When should I take my child to the emergency department or call 000?

Take your child to emergency immediately — or call 000 — if they develop a rash that does not blanch when pressed under a glass, are unusually pale, mottled, or blue, are very difficult to wake or limp, are breathing very fast or grunting, or if your child is under 3 months with any fever. Trust your instinct — if something feels wrong with your child, seek help immediately. GPs and emergency nurses would rather assess and reassure than have a family wait at home with a child who needs urgent attention.

What temperature counts as a fever in a child?

A fever is a core temperature of 38.0 °C or higher. Tympanic (ear) and rectal thermometers are the most accurate; forehead strip thermometers are unreliable. The number matters less than how your child looks and behaves. A child with 40 °C who is alert and drinking is often less concerning than one with 38.5 °C who is pale and very difficult to rouse. If your child is under 3 months with any fever at all, seek medical care on the same day.

Should I give paracetamol or ibuprofen for my child's fever?

Both are appropriate when your child is uncomfortable. Paracetamol (15 mg/kg every 4–6 hours) can be used from birth; ibuprofen (5–10 mg/kg every 6–8 hours) suits children from 3 months who are well hydrated and without asthma or chickenpox. The goal is comfort, not a specific temperature number. Routinely alternating the two medicines is not recommended — it increases the risk of dosing errors without clear benefit. Always dose by your child's weight, not their age, using age-appropriate formulations.

What is Kawasaki disease and how will my doctor recognise it?

Kawasaki disease is an inflammatory blood vessel condition in young children, peaking between 6 months and 5 years. Left untreated, it can cause lasting coronary artery aneurysms. The diagnosis requires fever ≥5 days plus four of five: bilateral red eyes without discharge, a rash, red or cracked lips or strawberry tongue, swollen neck lymph nodes, and redness or swelling of the hands or feet. Early hospital treatment with intravenous immunoglobulin substantially reduces the risk of heart complications. Tell your GP if your child's fever has lasted 5 days or more.

My child had a convulsion during a fever — is this epilepsy?

Febrile convulsions are seizures triggered by fever, not epilepsy. They affect about 3–5% of children aged 6 months to 6 years and are usually benign. A 'simple' febrile convulsion — generalised, under 15 minutes, once in 24 hours — carries a low long-term epilepsy risk, and about 30% of children will have a second episode. A 'complex' febrile convulsion — focal, longer than 15 minutes, or recurring within 24 hours — needs urgent assessment and possibly a lumbar puncture. Call 000 if a convulsion lasts more than 5 minutes.

How do I know if my child's fever is just a virus or something to worry about?

Viral infections cause most childhood fevers and most children improve within 5–7 days. Generally reassuring signs include a child who is drinking, alert, and interacting normally between temperature spikes. Warning signs that warrant same-day review include fever lasting more than 5 days, a rash that does not fade under pressure, unusual pallor, difficult breathing, persistent vomiting, any infant under 3 months, or a parent who feels something is wrong. Parental instinct is diagnostically valuable — contact your GP or HealthDirect 1800 022 222 when you are uncertain.

Paediatric fever

Paediatric fever: red flags, when to escalate, and the AU approach

By Dr HB Lo, FACRRM Reviewed 16 July 2026 12 min read

Fever in children — temperature ≥38.0 °C — is one of the most common paediatric presentations in Australian general practice. Any fever in an infant under 3 months requires urgent assessment regardless of apparent wellbeing.

Most fevers are self-limiting viral infections. The key clinical skill is identifying the minority with serious bacterial infection, meningococcaemia, Kawasaki disease, or sepsis using a structured red-flag traffic-light approach. Red features — pallor, mottled skin, non-blanching rash, or altered consciousness — require immediate escalation.

Antipyretics (paracetamol or ibuprofen) are given for comfort, not to normalise the temperature reading.

What fever in children actually means

Fever — a core temperature of ≥38.0 °C — is one of the most common reasons parents bring children to Australian general practice. It generates after-hours calls, drives a large proportion of paediatric emergency department presentations, and triggers significant parental anxiety. Yet the vast majority of childhood fevers are caused by self-limiting viral infections: upper respiratory tract infections, gastroenteritis, viral exanthems, and otitis media.

The body’s fever response is a host-mediated immune mechanism driven by cytokines — interleukin-1, interleukin-6, tumour necrosis factor, and prostaglandin E2 acting on the hypothalamic set-point — and is generally useful rather than harmful within normal fever ranges. Antipyretics from RCH Melbourne are prescribed for comfort, not to suppress this response.

