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Symptoms

Fever in children and babies: what to do and when to go to the ER

Is this an emergency?

This is not an emergency service. Call 911 or go to the nearest emergency room if you have:

  • A baby under 3 months with 100.4 °F (38.0 °C) or higher
  • Spots on the skin that do not fade when pressed, with a fever
  • A seizure, a stiff neck, or being very hard to wake
  • Grunting, the chest pulling in, flaring nostrils or bluish lips
  • Signs of severe dehydration: barely peeing, sunken eyes, cold hands
  • A bulging soft spot, or a weak, high-pitched or nonstop cry in a baby
  • Green or bloody vomit
  • Dengue warning signs: belly pain, repeated vomiting, or bleeding from the nose or gums

Warning signs: when to go to the ER

A fever in children is a temperature of 100.4 °F (38.0 °C) or higher, and it is usually a viral infection the body fights off on its own. What matters most is your child's age and how they look. On a video visit, the doctor sees kids of all ages and helps you dose by weight. A baby under 3 months with a fever needs the emergency room.

Other names: Fever in babies, Child fever

Can we help by telehealth?YesWe can help by telehealth.
US$79Doctor visit

Possible causes

What is a fever in children, and how do you measure it?

A fever is a temperature of 100.4 °F (38.0 °C) or higher. The fever itself is not dangerous: it is a sign the body is fighting an infection. If the fever is an adult’s, read fever in adults.

Use a digital thermometer, never a mercury one. For babies, a rectal reading is the most accurate. Forehead (temporal artery) thermometers work at any age, ear thermometers from 6 months, and oral readings only from age 4. Forehead strips and armpit readings are less reliable. Write down each reading, the time and any medicine you gave.

No warning signs? Talk to the doctor by video

If you have none of the warning signs on this page, the doctor can evaluate you by video and tell you whether you need to be seen in person.

For problems that are not emergencies. In an emergency, call 911.

How we care for your child's fever by video

Dr. Diana Nieves Castro, a general practice physician licensed in Puerto Rico with several years of emergency-department experience, sees children of all ages, babies included, in English or Spanish. We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you, such as a urine test or blood work.

The doctor looks at your child on camera, asks how the fever started, looks for the cause (a cold or cough, ear pain, hand, foot and mouth disease…) and gives you the right dose for their weight. If appropriate, the doctor prescribes and we send your prescription to your pharmacy. We do not prescribe controlled substances. More on our online doctor visit for kids.

If your child is under 21, a parent with patria potestad (parental authority) or a legal guardian stays on camera for the whole visit and shows photo ID. Read how to prepare your child for a video visit.

Your doctor

Dr. Diana Nieves Castro, MD

General practice physician

Several years of emergency-department experience.

Founding Executive Director of The Health Initiative.

Meet the doctor

The visit in 3 steps

Request a visit online 24/7 — we confirm your time by email or text.

  1. Request the visit and pay by card. Choose Doctor visit.

  2. We send you a secure video link. It works on your phone, tablet or computer.

  3. The doctor evaluates your child with you on camera. If appropriate, she prescribes and we send your prescription to your pharmacy; if a test would help, you get a lab order for a lab near you.

Price

A doctor visit costs US$79, the same price for every age, with no membership. You are charged when you request the visit and get a full refund if it can't take place, including if the parent or guardian check can't be completed. A school note after the visit is included at no extra charge. See pricing. Your child needs to be physically in Puerto Rico during the visit; visiting families are welcome.

Video visit

Doctor visit

US$79

For a new problem, urgent care (non-emergencies), primary care, children, birth control, STIs, skin and acne, and visitors. Includes a doctor's note if you need one.

  • You’re charged when you request the visit.
  • Full refund if the visit can’t take place

Common causes of fever in children

It is almost always a viral infection. The causes table on this page lists the usual ones: colds, flu, ear pain, hand, foot and mouth disease, diarrhea and vomiting, urinary tract infections and, in Puerto Rico, dengue. Other symptoms help the doctor tell which it is.

Dengue in children in Puerto Rico

Dengue hits children and teens hard on the island: in 2024, 10- to 19-year-olds were 29.3% of cases, according to the CDC. Warning signs usually appear 24 to 48 hours after the fever goes away, so keep watching your child once it breaks. If dengue is possible, use acetaminophen and do not give ibuprofen. Read our dengue warning signs guide.

Home care and fever medicines

If your child has a fever and no warning signs:

  • Offer fluids often and let them rest.
  • Acetaminophen or ibuprofen can make your child more comfortable; you do not need to treat the number if they are resting comfortably.
  • Dose by weight, not just age. Use the syringe or cup that comes with the medicine, never a kitchen spoon.
  • Do not give acetaminophen under age 2 without a doctor's guidance, and do not give ibuprofen to babies 6 months or younger.
  • Never give aspirin to a child unless their doctor tells you to.
  • Do not overdress them.

How many days of fever is too long, and when is a test ordered?

Even if your child looks well, get them checked if:

  • Your child is under 2 and the fever lasts more than 24 hours without a clear cause. A urine test may be needed: the doctor gives you a lab order for a lab near you and goes over the result with you.
  • Your child is 2 or older and the fever lasts more than 3 days (72 hours).
  • The temperature keeps rising above 104 °F (40 °C).
  • For their safety, if the fever lasts 5 days or more, at any age, have your child examined in person.

Fever in children: when to go to the ER

For their safety, if your baby is under 3 months and has a temperature of 100.4 °F (38.0 °C) or higher, go to an emergency room or call 911, even if the baby seems fine and even in the middle of the night. If your baby is 3 to 6 months old and reaches 102.2 °F (39 °C) or higher, get them seen in person soon.

At any age, call 911 or go to the ER if your child has a fever plus any warning sign on this page. In babies, also watch for a bulging soft spot, fewer than 6 wet diapers a day, or green vomit. In children 1 to 5, a high-pitched noise when breathing at rest (stridor), or heavy drooling and not being able to swallow. In older children and teens, severe pain in the lower right belly, testicular pain, or an asthma attack that does not improve with their inhaler.

Frequently asked questions

What temperature is a fever in a child?

100.4 °F (38.0 °C) or higher. More than the number itself, what matters is your child's age, how they look and how long the fever lasts.

Do you see babies by video?

Yes. The doctor sees children of all ages, with a parent or legal guardian on camera. For safety, a baby under 3 months with 100.4 °F (38.0 °C) or higher needs the emergency room right away, even if the baby seems fine.

How many days of fever is normal for a child?

Get your child checked if a fever lasts more than 24 hours under age 2, or more than 3 days at age 2 or older. After 5 days of fever, have your child examined in person.

Can I alternate acetaminophen and ibuprofen?

Ask the doctor before alternating them, because it is easy to mix up doses. Work out each dose from your child's weight, use the measuring device that comes with the medicine, and never give aspirin.

Can the doctor prescribe for my child online?

If appropriate, the doctor prescribes and we send your prescription to your pharmacy. Many viral fevers only need home care, and antibiotics do not work on viruses. The doctor will explain what your child needs.