In brief
- A fever is a body temperature of 38 degrees Celsius or higher.
- Call your general practitioner immediately if your child has a fever and:
- is less than 3 months old (and the fever is not due to a vaccination)
- has a heart or lung disease or diabetes mellitus
- uses medication that weakens the immune system
- has a weaker immune system, such as a child with Down’s syndrome
- has missed a vaccination at the well-baby clinic (consultatiebureau)
- If your child has a fever, make sure to watch for other symptoms. Check on your child regularly.
- Is your child behaving differently than usual?
- Is your child drowsy, having trouble breathing or crying inconsolably? Or does your child look grey or ashen?
- Does your child have red spots that do not go away when you press on them?
- Is your child vomiting repeatedly (a few times an hour)?
- Is your child refusing to drink or not peeing (urinating) enough?
- Is your child getting sicker or getting worse?
- These are warning signs. Phone your general practitioner immediately.
- Dutch healthcare practices in general may differ from what you are used to in your home country. Learn more.
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Fever in a child
Fever is common in children, especially in children less than 5 years old.
Your child has a fever if their body temperature is 38 degrees Celsius or higher.
How to take your child's temperature
Take the temperature rectally (in the bottom). This is the most accurate method.
An ear thermometer is less accurate and should not be used for children less than 3 months old.
Taking the temperature once a day is enough for a child who is not very sick. You do not have to take your child’s temperature if they don’t feel sick (anymore).
How high?
Body temperature always rises a little in the evening, also in children with a fever.
During an infection, the body temperature can increase up to 40 or 41 degrees Celsius. That is nothing to worry about. Fever is not harmful to the body or the brain. As long as the body can get rid of the heat, the temperature rarely rises above 41 degrees.
The temperature itself doesn’t say much about the severity of the illness. Do watch for other symptoms to see if your child is very sick. It is not necessary to keep taking your child’s temperature.
How long?
The fever can last several days. How long the fever lasts doesn’t say much about the severity of the illness. Once the body has overcome the infection, the temperature drops again.
How does fever develop in children?
Fever is a normal reaction of the body to a viral or bacterial infection. Fever probably helps fight the infection. At a higher temperature, the body produces more antibodies against viruses and bacteria.
Fever is usually caused by a harmless viral infection. For example, a cold with a sore throat and a cough.
Fever can also be caused by a bacterial infection.
Sometimes fever can also be a sign of a serious infection. For example, pneumonia or meningitis. But that is much less common.
Fever can also develop after vaccination (in Dutch) at the well baby clinic. The body reacts to this by producing antibodies (just like it does for an infection). If your child later comes into contact with the real bacteria or virus, they are prepared for it and will not get sick. And that’s precisely the purpose of the vaccination.
Most vaccines can cause fever in the first 2 days. The MMR (measles, mumps and rubella) vaccine (BMR in Dutch) sometimes causes fever after 5 to 12 days.
What can you do yourself if your child has a fever?
Fever itself is not a cause for concern. Do always watch your child for other symptoms.
- Give your child extra drinks. Or an ice lolly. The fever and sweating can cause your child to lose a lot of fluids.
Eating is less important. Don’t force your child to eat. - Make sure your child gets enough rest. They don’t have to stay in bed, and can also go outside.
- The body needs to be able to lose the heat. So dress your child in thin, loose-fitting clothes. In bed, a sheet is often enough. If your child is cold or shivering, you can cover them with a blanket for a little while’.
Doctors do not recommend sponging the skin with cold water or placing a cold wet cloth (compress) on the skin to cool down. - Make sure there is a parent (or other adult) at home who regularly checks on your child.
- Is your child playing, laughing, looking and reacting normally? Is your child breathing calmly and regularly? Does your child have a healthy skin colour? Is your child drinking and peeing normally? Then your child probably isn’t very sick.
- Sometimes a child with a fever can become sicker quickly. In that case, it is important that someone notices this. So also keep watching your child for other symptoms. This way you will soon notice if your child gets sicker. Call your general practitioner immediately if your child has one or more of these symptoms:
- Your child becomes drowsy.
- Your child is breathing faster or wheezing.
- Your child’s lips turn blue or their face turns pale and grey or ashen.
- Your child develops red spots that do not go away when you press on them.
- Your child is not peeing or drinking enough.
- Your child is crying inconsolably.
- Your child is acting differently than usual.
- Your child is getting worse and worse.
