Bachon Ka Bukhar (Fever) by Age: Under 3 Months, Sponging, No Aspirin
How hot is too hot? For a child, the honest answer is that the number on the thermometer matters less than the age of the child and how the child looks. Bachon ka bukhar (a child’s fever) is managed differently at 2 months, 2 years and 12 years, and this guide gives each band its own rules: when to sponge, what to give, what never to give, and the two lists that decide whether you go to the doctor today or the hospital now.
At a glance
- A fever is: 38 °C or above, measured under the arm, in the ear, or (for babies) in the bottom with a digital thermometer. Hand-on-forehead is a guess.
- Under 3 months with any fever: emergency department, now. No home management, no waiting for the morning.
- Medicine: paracetamol, dosed by weight from the pack or by a pharmacist; ibuprofen only over 6 months and only in a child who is drinking. Never aspirin under 16. Never the two mixed without advice.
- Sponging: lukewarm water only. Never cold water, ice, spirit or a fan on wet skin.
- Doctor today: fever over 3 days, over 39 °C with the child unwell, or a fever that returns after a clear day.
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What a fever is doing
A fever is the body raising its own thermostat to fight an infection, and most childhood fevers come from viruses, last two or three days, end on their own, and do no harm to the brain, whatever the old fear about 40 °C “cooking” a child says. What a fever does do is make a child miserable, dehydrated and off food. The care is aimed at that: comfort, fluids, and watching for the signs that the cause is serious.
Measure properly: a digital thermometer under the arm, held for the full beep with the arm pressed to the side, is fine for home, ear thermometers are unreliable under 6 months, and forehead strips and the back of a hand tell you nothing you can act on. Write the reading and the time down.
Bachon ka bukhar: the rules by age
Under 3 months
One rule, no exceptions: 38 °C or above, however well the baby seems, means the emergency department now, because babies this young cannot wall off infections and a serious one can look like nothing more than a warm, slightly sleepy baby for the first hours. No paracetamol first unless a doctor says so on the phone. No sponging. No second reading in an hour. Go.
A baby under 3 months who is unusually cold (below 36 °C), floppy or not feeding is also seen now.
3 to 6 months
A fever of 38 °C or more is seen by a doctor the same day, and 39 °C or more at once, with paracetamol at the weight-based dose for this baby once a doctor has said so. Fluids are breast milk or formula, offered more often, and nothing else: no water, no herbal drinks, no ghutti.
6 to 12 months
A well baby who is feeding, wetting nappies and can be comforted can be managed at home for a day or two with paracetamol by weight, extra milk feeds and sips of water; a doctor today if it lasts past 3 days, reaches 39 °C with the baby clearly unwell, or the baby is off feeds. Paracetamol is the usual choice here.
1 to 3 years
The busiest band for fevers and the peak age for febrile fits. Home care as above, watching fluids closely, because a toddler with a sore throat will refuse cups, so offer ORS, diluted fruit, ice lollies, dahi, whatever goes in. Fever with a limp, an ear pulled at, pain passing urine, or a rash needs a doctor today.
3 to 6 years, and older
The same 3-day and 39 °C rules apply, and school stays off until 24 hours without fever and without medicine. Aspirin remains out until 16 because of the risk of Reye’s syndrome, and many “adult” fever tablets and some cold powders contain it.
Home care that helps
- Undress the child to a single light layer and remove blankets; a razai traps heat and raises the reading.
- Keep the room comfortable rather than cold (around 20 to 22 °C if you can control it), with any fan on the far side of the room, because a fan blowing on damp skin makes a child shiver, and shivering raises the temperature.
- Offer fluids every 15 to 20 minutes: breast milk or formula for babies, and for older children water, ORS, diluted fruit, thin daal water, milk if they want it. Our ORS recipe is the one to use if the child is sweating heavily, vomiting or has loose stools.
- Give paracetamol at the dose for the child’s weight, from the pack or worked out by a pharmacist, no more often than the pack allows, and only if the child is uncomfortable. Write down each dose and time.
- Sponge only if the child is hot and miserable and medicine has had 30 minutes to work: a cloth wrung out in lukewarm water (about 30 °C, comfortably warm on your wrist) over the forehead, neck, armpits and groin, stopped after 10 to 15 minutes or as soon as the child shivers. Cold water makes the body fight back and warm up.
- Check the child every 2 to 3 hours through the night for breathing, colour, whether they rouse and settle, and whether they will drink, and take the temperature at bedtime and on waking, not every 20 minutes. Let them sleep. Do not force food.
The wet cloth on the forehead, the thin cotton sheet, the sips of daal water and the sponge bath are old and sound, provided the water is lukewarm. What is out: a cold bath, ice packs, wiping with spirit or vinegar (absorbed through skin, fumes inhaled), onion slices under the feet, blankets to “sweat it out,” and a fan on a wet child. The kahwa and honey-ginger drinks are not for a baby; nothing but milk under 6 months, no honey under 1, and for older children the honey and ginger cough remedy is for the cough, not the fever.
