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For information on COVID-19, please visit the National Coronavirus website. Approved by the South African Government.

Symptoms: Pain or fever in children

When pain or fever grips your little one, it can be very distressing and cause a lot of anxiety.1a,b It may help to know that children, just like adults, experience headaches, tooth aches, sore throats or get infections such middle ear infection.2a,3a,b,4a Very young children or babies are unable to tell us that they are in pain, and you may notice that your little one is cranky or fusses more than usual, has difficulty sleeping or refuses to eat. 2b,3b


Most of these infections are caused by the common cold viruses, but about 30% may be caused by bacteria. 3c

Symptoms include: 3b

  • Pain with swallowing is the hallmark symptom
  • High fever
  • Headache
  • Feeling unwell
  • Upset tummy
  • Foul smelling breath

On examination, the doctor may see swollen tonsils, often with a bit of puss on them, or a red throat. Glands in the neck may be swollen. 3b Treatment includes management of pain and fever, drinking enough fluids and rest. If the infection is caused by bacteria, an antibiotic may be prescribed. 3d


Headaches are common in children and adolescents and are often the main reason why a child visits their healthcare professional. The majority of childhood headaches are caused by conditions such as a tension-headache or migraine, or a headache due to a viral infection. 5a,b

Tension-type headache is probably the most common type of headache in childhood but generally is less disabling than migraine. The pain is mild to moderate, may last for 1 hour or for several days, and often is described as “band-like,” pressure, or tightening. Triggers may be similar to migraine and include stress, fatigue, and illness but also include muscle pain and tension, particularly in the neck and shoulders. 5c

When should you be concerned about your child’s headache?

In general, you should not hesitate to contact your healthcare professional if you are at all concerned about your child’s wellbeing. Having said that, please contact your healthcare professional if your child displays any of the following symptoms: 5d,e

  • Headache accompanied by light sensitivity, nausea , vomiting and pain with eye movement or sleepiness
  • Headache becomes more severe or more frequent
  • Headache becomes worse with coughing, sneezing or straining
  • Headache accompanied by fever, weight loss, rash, and joint pain
  • Headache that wakes your child up, or they wake up with a headache on a regular basis
  • If you notice any abnormal movement or eye movement in your child


Fever in children is one of the most common reasons for parents or caregivers to seek medical attention for their child. It is frequently a cause for concern among parents and healthcare providers who fear that it may be associated with increased risk for seizures (fits). There is also confusion about how and whether to manage fever. 6f Fever is defined as a body temperature ≥ 38C. 6d The recommended way to measure a child’s temperature is with an infrared thermometer in the ear, or with a normal thermometer under the arm (in the armpit or axilla). A child’s temperature should not be measured by placing a thermometer in their mouth. 6g

Tips on how to measure a temperature with a digital thermometer under the arm (in the axilla) 6h

  • Do not measure temperature directly after bathing.
  • Ensure that the child’s axilla is dry.
  • Place the tip of the thermometer in the armpit and lightly press the child’s elbow against the chest to close the tip of the thermometer in the armpit.
  • Read the temperature when the indicator sound (‘beep’) is heard.

Home care tips to manage a fever. 6b

Do not over-dress or underdress the child, or wrap the child in heavy blankets

Check the child during the night, but do not wake the child up just to administer medication for a fever.

Encourage the child to drink fluids regularly (breast milk is best for breastfeeding children)

Seek medical advice if the fever does not get better within 48 hours, or if the child’s condition worsens.

To ensure that you are using the correct medication at the correct dose, speak to your doctor or pharmacist before administering medication for fever.

Sponging with tepid water is not recommended.

When to see my doctor if my child has a fever: 6d,e

  • If you are in any way concerned about your child, do not hesitate to see your doctor.
  • If your baby is younger than 3 months old, it is recommended that you see your doctor to determine the reason for a fever.
  • If your child cries inconsolably and cannot calm down, or cries when you touch him or her.
  • If your child stops eating or drinking.
  • If your child develops a rash.
  • If the fever continues for more than 48 hours. As the age-old saying goes: knowledge is power! It is possible to provide comfort and care to your little one at home, with a little help from paracetamol. 6a

Paracetamol is endorsed by expert bodies, including the World Health Organisation. 7a

Did you know that paracetamol has been around for more than 150 years? 8a It is endorsed by expert bodies around the world, including the World Health Organisation.7a Paracetamol may be given to children younger than 3 months of age, and children with chickenpox. 7c For more information, refer to your healthcare provider.


  1. Clinch J, Dale S. Managing childhood fever and pain – the comfort loop. Child Adol Psych Mental Health 2007;1:7. doi:10.1186/1753-2000-1-7.
  2. Miyamoto RT. Otitis Media (Acute) [online] June 2020 [cited] September 2020.
  3. Sasaki CT. Tonsillopharyngitis [online] September 2019 [cited] 4 September 2020;
  4. Van den Anker JN. Optimising the management of fever and pain in children. Int J Clin Pract 2013;67(178):26-32.
  5. Blume HK. Pediatric Headache: A Review. Paediatrics in Review 2012;33;562. DOI: 10.1542/pir.33-12-562.
  6. Green R, Jeena P, Kotze S, Lewis H, Webb D, Wells M. Management of acute fever in children: Guideline for community healthcare providers and pharmacists. S Afr Med J 2013;103(12):948-954. DOI:10.7196/SAMJ.7207.
  7. De Martino M, Chiarugi A. Recent Advances in Pediatric Use of Oral Paracetamol in Fever and Pain Management. Pain Ther 2015;4:149–168. DOI 10.1007/s40122-015-0040-z.
  8. 150 years of paracetamol. GP Pharma Update Mar/Apr 2019.

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