
Digital thermometers are inexpensive and fast. Forehead (temporal artery) and ear thermometers are convenient for squirmy toddlers and give readings comparable to rectal temperatures. Whichever tool you use, take the reading when your child has been resting for a few minutes, not right after a bath or bundled in blankets, since both can skew the number.
When a Fever Needs Immediate Medical Care
Age is the single biggest factor in how seriously to treat a fever. Any baby under 28 days old with a rectal temperature of 100.4°F or higher needs emergency evaluation, period. At that age, even a low-grade fever can signal a dangerous infection, and newborns don’t always show obvious signs of being sick. Doctors will typically admit a febrile newborn to the hospital for testing regardless of how well the baby appears.
For infants between 1 and 3 months, the threshold is a bit more nuanced. A baby in that age range who looks sick (abnormal cry, extreme sleepiness, rectal temperature above 101.3°F) or who has risk factors for serious bacterial infection also needs prompt medical evaluation and possible hospital admission. A well-appearing baby in this range with a lower fever can sometimes be monitored more conservatively, but your pediatrician should still be called the same day.
For children 3 months to 3 years old, a temperature above 102.2°F (39°C) with no obvious source, like a runny nose or ear pain, warrants a call to your doctor. Children who aren’t fully vaccinated carry a higher risk of hidden bacterial infections at these temperatures.
Red Flags at Any Age
Regardless of the number on the thermometer, call your doctor or go to the emergency room if your child shows any of these:
- Extreme sleepiness or unresponsiveness: not just tired, but difficult to wake or not making eye contact
- Inconsolable crying: nothing calms them down, and the cry sounds different than usual
- Difficulty breathing: flaring nostrils, ribs pulling in with each breath, or breathing that sounds labored
- A rash that doesn’t fade when pressed: flat purple or red spots (petechiae or purpura) that stay visible when you press a glass against the skin can signal a serious blood infection
- Stiff neck or pain when bending the head forward: in children over 3, this is a reliable sign of possible meningitis
- Poor appetite combined with lethargy and irritability: any combination of these suggests the illness may be more than a simple virus
If the fever keeps climbing, your child starts looking worse, or new symptoms appear, go back to the doctor even if you were just seen.
Comfort Care at Home
A fever itself isn’t dangerous in most cases. It’s actually part of your child’s immune response. The goal of home treatment isn’t to eliminate the fever entirely but to keep your child comfortable enough to rest and drink fluids.
Dress your child in lightweight clothing and keep the room at a comfortable temperature. Piling on blankets to “sweat it out” doesn’t help and can actually push their temperature higher. If your child is shivering, a single light blanket is fine until the shivering passes.
A lukewarm sponge bath can bring some temporary relief, but it works best when combined with fever-reducing medication. On its own, the temperature tends to bounce right back up once the bath is over. Never use cold water, ice, or rubbing alcohol. These cause shivering, which forces the body to generate more heat and makes things worse.
Keeping Your Child Hydrated
Fever increases fluid loss through sweat and faster breathing, so dehydration is the most common complication to watch for. Offer small, frequent sips rather than large amounts at once, especially if your child is also vomiting or has diarrhea. Water is fine for older children. For babies and toddlers who are vomiting or have diarrhea, an oral rehydration solution replaces lost water, sugar, and electrolytes more effectively than water or juice alone.
Watch for these signs of dehydration:
- Fewer wet diapers: no wet diaper for three hours or longer in an infant
- Dry mouth and no tears when crying
- Sunken eyes, cheeks, or the soft spot on top of a baby’s skull
- Skin that stays “tented” after a gentle pinch instead of flattening back immediately
- Unusual crankiness or low energy
If you notice several of these together, your child needs medical attention to prevent the dehydration from getting worse.
Fever-Reducing Medication
Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are the two options for bringing a fever down. Acetaminophen can be used at any age. Ibuprofen should not be given to babies younger than 6 months, as it hasn’t been proven safe for that age group and isn’t FDA-approved for it.
Dosing is based on your child’s weight, not their age. If you know your child’s current weight, use that to find the correct dose on the product’s packaging chart. If you’re unsure, use age as a backup, but weight is more accurate. For children under 12, acetaminophen can be given every 4 hours, up to 5 doses in 24 hours. Ibuprofen can be given every 6 to 8 hours.
Never give aspirin to a child or teenager. It’s linked to a rare but serious condition called Reye’s syndrome that affects the brain and liver.
Should You Alternate Medications?
Many parents have heard about alternating acetaminophen and ibuprofen every few hours. Despite how common this advice is, there’s no evidence that alternating is safer or more effective than using a single medication. The bigger concern is practical: juggling two different drugs on two different schedules (every 4 hours for one, every 6 to 8 for the other) creates real confusion, and the risk of accidentally overdosing on one of them goes up. Sticking to one medication at a time is the safer approach.
What to Know About Febrile Seizures
Febrile seizures happen in about 2 to 5 percent of children, typically between 6 months and 5 years old. They’re triggered by a rapid rise in body temperature rather than by how high the fever gets. Watching your child have a seizure is terrifying, but most febrile seizures are what doctors call “simple”: they involve full-body stiffening and shaking, last under 15 minutes (usually just one to two minutes), and don’t recur within 24 hours.
If your child has a seizure, place them on their side on a flat surface, away from anything they could hit. Don’t put anything in their mouth. Time the seizure on your phone. If it lasts longer than 5 minutes, call 911. After a first febrile seizure, your child should be evaluated by a doctor even if they recover quickly, to rule out other causes. The reassuring news is that simple febrile seizures don’t cause brain damage and don’t mean your child has epilepsy.
How Long a Fever Typically Lasts
Most viral fevers in children range between 100.4°F and 104°F and resolve within three to five days. The fever often peaks in the late afternoon or evening and dips in the morning, which can create a frustrating cycle where your child seems better, then worse, then better again. This is normal.
If the fever persists for five days or more, especially if your child isn’t improving overall, your doctor may want to investigate further with blood work or other tests. A fever that goes away for 24 hours and then returns can also signal a secondary infection, like an ear infection developing after a cold, and is worth a follow-up call. The best gauge of how your child is doing isn’t the thermometer alone. It’s how they act between fever spikes. A child who perks up, plays a bit, and drinks fluids when the fever comes down is generally on the right track.