Child with a fever: clinic or hospital? The signs that mean hurry

What counts as a fever, and how much the number matters

An armpit temperature from 37.5°C, or an ear or rectal temperature from 38°C, is a fever. How high it goes does not reliably reflect how serious the illness is. A child at 40°C with an ordinary cold may still be running around, while a child at 38.5°C who is listless and refusing to drink may be sicker. Doctors look at how the child seems once the fever comes down with medicine: if they go back to playing and smiling, it is usually not a serious illness.

The exception is a baby under 3 months, where the number matters a great deal. Their immunity is immature and serious infections show few outward signs, so any temperature of 38°C or more at this age needs a doctor immediately, every time. Do not give fever medicine and wait to see.

Danger signs: go to the emergency room now, do not wait

• Under 3 months old with a temperature ≥38°C
• A seizure or jerking, even if it has stopped
• Very drowsy, hard to wake, unresponsive, or an unusual high-pitched cry
• Fast breathing, laboured breathing, ribs pulling in, flaring nostrils, or blue lips, fingers or toes
• Purple-red spots or blotches that do not fade when pressed with a clear glass
• Stiff neck, cannot bend the chin to the chest, or a bulging tense fontanelle in a baby
• Repeated projectile vomiting, or green vomit
• Dehydration: no urine for over 8 hours, dry mouth, crying without tears, sunken eyes
• Dengue warning signs: severe abdominal pain, persistent vomiting, nosebleed or bleeding gums, cold hands and feet, restlessness, especially as the fever starts to fall

Good to know: If you are not sure whether it qualifies, treat it as if it does. Going to the emergency room and being told it is nothing serious is better than waiting and missing something. Call 1669 at any hour.

When the clinic is the right place, not the hospital

A child over 3 months who has a fever but, once it comes down, still plays, smiles, drinks water or milk, and has none of the danger signs above most likely has a self-limiting viral infection. A neighbourhood clinic has advantages here: short waits, no time in a crowded emergency department alongside seriously ill patients, and a doctor with more time to examine and explain.

Come within 24 hours if: fever for more than 2–3 days with no sign of easing · heavy cough or wheezing · complaining of earache, severe sore throat or difficulty swallowing · painful or unusually frequent urination · more than 5–6 loose stools a day · a rash with the fever · a fever that comes back high after 1–2 days of improvement, which can signal a secondary bacterial infection.

Mongkhondee Clinic sees children for general illness, offers nebuliser treatment for wheezy or tight-chested children, and does basic blood tests when needed, such as a complete blood count when dengue is suspected. If the doctor judges that a hospital is the right place, we say so plainly with the reason. We are open until 20:00 on weekdays, so you can come after work.

Managing a fever at home correctly

Good to know: Never give aspirin to children. It risks Reye's syndrome, which can be fatal. During the rainy season, when dengue circulates, avoid ibuprofen until a doctor has examined the child, because it increases the risk of bleeding.

How many days of fever before seeing a doctor

Fever from a common virus rarely lasts more than 3 days. If the fever is still high on day 3 or not trending down, have the child seen even if they look well, because some infections, such as urinary tract infection in toddlers or dengue, have no specific signs in the first days. Fever beyond 5 days must always be assessed, and so should a fever that goes away and returns.

With dengue the most dangerous window is days 3–7, particularly as the fever falls. Read dengue symptoms and danger signs, and for a small child with a wheezy cough, RSV in young children.

What to bring for the doctor

• When the fever started, the highest temperature, and the time of the last dose of medicine
• Every accompanying symptom, however minor: rash, loose stools, less urine
• Medicines already given, with the bottle or a photo of the label
• The vaccination book, to see whether the child is protected against the suspected illness
• Exposure history, for instance flu or hand-foot-and-mouth going round at school
• Your child's most recent weight, for accurate dosing

Preventing fevers with vaccines

Many childhood fevers come from diseases with a vaccine: flu, pneumococcal pneumonia, chickenpox and dengue. Keeping vaccines up to date reduces the number of 2 a.m. temperature checks. Read optional vaccines for children and see children's vaccines.