A child’s fever at night: what to do in the first hour

Fever in a child almost always arrives in the evening. It is not your imagination: body temperature genuinely runs higher in the late afternoon and evening, so an illness that was quiet all day announces itself around bedtime, once every clinic on the island has closed.

Most of these fevers are viral and settle on their own. The purpose of this page is not to tell you that everything is fine. It is to give you an order to do things in, and the short list of signs that mean the answer is no longer ‘wait until morning’.

The number matters less than the child

A parent’s first instinct is to read the thermometer and decide from the figure. Doctors do close to the opposite. A two-year-old at 39°C who is cross but drinking, looking at you and still interested in something is in a better position than a child at 38.2°C who is limp, refusing fluids and difficult to rouse.

Write the number down, because the pattern across the evening is useful. But when you describe your child on the telephone, describe the child: how they are breathing, whether they are drinking, whether they are alert, what their skin looks like.

The first hour

1. Take the temperature, and note the time

Under the arm or in the ear, whichever your thermometer is made for. One reading tells you very little; three readings across an evening tell a doctor a good deal.

2. Offer fluids, little and often

Small amounts frequently stay down better than a full glass. Water, milk for a baby who takes it, oral rehydration solution, diluted juice. Wet nappies, or ordinary trips to the toilet, are the reassurance you are looking for.

3. Uncover, but do not strip

One light layer and a cool room, without a pile of blankets. Do not use a cold bath, ice or an alcohol rub. They make a child shiver, and shivering is how the body raises its temperature. You end up further from where you wanted to be, with an unhappy child as well.

4. Paracetamol for comfort, not to chase the number

The aim is a child comfortable enough to drink and to sleep, not a thermometer reading of 37. Dose by weight, following the instructions on the packet or your pharmacist’s advice, and keep to the intervals. Never give aspirin to a child. If you are not sure what your child should have, ask before you give it. That is a perfectly reasonable thing to telephone about at any hour.

5. Then look again in an hour

This is the step people skip. Once the paracetamol has had time to work, look at your child again: are they drinking, are they responding, do they look better than they did? That comparison is the single most useful thing you can tell a doctor.

Call a doctor tonight if

• Your child is under three months old and has any fever at all
• The fever has been going for more than three days
• They will not drink, or they have not passed urine for many hours
• They are far more drowsy, or far more irritable, than usual even after paracetamol
• There is persistent vomiting, or a bad headache with a stiff neck
• The breathing looks fast or laboured
• Something is not right and you cannot say what

That last one belongs on the list. Parents register changes in their own child long before they can put a name to them, and it is one of the more reliable signs in paediatrics.

Do not wait for a home visit. Go to the nearest hospital emergency department or call SAMU on 114 if there is a fit or convulsion, breathing laboured enough to pull the ribs in, a rash that does not fade when a glass is pressed against it, a child who cannot be woken, skin that is grey, mottled or blue, or a fever in a baby under three months.

Calling and being told it can wait is a good outcome

A fair number of the calls we take at night end with a doctor explaining what to watch for, and no visit being made. Nobody is charged for that conversation and it is not a wasted call. Knowing that what you are looking at is ordinary, and knowing exactly which change would make it no longer ordinary, is most of what people are telephoning for at midnight.

What a doctor does at the house

A night consultation is a full examination carried out in the child’s own bed rather than in a waiting room at one in the morning: temperature, breathing, throat, ears, chest, abdomen, skin and hydration. Where the source is obvious and simple it is treated on the spot. Where it is not, the doctor says so plainly and explains what should happen next, and how quickly.

A visit between 7pm and 7am is Rs 3,000, the same figure anywhere on the island. It does not cost more because you live further from a town.

Worth having in the house before you need it

• A working thermometer, and a spare battery for it
• Paracetamol in a children’s formulation, in date
• Oral rehydration sachets
• Your child’s current weight, written down
• A note of any regular medicine and any allergy

None of it is dramatic. It is simply the difference between managing the first hour and spending it looking for things.

Frequently asked questions

What temperature counts as a fever in a child?

A temperature of 38°C or above is generally treated as a fever. How your child looks and behaves matters more than the figure, and a doctor will ask about both.

Should I alternate paracetamol and ibuprofen for a child’s fever?

Not on your own initiative. Alternating is sometimes advised by a doctor for a particular child, and there are situations, including a suspected mosquito-borne fever such as dengue, where anti-inflammatories are best avoided altogether. Ask before starting, and never give aspirin to a child.

When should a child’s fever go to hospital rather than a home visit?

Go to hospital or call SAMU on 114 for a fit or convulsion, breathing laboured enough to pull the ribs in, a rash that does not fade under a glass, a child who cannot be woken, skin that is grey, mottled or blue, or any fever in a baby under three months.

Can a doctor come to the house at night for a child in Mauritius?

Yes, at any hour, including Sundays and public holidays. A night consultation between 7pm and 7am is Rs 3,000, the same rate anywhere on the island.

Does every high fever in a child need hospital?

No. Most childhood fevers are viral and are managed at home with fluids, light clothing and paracetamol for comfort. Hospital is for the specific warning signs above, and for any fever in a baby under three months.