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.