New fever management: Important tips for worried parents!

New fever management: Important tips for worried parents!

On August 1, 2025, a new S3 guideline for fever management in children and adolescents was published by the German Society for Child and Adolescent Medicine (DGKJ). This guideline, which was coordinated by Prof. Dr. David Martin, pediatrician at the University of Witten/Herdecke, presents fever as a physiological defense reaction of the body and emphasizes that this is not an illness that requires treatment, but rather a natural reaction. Fever should not be considered an emergency situation unless there are serious warning signs.

The guideline offers clear, scientifically based recommendations for action on how parents, doctors and nursing staff should best deal with fever. A key goal is to encourage parents to trust the natural course of fever and avoid unnecessary medications or doctor visits. Above all, information about fever management should be conveyed to parents at an early stage, ideally with the first vaccination.

What parents should consider

The new guidelines emphasize that temperature measurement should be differentiated depending on the child's age. Rectal measurement is recommended for infants, while slightly older children should be measured with a tympanic membrane thermometer. Forehead and axillary measurements are considered inaccurate and are not suitable for assessing fever alone. In children under three months of age, medical attention is required if the temperature is ≥ 38.0 °C, while in older children the level of fever is less important than the child's general well-being.

Parents should also take seriously warning signs that may indicate serious illness, including loss of consciousness, excessive crying, skin bleeding, and shortness of breath. Particular attention should be paid to the recapillarization time, which should not be longer than two seconds; a longer period of time may indicate a circulatory disorder. For risk assessment, the guideline provides a traffic light system that indicates the urgency of medical intervention.

Drug and non-drug measures

The recommendations for treating fever are clear. Fever-reducing drugs such as paracetamol or ibuprofen should only be given if the child is suffering from them. It is advisable to administer these medications in doses appropriate to age and weight. For example, paracetamol can be used in cases of severe impairment, while prophylactic administration before vaccinations is not recommended, apart from the specific recommendation for meningococcal B vaccination.

Non-drug measures are also crucial. Adequate fluid intake, undisturbed sleep and a pleasant ambient temperature are essential for the well-being of the sick child. If fever increases, heat should be provided to support body temperature and overheating should be avoided. Calf wraps can be helpful in certain conditions, but should only be used on warm extremities.

Return to community

The S3 guidelines provide clear guidelines for returning to schools or daycare centers. Children should be fever-free and sufficiently resilient for at least a full day before taking part in community life again. Employers are encouraged to support this readjustment period to ensure children can make a full recovery. The comprehensive development of the guidelines also involved 15 specialist societies, professional associations and patient organizations and can be downloaded from the AWMF.

The publication from May 1, 2025 is valid until April 30, 2030 and provides comprehensive guidelines that are intended to support not only doctors and nurses, but especially parents in these sensitive situations. Fever management is an important part of child health care, and proper management is essential for children's recovery and well-being. Further information can be found at University of Witten/Herdecke, DGKJ and foamio.org.