The clinical challenge is recognising the small minority in whom fever signals serious illness: serious bacterial infection (SBI), meningococcaemia, Kawasaki disease, or sepsis. The margin between those children and the majority who need only reassurance and safety-netting is precisely what structured assessment is designed to close.

A critical point: the temperature number is poorly predictive of severity. A child with 40.5 °C who is pink, alert, drinking, and returning smiles is usually less concerning than a child with 38.5 °C who is mottled, lethargic, and not responding to social cues. Clinical observation takes precedence over the thermometer reading.

A. Core clinical — the AU general practice framework

Traffic-light risk stratification

The Royal Children’s Hospital Melbourne Clinical Practice Guidelines and NICE NG143 both endorse a structured traffic-light approach: green (low risk), amber (intermediate), and red (high risk — act immediately).

Red features — immediate action, call 000 or transfer by ambulance:

Pale, mottled, ashen, or cyanotic skin or lips
No response to social cues; weak, high-pitched, or continuous cry; won’t wake or stay awake; appears very ill
Grunting; respiratory rate >60; moderate or severe chest indrawing
Capillary refill ≥3 seconds; reduced skin turgor; no tears
Non-blanching rash — purpuric or petechial; this is meningococcaemia until proven otherwise — give ceftriaxone and call 000
Bulging fontanelle; neck stiffness; photophobia; seizure with focal features
Any fever ≥38 °C in an infant under 3 months — always red, regardless of other signs
Hyperpyrexia ≥41 °C
Limp with fever — septic arthritis or osteomyelitis until proven otherwise
Known or suspected immunocompromise

Amber features — close observation and investigation:

Pallor reported by parent; reduced response to social cues; wakes only with prolonged stimulation
Nasal flaring; SpO₂ ≤95% on room air; crackles on auscultation; tachypnoea for age
Tachycardia; capillary refill 2–3 seconds; dry mucous membranes; less than half normal oral intake
Fever ≥5 days (think Kawasaki disease)
Age 3–6 months with fever 38–39 °C; rigors; limb swelling or refusal to weight-bear

Green features — low risk:

Normal skin colour; alert, responsive, and smiling; consistent interactive eye contact
Normal cry; moist mucous membranes; feeding and drinking adequately
No amber or red signs

Age-stratified assessment

Infant under 3 months: Any fever ≥38 °C is a red-zone emergency. Young infants have immature immune responses, localise infection poorly, and can deteriorate with alarming speed. Standard management is a full septic workup — bloods including FBC, CRP, blood culture, and lactate; urine obtained by catheter or suprapubic aspiration (bag urine is insufficient for diagnosis); lumbar puncture for CSF MC&S, protein, glucose, and viral PCR; and chest X-ray if respiratory signs are present. Empirical antibiotics per eTG are started and the child is admitted. If neonatal herpes simplex is possible (vesicular rash, seizures, or under 21 days), add IV aciclovir.

Age 3–24 months: Viral upper respiratory tract infections dominate, but urinary tract infection (UTI) is the most commonly missed SBI in febrile infants. A urine specimen is mandatory in any febrile infant under 2 years without a clear localising source — collected by clean catch (≥3 months) or catheter/suprapubic aspiration when clean catch is not feasible. Kawasaki disease peaks in the 6–24 month age group; fever duration of 5 days or more should prompt active consideration.

Age 2–5 years: Common viral pathogens (adenovirus, parainfluenza, respiratory syncytial virus, COVID-19, influenza) account for the vast majority. Group A Streptococcal pharyngitis, pneumonia, UTI, and otitis media remain important bacterial diagnoses to consider when localising signs are present.

School age and adolescent: Similar viral spectrum plus Epstein-Barr virus (EBV infectious mononucleosis) and atypical pneumonia. For fever persisting beyond 1–2 weeks, broaden the differential to include autoimmune conditions, malignancy, and chronic infections.

Antipyresis

Per RCH Melbourne and Australian Medicines Handbook:

Paracetamol 15 mg/kg orally or rectally every 4–6 hours (maximum 75 mg/kg per 24 hours; maximum single dose 1 g in children over 12 years)
Ibuprofen 5–10 mg/kg orally every 6–8 hours (do not use under 3 months; use with caution in dehydration, varicella, asthma, or renal impairment)
The goal is comfort, not temperature normalisation
Routine alternation of paracetamol and ibuprofen is not recommended — increases dosing error risk with no reliable evidence of improved outcomes
Tepid sponging and cold baths are discouraged — cause shivering, distress, and have no benefit on comfort or outcomes
Antipyretics do not prevent febrile convulsions — counsel families explicitly on this point

B. Time-critical paediatric conditions

Meningococcal disease

Neisseria meningitidis causes rapidly progressive invasive bacteraemia and/or meningitis. The Australian National Immunisation Program funds meningococcal B vaccines for all infants at 2, 4, and 12 months, and ACWY at 12 months and in adolescence. Vaccine coverage modifies pretest probability but does not exclude disease.

