Fever in Children: What to Record, When to Worry
A child's fever produces one of the most common parental questions to any doctor: is this normal, is it dangerous, when should I worry? The specific pattern — how high, how long, what other symptoms, how the child looks — matters more than any single number. A recorded fever chart across the illness turns a hazy 'she had a temperature' into a specific timeline the doctor can act on.
What temperature actually means
- Normal: 36.5-37.5°C (97.7-99.5°F).
- Low-grade fever: 37.5-38.5°C (99.5-101.3°F).
- Moderate: 38.5-39.5°C.
- High: 39.5-40.5°C.
- Very high: > 40.5°C.
Age-specific fever thresholds for concern
- Age: < 3 months · Threshold triggering same-day medical review: Any fever ≥ 38°C — emergency
- Age: 3-6 months · Threshold triggering same-day medical review: ≥ 39°C or persistent
- Age: 6 months - 2 years · Threshold triggering same-day medical review: ≥ 39°C with poor feeding/lethargy
- Age: 2-5 years · Threshold triggering same-day medical review: > 39.5°C or lasting > 3 days
- Age: Any age · Threshold triggering same-day medical review: With rash, breathing difficulty, dehydration
What to track during the illness
- Temperature reading with time and route (oral, axillary, rectal, tympanic).
- Any medicine given, dose, time.
- Response — did the temperature drop, by how much, for how long.
- Fluid intake.
- Wet nappies or urination frequency.
- Feeding — normal, reduced, refusing.
- Activity level — playful, lethargic, difficult to rouse.
- Other symptoms — cough, vomiting, rash, ear pulling, complaints.
Symptoms that always warrant emergency care
- Any fever in an infant under 3 months.
- Difficulty breathing or fast breathing.
- Blue lips or extremities.
- Extreme lethargy or difficulty rousing.
- Persistent vomiting.
- Signs of dehydration — sunken eyes, dry mouth, no urine for 8+ hours.
- Non-blanching rash (spots that don't fade under pressure).
- Stiff neck, sensitivity to light.
- Seizure.
- Persistent crying inconsolable.
- Fever > 40.5°C not responding to medicine.
Fever medication basics
- Paracetamol 15 mg/kg every 4-6 hours (max 60 mg/kg/day).
- Ibuprofen 5-10 mg/kg every 6-8 hours (> 6 months only).
- Alternating them not usually needed.
- Sponging with lukewarm water can help.
- Don't overdress or under-dress the child.
- Never aspirin in children (Reye's syndrome risk).
The specific value of the fever log
- Pattern of fever (constant, intermittent, evening-peaking) suggests different causes.
- Response to medicine tells doctor if bacterial vs viral is more likely.
- Duration decides investigation urgency.
- Associated symptoms guide diagnosis.
A 5-day fever log with times, temperatures, and responses is what a paediatrician reads first at the visit. A description of 'she had a fever for a week' with no specifics is much harder to act on.
References
Free for 90 days, no card needed. After that, keeping the record costs ₹349 for the year.
General information, not medical advice. Always talk to a qualified doctor about your own care. Where this and your doctor disagree, your doctor is right.