Child Has a Fever at Night? What to Do at Home and When to Come In

Short answer: Check your child's temperature with a digital thermometer under the arm, dress them lightly, offer plenty of fluids or breastfeeds, and use a children's fever medicine only as directed if they are distressed. Come in immediately if your baby is under 3 months, your child has a fit, is very drowsy, breathing fast, not drinking, has a rash that doesn't fade when pressed, or the fever has lasted more than two or three days.

It's close to midnight and the child who was running around the shamba this afternoon is now hot, whiny and refusing supper. Do you watch until morning, or find transport now? This guide helps you decide.

What is a fever?

A fever is the body's normal response to an infection, such as a cold, malaria, an ear or chest infection, or a urinary infection. In Kenya's child health guidelines, a temperature of 37.5°C or more, measured under the arm, counts as a fever. Fevers often feel worse in the evening because body temperature naturally rises later in the day.

The fever itself is not usually dangerous. What matters most is how your child looks and behaves, and what is causing it.

How to measure your child's temperature

• Use a digital thermometer placed in the armpit, with the arm held gently against the body until it beeps.
• Avoid glass mercury thermometers, which can break.
• A hand on the forehead tells you a child feels hot, but not how hot.
• Write down the reading and the time, plus any medicine given. It helps the clinician.

How to keep your child comfortable at home

• Dress them lightly and use a light sheet. Don't wrap a feverish child in heavy blankets or sweaters.
• Keep the room comfortable and airy, not cold. Never keep a charcoal jiko burning in a closed room where a child sleeps.
• Offer plenty of fluids: breast milk, clean water, uji or soup. Small, frequent sips are easier than a big cup.
• Fever medicine made for children, such as paracetamol syrup, can ease discomfort if your child is distressed. Use the dose for their age or weight on the packet, or as advised by a clinician or pharmacist, and use the syringe or spoon provided.
• Never give aspirin to children.
• Don't sponge with cold water or use ice or alcohol rubs.
• Don't give leftover antibiotics or antimalarials without a test. They may be the wrong medicine and can hide the real problem.

Fever medicine eases discomfort, but it does not treat the cause.

When to come in immediately

Come straight to a facility, at any hour, if your child:

• Is under 3 months old and has a fever
• Has a fit (convulsion), even if it stops
• Is very drowsy, floppy or hard to wake, or is confused
• Is not able to drink or breastfeed, or vomits everything
• Is breathing fast or struggling to breathe (see the table below), or the chest pulls in with each breath
• Has a rash that doesn't fade when you press a clear glass against it
• Has a stiff neck, a bulging soft spot on the head (in babies), or cries when moved
• Has signs of dehydration: very few wet nappies, sunken eyes, no tears or a dry mouth
• Has had a fever for more than two or three days, or keeps getting fevers
• Has recently travelled to a malaria area such as the lake region, western Kenya or the coast

If your child is unconscious, not breathing normally or the fit lasts more than five minutes, call 999 or 112.

What counts as fast breathing?

Count breaths for one full minute while your child is calm, watching the chest or belly rise.

If your child has a fit

Fits with fever can be frightening. Stay calm, lay your child on their side on a safe surface, loosen tight clothing and don't put anything in their mouth. Note how long it lasts, then bring your child in to be checked, even if they seem fine afterwards.

Why testing matters

Malaria is less common in Nakuru's highlands than in lake and coastal areas, but it still happens, especially after travel. A malaria test gives an answer quickly, so your child gets the right treatment instead of a guess. Read more in malaria or typhoid: how to tell.

Plan for night-time before you need it

Save the numbers of two people who can drive you at night, or a trusted boda rider, and keep the MCH booklet, ID and some M-Pesa balance where you can find them in the dark.

How Primegala can help

Primegala Medical Centre at Maili Sita, opposite Kiamaina Primary School, is open 24 hours, every day. Our urgent care team assesses children at any hour, and our on-site laboratory runs malaria tests day and night. For a fever that is settling but needs review, book a child health visit.