Key features: fever, rapidly evolving petechial or purpuric rash that does not blanch under a glass (tumbler test), irritability, and shock. Meningism may be absent in young infants.

Action: Give ceftriaxone 50 mg/kg IV or IM (maximum 2 g) immediately on suspicion — do not wait for transfer or laboratory results. This is a lifesaving step. Call 000. Penicillin G is an acceptable alternative if ceftriaxone is unavailable. Notify the relevant State or Territory public health unit on clinical suspicion — meningococcal disease is a notifiable condition requiring immediate notification in all jurisdictions.

Kawasaki disease

Kawasaki disease is an acute paediatric vasculitis and the leading cause of acquired heart disease in Australian children. The Kawasaki Disease Foundation Australia notes peak incidence between 6 months and 5 years, with higher rates in children of East Asian background.

Diagnostic criteria: fever ≥5 days plus four of five:

Bilateral non-purulent conjunctivitis (limbal sparing)
Polymorphous rash (no vesicles)
Oral changes — red cracked lips, strawberry tongue, oropharyngeal erythema
Cervical lymphadenopathy ≥1.5 cm (often unilateral)
Extremity changes — hand and foot oedema or erythema acutely; periungual desquamation in the subacute phase

Incomplete Kawasaki disease — fever ≥5 days with fewer than four features plus supportive inflammatory markers (elevated CRP, ESR, platelet count, and transaminases; sterile pyuria; anaemia) — carries the same coronary risk and is treated on the same threshold per RCH Melbourne, especially in infants.

Treatment: IVIG 2 g/kg as a single infusion within 10 days of fever onset, plus aspirin. This reduces coronary aneurysm risk from approximately 25% in untreated disease to 3–5%. Echocardiography at diagnosis, 2 weeks, and 6 weeks is standard. Refer urgently to paediatrics when Kawasaki disease is suspected.

Paediatric sepsis

The Australian Sepsis Network paediatric pathway guides recognition and escalation: recognise → resuscitate → refer within 1 hour.

Recognise — age-specific tachycardia, tachypnoea, hypotension, mottled or cyanotic skin, altered conscious state, or a suspected source (pneumonia, UTI, cellulitis, meningitis).

Resuscitate:

IV access; blood for FBC, CRP, blood culture, lactate, blood glucose, and blood gas
Fluid bolus 10–20 mL/kg 0.9% sodium chloride — repeat if responsive; use 10 mL/kg and reassess frequently in infants
Empirical IV ceftriaxone 50 mg/kg (maximum 2 g) within 1 hour of recognition
Add IV aciclovir if neonatal HSV is possible; add antistaphylococcal cover (e.g. flucloxacillin) for suspected skin/soft tissue source

Refer — ambulance transfer with pre-notification to the receiving hospital.

Urinary tract infection

UTI is the most common serious bacterial infection in febrile infants under 2 years. Diagnosis requires a correctly collected specimen — eTG is explicit that bag urine is suitable for screening only; a positive result must be confirmed by clean catch, catheter, or suprapubic aspiration before treatment.

Empirical oral trimethoprim or cephalexin is appropriate in well children without vomiting; ceftriaxone IV or IM for unwell or vomiting infants. All infants under 6 months with a confirmed first UTI require renal tract ultrasound within 2 weeks to identify structural abnormality.

Febrile convulsions

Febrile convulsions affect 3–5% of Australian children aged 6 months to 6 years. The RCH Melbourne distinguishes:

Simple febrile convulsion: generalised tonic-clonic, under 15 minutes, single episode in 24 hours — benign; approximately 30% risk of recurrence; long-term epilepsy risk only marginally above background
Complex febrile convulsion: focal features, duration >15 minutes, or more than one episode in 24 hours — lower threshold for LP and paediatric review; investigate the underlying fever cause carefully
Status epilepticus: ≥30 minutes — buccal midazolam (if available and stocked in the practice emergency kit) and 000 immediately

Antipyretics do not prevent febrile convulsions. Families who have witnessed a prolonged or complex febrile convulsion should be provided with an emergency management plan including buccal midazolam.

C. Investigation approach

Investigation is guided by risk zone:

Green zone: No investigation is needed in most cases. Clinical review within 24–48 hours is appropriate for amber-zone children who are managed at home.

