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On-and-Off Fever in Babies: When to Worry & What to Do
By Alpro Pharmacy
February 12, 2025
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Fever is one of the most common concerns among parents, especially when their baby experiences recurrent or on-and-off fever. It is distressing to see your little one feeling unwell, and many parents worry whether it indicates a serious health problem. However, fever itself is not an illness but a natural defense mechanism of the body against infections and other underlying conditions. So, why does fever keep coming back, and how should parents manage it?
What Is Considered a Fever?
A baby is considered to have a fever if their temperature reaches:
- ≥ 38°C (100.4°F) (rectal or ear measurement)
- ≥ 37.8°C (100°F) (oral measurement)
- ≥ 37.5°C (99.5°F) (axillary/armpit measurement)
Fevers are typically categorized into:
✅ Low-grade fever: 37.5°C – 38.4°C (99.5°F – 101°F) – Usually mild and does not require immediate intervention.
❗ Moderate fever: 38.5°C – 39.4°C (101.3°F – 103°F) – Can cause discomfort but often manageable at home.
⚠️ High fever: 39.5°C (103.1°F) or above – Requires medical attention, especially if persistent.
Why Does My Baby Have Recurrent Fever?
Several factors can cause a baby to have fever that comes and goes:
a) Viral Infections (Most Common Cause)
Viruses account for 80-90% of fevers in babies. Common viral illnesses that cause on-and-off fever include:
- Common colds (Rhinovirus)
- Flu (Influenza)
- Roseola (sudden high fever lasting 3-5 days, followed by a rash)
- Hand, Foot, and Mouth Disease (HFMD)
- Respiratory Syncytial Virus (RSV)
Viral fevers usually last 3-5 days and resolve on their own.
b) Bacterial Infections
Unlike viral infections, bacterial infections may require antibiotics. Examples include:
- Ear infections (Otitis Media)
- Urinary tract infections (UTIs)
- Pneumonia
- Bacterial throat infections (Strep throat)
- Meningitis (rare but serious)
A bacterial fever may persist longer, be higher in temperature, and return if untreated.
c) Post-Vaccination Fever
It is normal for babies to develop a mild fever (below 38.5°C) 24-48 hours after vaccinations like DTaP, MMR, or pneumococcal vaccines. This is a sign that the body is building immunity. Fever should not last beyond 48 hours.
d) Teething Fever: A Myth
Contrary to popular belief, teething does not cause high fever. Mild temperature elevation (< 38°C) is possible due to gum inflammation, but persistent or high fever is not from teething alone.
e) Environmental Factors
- Overdressing or hot weather can cause heat-related fevers.
- Dehydration can lead to mild fever and irritability.
f) Underlying Health Conditions
If a baby frequently experiences fever without an obvious cause, underlying conditions such as autoimmune disorders, periodic fever syndromes, or immunodeficiencies may need to be ruled out by a doctor.
Specific Management Strategies
A. Medication Management
- Paracetamol (Acetaminophen):
- Dosage: 15 mg/kg per dose every 4-6 hours, up to a maximum of 4 doses per day.
- Use in infants >2 months old.
- Available in liquid form; ensure accurate dosing using a syringe, not a spoon.
- Ibuprofen:
- Dosage: 10 mg/kg per dose every 6-8 hours.
- Use only in infants >6 months old.
- Avoid ibuprofen in dehydrated or febrile infants with possible kidney issues.
B. Hydration Management
Maintaining hydration is essential, as fever increases fluid loss. Specific recommendations include:
- For infants <6 months:
- Continue breastfeeding or formula feeding on demand (every 2-3 hours).
- If the baby refuses to feed, offer smaller, more frequent feedings.
- Avoid plain water, as it can cause electrolyte imbalances.
- For infants >6 months:
- Continue milk feeds and introduce oral rehydration solutions (ORS) like Pedialyte if signs of dehydration occur (e.g., dry lips, decreased urine output).
- Offer small spoonfuls (5-10 ml) of ORS every 5-10 minutes.
- Avoid sugary drinks, sodas, or fruit juices, as they may worsen dehydration.
C. Temperature Control and Comfort Measures
- Dress the baby in light, breathable clothing and keep the room at a comfortable temperature (21-23°C or 70-74°F).
- Lukewarm sponge baths can help bring down fever (avoid cold water or alcohol rubs, which may cause shivering and worsen discomfort).
- Encourage rest and sleep, but do not force sleep if the baby is irritable.
Should I Worry About Febrile Seizures?
Some babies (typically between 6 months – 5 years old) may develop febrile seizures when fever spikes rapidly. While terrifying to witness, febrile seizures are usually harmless and do not cause brain damage. If a seizure occurs:
✅ Stay calm and lay the baby on their side.
✅ Do not put anything in their mouth.
✅ Time the seizure – If it lasts >5 minutes, seek emergency care.
How Can Parents Prevent Frequent Fevers?
While fever itself cannot always be prevented, you can reduce the risk:
- Practice good hygiene – Wash hands frequently, especially before feeding.
- Stay up to date with vaccinations – Helps protect against serious infections.
- Ensure proper nutrition – Strengthens the immune system.
- Avoid crowded places during flu season – Reduces exposure to viruses.
Conclusion: When in Doubt, Consult a Pediatrician or a Pharmacist
Recurrent fever in babies is often caused by common viral infections and usually resolves within 3-5 days. However, if fever is persistent, high, or accompanied by worrying symptoms, it’s best to seek medical advice.
💡 If you are concerned about your baby’s fever, visit your nearby pediatrician or Alpro Pharmacy for expert guidance.
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If you have any health-related questions, you can consult our medical professionals at MamaBe Expert Group. Our pharmacists are ready to assist you.
Disclaimer: Regardless of the date of the content on the website, no content is a substitute for direct medical advice from a qualified healthcare professional.
Citations
- American Academy of Pediatrics. (2021). Fever and your baby: When to worry. Retrieved from https://www.healthychildren.org
- Chiappini, E., Venturini, E., Remaschi, G., et al. (2017). Update of the 2009 Italian Pediatric Society Guidelines for Management of Fever in Children. BMC Pediatrics, 17, 210. https://doi.org/10.1186/s12887-017-0951-7
- Sullivan, J. E., & Farrar, H. C. (2011). Fever and antipyretic use in children. Pediatrics, 127(3), 580-587. https://doi.org/10.1542/peds.2010-3852
- World Health Organization. (2023). Managing fever in young children. Retrieved from https://www.who.int
