This is the most common reason parents call after-hours services in Australia. Most childhood fevers are caused by self-limiting viral infections and will resolve in 3 to 5 days. A small percentage signal something serious. The trick is learning the difference — and the rules are different depending on age.
Age changes everything
Children are not small adults, and the threshold for concern shifts dramatically across the first year of life.
Under 3 months — always go to ED
Any rectal or under-arm temperature of 38°C or higher in a baby under 3 months is treated as a hospital-level concern until proven otherwise. The reason is simple: their immune systems are immature, their signs of infection are subtle, and serious bacterial infections (urinary tract, blood, meningitis) can progress quickly. Do not come to us with a febrile newborn — go straight to Box Hill or Austin ED.
3 to 12 months — fever is more often viral, but we still have a lower threshold for full assessment. Phone us first; we'll usually ask you to walk in.
12 months and older — this is where the rules I'll describe below apply.
Why the thermometer is the least important number
Parents focus on the temperature. Doctors focus on how the child looks. A child with a temperature of 39.5°C who is sitting up watching TV, drinking, and chatting is in much better shape than a child with a temperature of 38.2°C who is floppy, won't drink, and is staring vacantly. The thermometer reading guides us; it doesn't decide for us.
The five behaviour signs that mean walk in tonight
- Drowsiness or floppiness — not just tired, but unrousable or difficult to wake.
- Refusing to drink for more than 8 hours, or fewer than half their usual wet nappies.
- Breathing fast or with effort — chest pulling in, nostrils flaring, grunting.
- A non-blanching rash — purple spots that don't fade when you press a glass against them.
- Your parental gut feeling that something is different about this illness. Take it seriously — we do.
If any of these are present, do not wait until morning.
What we do in the clinic
- Vitals — temperature, heart rate, respiratory rate, oxygen saturation
- Look at the child — colour, alertness, hydration, breathing pattern
- Ear, nose, throat examination
- Chest examination
- Abdominal examination
- Look for a rash
- Urine dip if the source isn't obvious (UTIs are easy to miss in young children)
If everything looks like a routine viral illness, we'll send you home with paracetamol/ibuprofen advice and clear instructions on when to come back. If anything looks more concerning, we'll arrange transfer to ED.
When we'll send you to Box Hill ED instead
Some presentations are beyond after-hours urgent care:
- Any infant under 3 months with fever
- Children with seizures (even brief febrile convulsions if first ever)
- Suspected meningitis (fever + headache + neck stiffness + photophobia)
- Suspected sepsis (high fever, looking very unwell, mottled skin)
- Severe dehydration requiring IV fluids
What to do at home for the simple fevers
- Paracetamol — 15 mg/kg per dose, up to four times in 24 hours (every 4–6 hours). Use weight-based dosing, not age.
- Ibuprofen — 10 mg/kg per dose, up to three times in 24 hours (every 6–8 hours). Only over 3 months of age, with food, and only if the child is well hydrated.
- Offer small frequent drinks. Hydration matters more than calories.
- Light clothing. Don't bundle up a feverish child.
- Re-check the temperature and behaviour every 2–3 hours.
The traffic-light rule
Green — alert, drinking, engaging. Treat at home, see GP if not better in 48 hours.
Amber — quieter than usual, drinking less, but rousable and tracking. Phone us; we'll usually ask you to walk in.
Red — drowsy, won't drink, fast breathing, rash, parent worried. Walk in to Manningham After-hours Emergency Care or, if your gut says ED, go to ED.