Amber zone: FBC and CRP; urine MC&S in all infants under 2 years with fever without source; blood culture if the child appears moderately unwell; chest X-ray if respiratory signs are present.

Red zone: Full septic workup as described above; empirical antibiotics without delay; urgent transfer.

Investigation pearls:

FBC and CRP are useful screening tools but imperfect — CRP >40 mg/L is amber, >100 mg/L is more concerning, but early bacterial infection can have a normal CRP. A blood culture should be collected before antibiotics where possible, but never delay treatment in a haemodynamically unstable child
Procalcitonin has better discrimination for SBI in emergency settings but is not routinely available in Australian general practice
In suspected meningococcaemia, do not delay ceftriaxone for blood culture or imaging

D. Australian operations

MBS items

Standard general practice consultations — items 23, 36, 44, 132/133 — are used for paediatric fever assessment. After-hours items 5000–5071 are frequently applicable, as fever commonly presents outside business hours. Telehealth consultations (items 91800–91891) are appropriate for green-zone safety-netting calls only; amber or red-zone presentations require face-to-face clinical assessment.

The Aboriginal and Torres Strait Islander Health Assessment, MBS item 715, provides a comprehensive vehicle for paediatric health review including immunisation status — a critical modifier of infection risk.

PBS items

Paracetamol and ibuprofen are available over the counter at pharmacies
Amoxicillin and amoxicillin-clavulanate are PBS-subsidised for bacterial infections
Cephalexin and trimethoprim are PBS-subsidised for UTI
Ceftriaxone is PBS-restricted to hospital and approved community emergency use
Dexamethasone is PBS-listed for croup (single dose for moderate-to-severe croup is standard management per RCH Melbourne)
IVIG for Kawasaki disease is supplied through the National Blood Authority and administered in hospital

The National Immunisation Program schedule — funded vaccines at no cost — has substantially reduced the burden of SBI in Australian children: Haemophilus influenzae type b (Hib), pneumococcal (13-valent), meningococcal B and ACWY, rotavirus, measles-mumps-rubella (MMR), and varicella. Checking and updating immunisation status at every clinical opportunity modifies the risk interpretation of a febrile presentation.

Safety-netting

Written or clearly communicated verbal safety-netting is standard at the end of every paediatric fever consultation. Parents should be instructed to return immediately or call 000 if:

A non-blanching rash appears
Child becomes significantly more lethargic or harder to rouse
Breathing worsens — faster, noisier, or more laboured
Feeding stops or vomiting prevents hydration
Fever persists beyond 5 days
A convulsion occurs
The parent is worried — parental instinct is diagnostically valuable

HealthDirect 1800 022 222 (HealthDirect) offers 24-hour nurse triage and is widely promoted in Australian safety-netting. The state-based Maternal and Child Health lines provide additional parental support.

Notifiable disease obligations: Meningococcal disease requires immediate notification to the State or Territory public health unit in all Australian jurisdictions. Measles, pertussis, and invasive pneumococcal disease are also notifiable — timelines vary by state. Do not wait for laboratory confirmation before notifying for meningococcal disease.

E. Special populations

Aboriginal and Torres Strait Islander children carry a higher burden of invasive bacterial disease — including meningococcal disease, invasive pneumococcal disease, recurrent suppurative otitis media, and rheumatic fever. A lower threshold for investigation, antibiotic treatment, and hospital admission is standard practice. Engage Aboriginal Medical Services (AMS) or Aboriginal Community Controlled Health Services (ACCHS) wherever possible. Cultural safety, family-inclusive communication, and clear follow-up arrangements are foundational to good care.

Children with immunocompromise — receiving chemotherapy, immunosuppressants, or with congenital immunodeficiency or functional asplenia — have blunted immune responses and atypical presentations. Any fever in an immunocompromised child warrants urgent assessment, blood culture, and early empirical antibiotics without awaiting localising signs.

Returning travellers and newly arrived refugees: Consider malaria (blood film and PCR), dengue, typhoid, and hepatitis A in febrile children with recent travel to or arrival from endemic regions. Refugee children may have incomplete or undocumented immunisation histories — a structured catch-up health assessment including targeted screening for tuberculosis and parasitic infections is appropriate per ASID guidelines.

Neonates under 28 days: Fever may be absent despite life-threatening infection; hypothermia and lethargy are equally important warning signs. Listeria, Group B Streptococcus, Escherichia coli, and enterovirus are important pathogens. Herpes simplex neonatal infection typically presents in the first 21 days with seizures, vesicular rash, or hepatitis — add IV aciclovir to the empirical antibiotic regimen until HSV is excluded by PCR.

