Fever and Common Childhood Infections

How a fever is assessed

The assessment looks for the source of the fever and for signs that the child is seriously unwell: how alert and responsive they are, how they are breathing, how well they are drinking, urine output, skin colour, and whether there is a rash. A well-looking child with a high temperature is often less concerning than a listless child with a modest one.

When antibiotics help and when they do not

Antibiotics work against bacteria and do nothing for viral illnesses, which cause most coughs, colds, sore throats and stomach upsets in children. Using them unnecessarily causes side effects and contributes to resistance. They are prescribed when the examination and history point to a bacterial infection.

Warning signs that need same-day review

Seek urgent review for any fever in a baby under three months, difficulty breathing or fast breathing, a child who is very drowsy or difficult to rouse, a rash that does not fade when pressed, seizures, persistent vomiting with poor fluid intake, reduced wet nappies, or a fever lasting beyond five days.

Watch the child, not the thermometer

The single most useful shift for most parents is to stop treating the number as the measure of severity. Fever is the immune system working, not the illness itself, and how high it goes correlates poorly with how serious the cause is. A child can run a high temperature with a trivial viral illness and a much lower one with something significant.

What carries information is how the child looks and behaves, particularly once a fever medicine has brought the temperature down an hour or so later. A child who becomes brighter, takes fluids, responds to you and shows some interest in play is usually reassuring even if the temperature was high. A child who remains limp, glassy-eyed, difficult to rouse or uninterested in everything once the fever has settled is the one to be concerned about, regardless of the reading. Breathing, fluid intake and urine output are worth more attention than the thermometer.

Keeping a child hydrated

Dehydration, rather than fever itself, is what most often turns a manageable childhood illness into an admission. Fever increases fluid losses, and a child who is refusing to drink can slip behind faster than parents expect, particularly with vomiting or diarrhoea.

Offer small amounts frequently rather than large drinks at intervals, since a few spoonfuls every ten minutes stays down when a full glass does not. ORS is the most effective option for diarrhoea and vomiting and should be made up exactly as directed; making it stronger is harmful, not better. Coconut water, rice water, dal water, buttermilk and plain water all help, while fizzy drinks and undiluted fruit juices can worsen diarrhoea. Breastfeeding should continue and be offered more often. The most practical thing to monitor is urine: a child passing pale urine regularly is keeping up, while very dark urine, fewer than about three or four wet nappies a day, a dry mouth, no tears when crying, or a sunken soft spot in a baby all mean same-day review.

Common infections and what to expect

Most childhood fevers are viral and follow a recognisable course. Colds and coughs typically run three to five days of fever with congestion, and the cough can persist for two or three weeks afterwards without meaning anything has gone wrong. Young children commonly have six to eight such illnesses a year, more in the first year at daycare, which is normal rather than a sign of weak immunity.

Throat infections, ear infections, viral rashes and gastroenteritis make up much of the remainder. In Gurugram it is also worth being alert to the seasonal pattern: dengue tends to rise after the monsoon, and warrants attention where there is high fever with severe body aches, pain behind the eyes, or bleeding from the gums or nose. Typhoid is worth considering in a fever lasting beyond about five days, and malaria where there are chills and rigors. A fever that persists past five days, or one that settles and then returns, changes the assessment and should be reviewed rather than waited out.

Why antibiotics are often not prescribed

Leaving a consultation without antibiotics can feel like being turned away, and it is worth understanding why it is usually the right outcome. Antibiotics act only on bacteria and do nothing whatsoever to a virus, which causes the large majority of childhood fevers. Giving them for a viral illness does not shorten it, does not prevent a bacterial infection from developing, and is not a precaution.

There are real costs to giving them unnecessarily: diarrhoea, rash and allergic reactions in the individual child, disruption of gut bacteria, and the wider problem of resistance, which is already advanced in India and is making previously routine infections harder to treat. Where antibiotics are genuinely needed, they are prescribed without hesitation, and then the whole course should be completed rather than stopped when the child improves. Leftover antibiotics should never be kept and reused for a later illness, and antibiotics bought without a prescription are a significant part of how resistance has developed.

Frequently asked questions