Paracetamol and ibuprofen: what is safe, what is not
The dose of either medicine is decided by the child’s weight, not age, printed on the pack or worked out by a pharmacist or doctor, never taken from a neighbour’s bottle, a WhatsApp forward or memory. Two things cause most of the harm at home: doubling up, when a “cold and flu” syrup that already contains paracetamol is given alongside plain paracetamol, and dosing by the clock to keep the number down when the child is comfortable. Read every label. The medicine is for the child’s misery, not the thermometer.
Ibuprofen has extra rules: over 6 months only, only in a child who is drinking well and passing urine, not with chickenpox, and not in a child with asthma unless their doctor has said it is fine. Alternating the two is something a doctor may suggest for a specific child, not a home default, because it doubles the chance of a dosing mistake at 3 am.
No cough and cold medicines under 6. No aspirin under 16, and check “disprin” and old fever powders, which contain it. No leftover antibiotics; they do nothing for a viral fever.
Febrile fits
A small minority of children between 6 months and 5 years will have a fit with a fever at some point, usually as the temperature climbs fast. The child stiffens, jerks, may go blue around the lips, and is not responsive for a minute or two. It is terrifying and, in almost every case, harmless. Lay the child on their side on a safe surface, move hard objects away, put nothing in the mouth, do not hold the limbs, and time it. Every first febrile fit is seen in hospital the same day. A fit lasting more than 5 minutes, or a second one in the same illness, or one where the child does not come round, means an ambulance or the nearest emergency department now. Fever medicine does not prevent febrile fits, which is another reason not to chase the number.
Doctor today, or hospital now
Hospital now
- Any fever in a baby under 3 months, or a temperature under 36 °C in a young baby.
- Breathing fast or with effort, the chest sucking in between or under the ribs, grunting, flaring nostrils, or blue or grey lips.
- Drowsy, floppy, hard to wake, or a cry that is weak, high-pitched or unlike the usual.
- A fit, especially a first one, one lasting over 5 minutes, or a second in one illness.
- A rash that does not fade when a glass is pressed on it, or purple spots.
- A stiff neck, a bulging soft spot, or sensitivity to light.
- No urine for 6 to 8 hours, no tears, sunken eyes or soft spot, dry mouth.
- Vomiting everything, green vomit, or blood in vomit or stool.
- Cold, pale or mottled hands and feet with a hot body, or a child who cannot bear to be touched or moved.
Doctor today
- Fever lasting more than 3 days, or over 39 °C with the child unwell.
- Ear pain, sore throat with difficulty swallowing, pain on passing urine, a limp, a swollen joint, a new rash.
- Refusing all fluids for more than a few hours.
- A child with a heart, kidney, immune or metabolic condition, a premature baby, a child on regular medicines, or a fever after travel or contact with measles, typhoid or dengue.
A fever of 38 °C or more in a baby under 3 months is an emergency; go now, without giving medicine first. Never give aspirin to anyone under 16, never give cough and cold mixtures under 6, and never give leftover antibiotics. Paracetamol and ibuprofen doses are worked out by weight from the pack or by a pharmacist or doctor, and a syrup must not be given alongside another product containing the same drug. Ibuprofen is not used under 6 months, in a dehydrated or vomiting child, in chickenpox, or in a child with asthma without their doctor’s say-so. Never sponge with cold water, ice, spirit or vinegar, and never wrap a feverish child in blankets. Nothing but milk under 6 months, no honey under 1 year. If any of the hospital-now signs above appears at any point, the age band and the day count no longer matter.
Afterwards
A child is usually back to normal a day or two after the fever breaks, appetite last; a lingering cough is covered in a child’s cough by age. Keep the dose notes; that scrap of paper is worth more to a doctor than your memory of the night. For the adult version of home fever care, see our earlier guide, fever at home: fluids, sponging and red flags. The fever that comes with an ear infection is covered in a child’s earache, and the other children’s guides sit under Bachon Ki Sehat.
At what temperature should I worry?
Under 3 months, 38 °C is the line and it means hospital. Over that age, the child’s state matters more than the number: 39 °C in a child who drinks, plays a little and settles is less worrying than 38.2 °C in a child who is floppy. Over 3 days at any level needs a doctor.
Can I give paracetamol to my 2-month-old?
Not on your own decision. Under 3 months a fever is an emergency assessment, and the medicine can mask it. Go first; the doctor will advise on medicine.
My child is teething and has a fever. Is that normal?
Teething can raise the temperature very slightly. It does not cause a true fever of 38 °C or above. A fever in a teething baby is an infection until proven otherwise; manage it as a fever.