When to escalate

Call 000 immediately or transfer by ambulance when:

Any red-zone feature is identified on assessment
Non-blanching rash — give ceftriaxone IM/IV before transfer
Suspected paediatric sepsis — initiate resuscitation, call 000
Suspected Kawasaki disease — urgent paediatric referral on the same day
Any febrile infant under 3 months old
Febrile child with known immunocompromise
Status epilepticus or complex febrile convulsion

Refer to a paediatrician when:

Fever persists beyond 5 days and Kawasaki disease criteria are not met
Recurrent or cyclical fever patterns
Fever in a child with a chronic illness, developmental concern, or complex social situation
Diagnosis remains unclear after initial general practice workup

What this article is and is not

This is general health information drawn from current Australian general practice guidance: RCH Melbourne Clinical Practice Guidelines, NICE NG143, Australian Sepsis Network paediatric pathways, eTG complete, Australian Medicines Handbook, ATAGI and the Australian Immunisation Handbook, and the Kawasaki Disease Foundation Australia. It is not personal medical advice and does not create a doctor–patient relationship.

If your child has a high fever, a rash that does not blanch, is unusually difficult to wake, or you are worried, seek medical attention immediately — do not delay because of any information in this article. In an emergency, call 000.

For parent-focused resources: HealthDirect — Fever in children, Better Health Channel, RCH Melbourne parent information.

Sources cited

Frequently asked questions

When should I take my child to the emergency department or call 000?

Take your child to emergency immediately — or call 000 — if they develop a rash that does not blanch when pressed under a glass, are unusually pale, mottled, or blue, are very difficult to wake or limp, are breathing very fast or grunting, or if your child is under 3 months with any fever. Trust your instinct — if something feels wrong with your child, seek help immediately. GPs and emergency nurses would rather assess and reassure than have a family wait at home with a child who needs urgent attention.
What temperature counts as a fever in a child?

A fever is a core temperature of 38.0 °C or higher. Tympanic (ear) and rectal thermometers are the most accurate; forehead strip thermometers are unreliable. The number matters less than how your child looks and behaves. A child with 40 °C who is alert and drinking is often less concerning than one with 38.5 °C who is pale and very difficult to rouse. If your child is under 3 months with any fever at all, seek medical care on the same day.
Should I give paracetamol or ibuprofen for my child's fever?

Both are appropriate when your child is uncomfortable. Paracetamol (15 mg/kg every 4–6 hours) can be used from birth; ibuprofen (5–10 mg/kg every 6–8 hours) suits children from 3 months who are well hydrated and without asthma or chickenpox. The goal is comfort, not a specific temperature number. Routinely alternating the two medicines is not recommended — it increases the risk of dosing errors without clear benefit. Always dose by your child's weight, not their age, using age-appropriate formulations.
What is Kawasaki disease and how will my doctor recognise it?

Kawasaki disease is an inflammatory blood vessel condition in young children, peaking between 6 months and 5 years. Left untreated, it can cause lasting coronary artery aneurysms. The diagnosis requires fever ≥5 days plus four of five: bilateral red eyes without discharge, a rash, red or cracked lips or strawberry tongue, swollen neck lymph nodes, and redness or swelling of the hands or feet. Early hospital treatment with intravenous immunoglobulin substantially reduces the risk of heart complications. Tell your GP if your child's fever has lasted 5 days or more.
My child had a convulsion during a fever — is this epilepsy?

Febrile convulsions are seizures triggered by fever, not epilepsy. They affect about 3–5% of children aged 6 months to 6 years and are usually benign. A 'simple' febrile convulsion — generalised, under 15 minutes, once in 24 hours — carries a low long-term epilepsy risk, and about 30% of children will have a second episode. A 'complex' febrile convulsion — focal, longer than 15 minutes, or recurring within 24 hours — needs urgent assessment and possibly a lumbar puncture. Call 000 if a convulsion lasts more than 5 minutes.
How do I know if my child's fever is just a virus or something to worry about?

Viral infections cause most childhood fevers and most children improve within 5–7 days. Generally reassuring signs include a child who is drinking, alert, and interacting normally between temperature spikes. Warning signs that warrant same-day review include fever lasting more than 5 days, a rash that does not fade under pressure, unusual pallor, difficult breathing, persistent vomiting, any infant under 3 months, or a parent who feels something is wrong. Parental instinct is diagnostically valuable — contact your GP or HealthDirect 1800 022 222 when you are uncertain.

Source quality

Sources grouped by evidence tier. AU primary tier first; international where AU is silent or lagging; named-author reconstruction where guidelines have not yet caught up. How tiers work.