Fever in babies, children and adolescents - Fever management according to the S3 guideline (2025)
- Johanna
- Oct 26, 2023
- 6 min read
Updated: 2 days ago
Fever is one of the most common reasons why parents seek medical advice. Around 70% of all pediatric doctor visits are related to elevated temperature. At the same time, fever is one of the most unsettling symptoms:
How high is too high?
Do I need to reduce the fever?
When is it dangerous?
The good news: The current S3 guideline on fever management has provided clear, scientifically sound guidance since 2025 – not only for healthcare professionals, but also explicitly for parents.
The most important message first: In most cases, fever is not dangerous, but rather a natural, useful, and important reaction of the body to pathogens. It can occur for various reasons, such as viral infections, bacterial infections, reactions after vaccinations, and other illnesses. Here you will find information that will help you understand and treat fever in children and babies.
1. How to Recognize That Your Child Has a Fever
Fever isn't just indicated by a thermometer reading. Often, you'll first notice changes in your child's behavior:
Fatigue, reduced stamina, fussiness, general malaise
Warm skin, flushed face
During fever rise: cold hands and feet, which may appear bluish
During the temperature drop: sweating, sometimes profusely
Most importantly, according to guidelines: Your child's overall condition is more important than the number on the thermometer. A child with a temperature of 39°C (102°F) who is drinking, responsive, and seeking affection is often more stable than an apathetic child with a lower temperature.
2. How do you measure body temperature correctly?
Infants (0–12 months): rectal measurement is the most reliable.
Children from about 1 year of age: ear thermometer.
Adolescents: oral measurement is possible, but prone to interference.
Not recommended, as they are too inaccurate:
forehead or temporal thermometers.
axillary measurement.
These methods should not be used as the sole basis for assessment. How is your child doing? What is their general condition? Are there any other symptoms?
3. What Fever Is and Why It Can Be Useful
Fever is part of the immune response. The body deliberately raises its temperature to make it more difficult for pathogens to multiply and to activate the immune system.
Normal body temperature: 36.5°C – 37.5°C
Higher Temperature: 37.6 °C - 38.4°C
Fever: >38.5°C (for Newborns > 38.0°C)
The human body can effectively fight fevers up to 41°C (106°F).
It's important to understand that the temperature itself isn't the crucial factor; rather, it's how your child is doing overall. A child with a temperature of 40.5°C (105.3°F) isn't necessarily sicker than a child with a temperature of 38.5°C (101.3°F).
4. Duration of Fever
In most infections, the fever lasts approximately 3-5 days and then subsides on its own because your child's immune system successfully fights off the pathogens.
Some children have a fever for a shorter time, others for a longer time; this is normal. It's important to pay attention to your child's overall well-being. If the fever persists for a very long time or your child doesn't feel better despite a drop in temperature, seek medical advice.
5. Managing and Treating Fever
Fever itself is not dangerous and doesn't automatically need to be reduced. It's much more important to provide good support for your child.
What will help your child now:
Create a comfortable environment
Stay calm
Observe your child carefully, take their temperature regularly but not constantly, and write it down.
Sleep and rest
Closeness, comfort, and security
Comfortable room temperature
Light clothing that doesn't trap heat
Regular fluid intake
Preventing dehydration, especially in babies and toddlers: Make sure your child drinks enough, as they can dehydrate quickly and may need immediate medical attention if dehydrated. Diapers should be wet regularly, and your child should go to the toilet regularly.
Please do not:
Undress your child almost completely to "cool" the fever
Do not put them in a cold bath or take a cold shower!
6. Calf compresses – useful or not?
The guidelines clearly state:
Only useful if your child has warm hands and feet.
Only if there is noticeable discomfort.
Compresses must be body temperature, not cold.
Calf compresses:
Calf compresses with lukewarm water.
Damp, lukewarm washcloth on the forehead and around the calves
Change the compress after 10 minutes.
7. When should fever-reducing medication be used?
A key point of the guideline: It's not the temperature that matters, but your child's overall well-being. If your child is generally feeling well, you don't need to administer medication immediately. Fever-reducing medication is primarily used to alleviate symptoms, not to lower body temperature.
Important:
Always adjust the dosage according to body weight, not age.
Do not combine or alternate medications without consulting a doctor.
Do not administer more frequently than recommended (see package insert).
Do not administer prophylactically, including around vaccinations.
→ Exception: STIKO recommendation for meningococcal B vaccination.
Medications of choice:
Paracetamol
Ibuprofen
Available as syrup, suppositories, or tablets.
Not allowed:
Acetylsalicylic acid (ASA) for children under 12 years of age (risk of Reye's syndrome. This is a serious illness affecting the liver and brain and can be life-threatening).
!!!Be careful when giving your child over-the-counter medications. Not all medications are suitable for children of all ages. Ask your doctor or pharmacist about the correct dosage.
8. When should you seek medical advice?
The timing for seeking medical help depends on your child's age and overall condition. Regardless of temperature, certain warning signs should always be investigated.
Immediate medical attention is required if:
Changes in consciousness
Difficulty breathing
Pale, gray, or mottled skin
Skin hemorrhages (petechiae)
High-pitched or inconsolable crying
Signs of severe dehydration
Stiff neck, severe headache
Persistent vomiting or diarrhea
High fever (over 41°C/106°F) that rises rapidly
Fainting or febrile seizure. Call emergency services (112) immediately if your child has a febrile seizure or is unresponsive.
For Babies under 12 month:
Under 3 months: Any rectal temperature ≥ 38.0°C (101.4°F) should be checked by a doctor.
Under 1 year: Have the fever assessed by a doctor on the same day.
For Children older than 1 year:
If your child is older than 1 year and otherwise appears healthy, you can treat the fever at home.
The exact temperature alone is not the deciding factor for further action.
It is always important to observe how your child is feeling, whether there is an underlying cause, and if this cause needs to be treated.
Children of all ages:
If your child seems very ill
Fever does not decrease despite fever-reducing measures
Your child feels persistently very unwell
The cause of the fever remains unclear
Skin rash
Breathing difficulties, difficulty breathing
Fever + earache in children under 2 years old
If fever lasts longer than 3–5 days
If your gut feeling tells you that something is wrong
Weekend/Night: My child has a very high fever and I'm worried – what can I do?
Medical on-call service: 116 117
This hotline offers medical support in non-life-threatening situations. A team of professionals will listen carefully to your concerns, provide valuable advice, and determine whether your child's condition can be treated at home or if a doctor's visit is necessary.
9. What happens at the doctor's office?
Medical history: Fever pattern, fluid intake, accompanying symptoms, pre-existing conditions
Physical examination: Respiration, circulation, ears, throat, abdomen, skin, lymph node swelling
Further diagnostic tests if necessary: Urine, blood, swabs, ultrasound
Treatment:
Viral infections: Symptom-oriented, patience until the body has fought off the pathogens on its own.
Bacterial infections: Antibiotics only when clearly indicated → Fever alone is not a reason for antibiotics
In rare cases, hospitalization may be necessary, for example, if your child is severely dehydrated or a serious underlying cause is suspected. Your doctor will advise you on this and make the best decision for your child.
10. Rest is part of healing
The guideline recommends: Your child should be fever-free and able to resume normal activities for at least 24 hours before returning to daycare or school.
Treating a fever can be a stressful time for parents. Remember to take breaks and drink plenty of fluids while caring for your child.
Last updated: 01/2026
Resources:
https://www.dgkj.de/eltern/dgkj-elterninformationen/elterninfo-fieberkrampf https://www.kinderaerzte-im-netz.de/krankheiten/fieber/