- This booklet (in Dutch) can help you to find the recommendations for your child. You can read the booklet yourself or with your general practitioner
Febrile seizure (febrile convulsion)
Sometimes, children between 6 months and 6 years old with a fever can develop a febrile seizure (in Dutch). Your child becomes stiff and it arms and legs suddenly start shaking. This can understandably be frightening for you, but stay calm. Most of the time, a febrile seizure is not harmful. This is what you should do:
- Use a finger to make sure your child’s mouth is empty.
- Place your child on its side.
- Make sure your child cannot fall or bump or hurt themselves.
- Then phone your general practitioner immediately.
Only fever with no other symptoms?
Does your child only have a fever with no other symptoms, such as coughing, runny nose, earache or diarrhoea?
Then it could have a urinary tract infection (UTI). In this case you should phone your general practitioner.
Sometimes the doctor will ask you to collect your child’s urine and bring it to the doctor’s office. This can be difficult with young children. Click here to read how to collect the urine in a clean container (in Dutch). If that doesn’t work, you can buy urine collection bags from the pharmacy.
Medication for fever in children
Reducing the fever is not necessary
Parents often want to give medication to reduce the fever. This is not necessary and not useful. Fever is not a cause for concern. Fever probably helps to fight infection.
Medication does not help reduce the chance of a febrile seizure either.
Only give paracetamol (acetaminophen) for fever with pain
Does your child feel very sick? Is your child in pain? Or drinking less than usual? Then you can give paracetamol. Your child will often feel a bit better after half an hour. This is because the paracetamol relieves the pain.
Paracetamol usually also reduces the fever. If your child’s fever does not drop, that is not a cause for concern. You only give paracetamol to relieve the pain and not to reduce the fever.
Children over 1 year old can be given ibuprofen for pain for a short period of time instead of paracetamol. Doctors recommend giving paracetamol, because they and parents have more experience with it.
How much paracetamol (or ibuprofen) you can give depends on your child’s age and weight. Read the instructions on the package carefully. Contact your general practitioner if the indicated dose does not relieve the pain enough.
An explanation on how to insert a suppository can be found at apotheek.nl (in Dutch).
Antibiotics?
Antibiotics usually are not necessary for fever. Fever is often caused by a virus, and antibiotics are not effective against viruses. Antibiotics are effective against bacteria, but the body can often clear bacteria on its own. In that case, antibiotics are not necessary.
Read more about use of medication in the Netherlands here.
What happens next when a child has a fever?
The fever can last several days. Half of the children with fever still have a fever on the 4th day, and a quarter of the children still have a fever on the 7th day. The duration of the fever doesn’t say much about the severity of the illness. Most viral infections go away on their own.
Do keep watching for other symptoms (in Dutch). Even if you have taken your child to see your general practitioner. Sometimes a child with a fever can suddenly become sicker. The chance is small, but in that case you should call your general practitioner or out-of-hours service (huisartsenpost) immediately.
When to contact your general practitioner if your child has a fever
Contact your general practitioner or out-of-hours service immediately if your child has a fever and:
- is less than 3 months old (and the fever is not due to a vaccination)
- has a heart or lung disease
- has diabetes mellitus
- uses medication that weakens the immune system
- has a weaker immune system due to Down’s syndrome
- has been abroad (in a subtropical country) in the last 4 weeks.
These children are more likely to become very sick in case of an infection. The doctor will want to examine your child, even if they do not have any other symptoms yet.
Also contact your general practitioner:
- if your child has had a fever for 5 days;
- or if your child has had a fever and has missed a vaccination at the well baby clinic. This is because of the risk of a serious childhood illness.
The following applies to all children with fever:
Contact your general practitioner or out-of-hours service immediately if your child has a fever and one of the following warning signs:
- drowsy or difficult to wake up;
- groaning or crying inconsolably;
- having trouble breathing or breathing differently (breathing faster, wheezing, breathing loudly and drooling, or not breathing for short periods of time);
- a pale grey (ashen) or blotchy skin colour or blue lips;
- red spots that do not go away when you press on them (on the trunk, arms, legs or the whites of the eyes or the inside of the eyelids);
- gets sicker in a short period of time (different to how you have seen your child sick before);
- gets sicker and vomits repeatedly (several times an hour; with or without diarrhoea);
- drinks a lot less than usual (less than half of what the child usually drinks);
- has not peed or had a wet nappy for half a day;
- arms and legs start shaking or has convulsions (febrile seizure);
- a swollen arm, leg or joint, which the child is unable to use properly;
- develops fever again after being fever-free for a few days.
More information about children with fever
The information about children with fever is based on the scientific guideline for general practitioners, the NHG-Standard Children with Fever (in Dutch).
Read more about your child with fever in this booklet (in Dutch). You can find more information, advice and tips here.