Choosing Wisely - Fever in children

Should I give my child painkillers for their fever?

People often want to give their child medicine, such as paracetamol or ibuprofen, to bring down the fever. This is not necessary, unless your child is distressed.

A fever is the body’s normal response to an infection, and fever can help slow the growth and spread of bacteria. So fever is a sign that your child’s immune system is doing its job – there is no need to try to bring down the fever.

If your child is in pain or is distressed, then painkillers can help them feel better. So if your child has a fever but is playing and happy, there is no need to give them paracetamol or ibuprofen. If your child has a fever and is miserable, paracetamol or ibuprofen can help.

• Children older than 1 month can take paracetamol.
• Children older than 3 months can take ibuprofen.
• The correct dose of paracetamol or ibuprofen for children who have pain or fever is worked out according to how much your child weighs.
• Paracetamol and ibuprofen should not be given at the same time.
• Do not give aspirin for pain or fever to children younger than 16. This can lead to Reye’s syndrome, which is very rare but can cause serious brain and liver damage.

Too much paracetamol can be dangerous

If you give your child paracetamol, you need to make sure you give the right dose. Too much paracetamol can damage your child’s liver. The right dose depends on:

• Your child’s weight
• The strength of paracetamol you are using. There are two strengths available in NZ (120mg/5mL and 250mg/5mL).

You can use the dosing table below to work out how much you should give your child:

Don’t give your child more than 4 doses in any 24 hours, and make sure you wait at least 4 hours between doses.

For more information about using paracetamol safely, please see:
https://www.kidshealth.org.nz/paracetamol

An online calculator to work out the right dose can be found:
https://www.healthnavigator.org.nz/tools/p/paracetamol-dose-calculator/

Does a fever mean my child needs antibiotics?

A fever does not mean your child needs antibiotics.

• Antibiotics only work to kill bacteria. Most children with fever do not have a bacterial infection, so antibiotics will not help them.
  
• Antibiotics have side-effects and shouldn’t be taken unless you really need them.
  
• Using too many antibiotics causes bacteria to become resistant, making them harder to kill, which is a serious problem for all of us.
  

For these reasons, antibiotics shouldn’t be given unless your child has a bacterial infection.

Does treating a fever reduce the risk of seizures?

Sometimes, children with fever may have a fit or seizure because of the fever. This is called a “febrile convulsion”. Medicine to bring down a fever, such as paracetamol and ibuprofen, does not help to reduce the chance of your child having this type of complication.

When should I take my child to the doctor?

• Babies under 3 months of age with a temperature above 38°C need to be checked by a doctor.
• Older children with a temperature above 40°C should also be seen by a doctor.
• If your child has a fever and any of these warning signs, see your doctor urgently: Rash, unusual sleepiness or floppiness, pain, irritability or persistent crying, inability to swallow, breathing difficulty, vomiting or loss of appetite.
• If you are worried about your child, whether or not they have a fever, you should take them to a doctor.

Check with your doctor or phone Healthline on 0800 611 116 if you are worried.

For more information about fever in children, visit HealthNavigator.org.nz or KidsHealth.org.nz.

It’s OK to ask questions

If you have questions about your symptoms or the medicines managing your symptoms, speak with your health professional.

Supporting evidence

For a list of supporting evidence for the issues discussed in this resource, please see:

• http://choosingwisely.org.nz/professional-resource/pchd/
• http://www.choosingwisely.org.au/recommendations/acn/

Developed by Choosing Wisely New Zealand, 2018. Choosing Wisely does not assume any responsibility or liability arising from any error or omission or from the use of any information in these resources.