Q: My child has a persistent high fever of 38-39°C despite cross-dosing. Should we go to the ER again?
Medically reviewed by Sang Hyun Ahn, MD
Content edited by Myeongchan Kim, MD
This post is a dramatization of a question and answer session experienced by our actual medical reviewers. Please note that this content is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
Question:
My child has a constant high fever measuring between 38°C and 39°C. Even though I am alternating (cross-dosing) fever reducers, the temperature does not drop below 38°C. We went to the emergency room yesterday, where they gave my child a fever-reducing injection. They were fine overnight, but the temperature has been over 38°C all day today. Should we go back to the ER? My child has chills and is having a hard time. Yesterday at the hospital, they confirmed it is not the flu. They didn't prescribe any new medication, told us to just continue the current medicine, and said there was nothing else to do besides the injection. They did not run any blood tests.
Answer:
It must be very distressing to see your child struggling with a high fever again today after having just visited the emergency room yesterday.
When to Visit the ER Immediately:
Please assess your child's current condition. If any of the following danger signs are present, you should return to the emergency room immediately:
Difficulty breathing (e.g., skin pulling in under the ribs, nasal flaring, or wheezing)
No urine output for more than 8 hours
Extreme lethargy, wanting to sleep constantly, or poor eye contact and responsiveness
Refusing to drink any fluids and having dry lips
A stiff neck, severe headache, or repeated vomiting
Red spots or a rash on the skin that does not fade when pressed
If your child does not have these symptoms, is able to take small sips of fluids, and responds normally while awake, please contact or visit your regular pediatrician today for a re-evaluation.
Guidelines for Alternating Fever Reducers (Cross-Dosing):
When alternating medications, be sure to follow the correct intervals for each specific drug. Acetaminophen (e.g., Tylenol) is typically given every 4 to 6 hours, while Ibuprofen (e.g., Motrin, Advil) is given every 6 to 8 hours. When alternating between the two different medications, you must wait at least 2 to 3 hours between doses. Always ensure you are giving the correct dosage based on your child's current weight.
Home Care Tips:
Offer one or two sips of water, breast milk, or formula every 5 to 10 minutes to maintain hydration.
Dress your child in a single layer of light, breathable clothing and keep the room temperature comfortable (around 22–24°C or 71–75°F).
Since your child is experiencing chills, do not use tepid sponge baths or cold packs, as these can worsen the chills and discomfort.
Remember that the primary goal of fever reducers is to relieve your child's discomfort, not necessarily to bring the thermometer number all the way down to normal.
Why the Fever Persists:
During the early days of a viral infection, a child's temperature may hover around 38°C even with appropriate medication. The most important factor is not the exact number on the thermometer, but whether your child is staying hydrated and remaining interactive while awake. Even though your child tested negative for the flu yesterday, other common childhood viruses (such as Adenovirus or Enterovirus) frequently cause high fevers that last for 3 to 5 days.
Please follow up with your pediatrician today for an in-person re-evaluation, as they can properly assess the persistent fever. If any of the severe symptoms listed above develop, head straight to the emergency room.
For extra peace of mind and clear guidance when tracking your child's symptoms, the FeverCoach app is always there to help.
