Fever: when to see a GP

A fever is one of the most common reasons Australian parents present to a GP or emergency department. Most of the time, a fever is not itself the problem. It is the body fighting something — usually a viral illness that will pass. The question is when to wait, when to call, and when to go.

What counts as a fever

A temperature of 38°C or above is a fever. Between 37.5°C and 37.9°C is a raised temperature — worth watching, not acting on. Temperatures below 37.5°C are normal variation.

Measurement matters. In children under three months, axillary (under-arm) or temporal artery (forehead) thermometers are reliable. Ear thermometers can be inaccurate in this age group. Rectal temperatures are the most accurate but are not usually necessary for routine fever checks.

Under 3 months — call the GP for any fever

This is a firm rule. Any fever of 38°C or higher in an infant under three months of age warrants a same-day medical review. The immune system at this age is too new to mount a reliable response, and a fever can be the first sign of a serious infection.

If you cannot get a GP that day, a paediatric emergency department is the right call — not an overreaction.

3 months to 3 years

A fever in a young child without obvious cause is more often a viral illness than anything else. The RACGP guidance emphasises assessing the whole child, not the number on the thermometer.

When to watch at home

• Fever up to 39°C.
• Child is still drinking fluids, still has wet nappies, still interacts when fever comes down with paracetamol.
• No rash. No breathing difficulty. No unusual drowsiness.
• Illness course is three to five days total, with daily fluctuations.

When to call the GP within the day

• Fever over 39°C sustained.
• Fever that has lasted more than three days.
• Child is reluctant to drink, fewer wet nappies, looking unwell even when the temperature is down.
• Rash appearing with the fever.
• Vomiting that is preventing any fluid intake.
• Ear pain, sore throat, cough that is worsening.

When to go to emergency — now

• A rash that does not fade when pressed (glass test) — possible meningococcal.
• Stiff neck, strong dislike of light, persistent severe headache.
• Fast or laboured breathing.
• Blue lips or unusually pale skin.
• A seizure of any kind, including a febrile seizure.
• Unusual floppiness or drowsiness — hard to rouse, or not making eye contact.
• Your gut says this is different. Parents are often right. Emergency triage is set up for this.

Febrile seizures

A febrile seizure is a convulsion triggered by a fever, usually in children aged six months to five years. It is terrifying to watch. It is usually harmless. Roll the child onto their side, time the seizure, do not put anything in their mouth. A first febrile seizure warrants an ED review. Subsequent simple febrile seizures usually do not need an ED visit unless they are prolonged (over five minutes) or unusual.

Medication — what actually helps

Paracetamol (Panadol, Dymadon) or ibuprofen (Nurofen, over 3 months) can be given at appropriate doses to reduce fever if the child is uncomfortable. The goal is comfort, not normothermia — a child who looks okay with a fever of 38.9°C does not need medication every four hours just to bring the number down.

Dose by weight, not by age. Read the pack. Do not alternate paracetamol and ibuprofen unless advised by a GP — it is rarely needed and increases the chance of dosing error. Never give aspirin to a child for fever — risk of Reye's syndrome.

The rest of the care

• Offer fluids frequently — water, breastmilk, formula, rehydration solution. Small sips are fine. Hydration matters more than food.
• Do not force eating. A child with a fever often does not want to eat, and that is okay for a day or two.
• Light clothing, comfortable room temperature. Do not over-rug.
• Rest. Their body is doing real work.
• Monitor. Not obsessively — but know where the temperature, the wet-nappy count, and the general energy are tracking.