Child has fever, when should the doctor come?

When fever in children needs a doctor

Children medicine carries an old GP rule: 'Look at the child, not the thermometer.' A cheerful four-year-old at 39.2 °C who drinks well is less worrying than a pale, floppy three-year-old at 38.5 °C who refuses to drink and breathes fast. The pure number is just one tile in a mosaic. Still, there are hard age limits where review is non-negotiable: infants in their first three months of life with any rectal fever above 38 °C belong immediately in medical hands, either via house call or paediatric A&E. At that age, bacteraemia can progress extremely fast and the immune defence is immature.

For older infants (3 to 6 months) the threshold is 38.5 °C, and any reduction in general condition, refusal to drink or change in skin colour triggers immediate review. From toddler age onward, general-condition criteria outweigh the temperature. You as parents are the most reliable diagnostic: a child who plays, drinks and smiles between fever spikes is very likely on the right path. A child who is apathetic, stops drinking, breathes fast, shows unusual skin spots, cannot be soothed or has unusually fixed eyes, that is the constellation where you do not wait, you call. Private house call, 116117, or 112 on acute worsening.

On febrile seizures: a first simple febrile seizure in children aged 6 months to 5 years, lasting less than 5 minutes and leaving an awakening child afterwards, is medically dramatic but usually harmless. The child still needs medical review afterwards, house call or hospital depending on severity. A seizure longer than 5 minutes, outside the age window, or a second seizure in the same episode is a 112 situation. With any high fever also watch for stiff neck, small punctate skin haemorrhages (petechiae) and rapidly increasing pain, suspicion of meningitis. With petechiae every half hour counts: better one 112 call too early than one too late.

Example: four-year-old with fever on a Saturday evening

A four-year-old boy in Steglitz has been feverish up to 39.2 °C since Friday, otherwise in good condition. He drinks regularly, plays during fever-free periods, sleeps normally. On Saturday evening fever climbs to 39.8 °C, he becomes more tired but breathes calmly and still drinks. The parents call. We come, examine, see red tonsils without exudate, clear lungs, soft abdomen, no petechiae. A strep rapid test is negative, an influenza test positive. Diagnosis: flu. Symptomatic treatment, parental safety-netting on red flags, follow-up arranged in 48 hours. Four days later the boy is fit again. Had he been apathetic and not drinking, we would have either arranged a hospital admission or planned additional diagnostics.

Alarm signs that justify immediate medical contact

• Infant < 3 months with rectal fever > 38 °C, always, immediately, no exceptions.
• Infant 3 – 6 months with fever > 38.5 °C or reduced general condition.
• Child of any age refusing fluids for more than 6 – 8 hours, dehydration risk.
• Fast, laboured breathing, nasal flaring, intercostal recession, suspicion of pneumonia or bronchiolitis.
• Small punctate skin haemorrhages (petechiae) that do not blanch under glass, call 112 immediately, suspicion of meningococcal sepsis.
• Stiff neck, light sensitivity, severe headache, suspicion of meningitis.
• Febrile seizure > 5 minutes or a second seizure in the same fever episode, 112.
• Apathy, unreachable child, fixed eyes, persistent crying without comfort.
• Fever unchanged after three days, rising, or returning after a fever-free interval, medical review.