A sick child on a Mallorca holiday

Fever in a child on holiday: what is normal, what is not

A fever is not an illness but a sensible defence. The body turns its temperature up because viruses and bacteria multiply less well in the warmth. Bringing a fever down therefore does not speed up recovery — it simply makes the child able to drink again and more settled, and that is what it is for.

From 38.0 °C it is called a fever, from 39.0 °C a high fever. Those numbers are the less important half of the picture. How your child seems tells you more than the thermometer. A child with 39.5 °C who drinks, gets up and plays again after medicine worries me less than a child with 38.3 °C who lies there listless, refuses to drink and barely responds.

A holiday brings several things together that make fever more likely: new germs on the plane, in the hotel and the kids' club, air conditioning, short nights, plenty of sun and a different daily rhythm. Most of these infections are harmless and over within three to five days.

Two things belong with every feverish child: drinking enough — more than at home in the heat — and light clothing rather than thick blankets. Give a weight-adjusted fever medicine when your child is visibly suffering, not because of a number on the thermometer. Stick to the dosage on the packet, or ask.

What is no longer normal: fever lasting more than three days, fever that returns after settling, fever with a stiff neck, a rash, breathing difficulty or reduced consciousness — or fever in a baby under six months. More on that below.

Viral or bacterial: why an antibiotic does not always help

The large majority of feverish childhood infections are caused by viruses — and no antibiotic works against a virus. That is not thrift, it is biology: antibiotics attack structures that bacteria have and viruses do not.

Many parents expect an antibiotic on holiday, because time is short and nobody wants to lose three days of it. I understand that well. But an antibiotic does not speed anything up in a viral infection. It can cause diarrhoea and a rash, changes your child's gut flora for weeks and contributes to resistance.

The two cannot be told apart reliably over the phone, nor from a single number. Findings that point more towards a bacterial infection are a one-sided, clearly localised finding — a markedly reddened tonsil with coating, an abnormal eardrum, a localised skin infection — a two-peaked course with the fever climbing again after settling, and a child whose condition does not improve even when the fever comes down.

That is why I examine before I prescribe. I look at throat, ears and skin, listen to chest and heart, assess the general condition and go through the past few days. If the examination points to a bacterial infection, I write a private prescription and you collect it at the nearest farmacia. If it does not, I tell you that just as plainly — and explain what to watch for over the next 24 hours.

Ear pain after swimming

Ear pain is the single most common complaint in children on a beach holiday. Behind it is either inflammation of the ear canal skin, brought on by water, warmth and friction, or a middle ear infection as part of an infection. Middle ear infections are more common in children than in adults because their eustachian tube is shorter and flatter.

Small children rarely say "my ear hurts". Watch for pulling or rubbing at the ear, crying more when lying down, refusing to drink and unusual restlessness at night. First steps are a weight-adjusted painkiller, sleeping propped up and keeping the ear dry — nothing into the ear canal, no cotton buds.

Which of the two it is comes down to looking into the ear. How that works, what helps at once and when it becomes urgent is set out in the guide to ear pain.

Tummy bugs in children: fluids and warning signs

With vomiting and diarrhoea in children, almost everything comes down to one thing: fluids. Children dry out considerably faster than adults, because proportionally their bodies hold more water and have less in reserve. At 30 °C in the shade it happens faster still.

Frequency matters more than the amount at once: one or two teaspoons every five to ten minutes is better than a large glass that comes straight back up. A vomiting stomach accepts small portions; large ones it does not.

• Suitable: an oral rehydration solution from the pharmacy — it replaces water and salts in the right proportions. Otherwise still water or weak tea.
• Not suitable: cola, fruit juices and sports drinks — too much sugar, which can make the diarrhoea worse.
• Breastfed babies carry on breastfeeding, if anything more often and for shorter periods.
• Food as appetite allows, once the vomiting eases. A strict diet is not necessary; going hungry does more harm.

Signs of fluid loss that mean your child needs to be seen: dry lips and a dry mouth, clearly fewer wet nappies or passing urine less often, no tears when crying, sunken eyes, in babies a sunken fontanelle, along with listlessness and unusual drowsiness. In a baby that applies immediately.

Also needing to be seen: blood in the stool, persistent green, bile-stained vomiting, severe or one-sided tummy pain, and vomiting that prevents any fluid staying down for more than 24 hours. More on causes and course is in the guide to stomach and bowel problems.

Insect bites in children

In children insect bites often look more dramatic than in adults: the local swelling gets bigger, itches more and lasts longer. A large, warm, reddened swelling around the bite is not in itself an allergy — it is usually a vigorous local reaction.

Cooling helps at once. The real trouble comes from scratching: scratched-open bites get infected, especially once sand, salt water and sun cream are involved. Short fingernails and an anti-itch gel help more than you would think.

Call 112 immediately for breathing difficulty, swelling in the mouth or throat, weals over the whole body, circulatory collapse or a sting inside the mouth. Those are signs of an immediate allergic reaction and not a case for a house call. Treatment, allergy signs and jellyfish contact are covered in the guide to insect bites.

What I do on a house call

I examine your child where it is. A feverish child should not be driven around in 30 °C heat, and in familiar surroundings a child is usually far easier to examine than in unfamiliar rooms.

• An unhurried history: the course of the past few days, how much has been drunk, nappies, previous illnesses, vaccinations, medicines already given.
• Physical examination: general condition, temperature, pulse and breathing, listening to chest and heart, throat and ears with the otoscope, palpating the abdomen, assessing skin and neck.
• Putting it in context: I tell you whether watching and waiting is enough — and how you will recognise over the next few hours that it is not.
• Treatment on site: weight-adjusted fever and pain relief, advice on replacing fluids and, where the examination supports it, a private prescription for the nearest farmacia.
• A clear word when it belongs in hospital: if I see signs that need inpatient assessment, I say so immediately and not the next day.
• A written report: you receive the examination and my assessment in writing, along with the private invoice for your travel health insurance.

The house call costs a flat 250–450 € depending on time of day — you pay on site and receive a private invoice. I call you back personally after your enquiry; there is no switchboard and no call centre.

Honestly: what I am not

Acute holiday complaints in children, meaning feverish infections, tummy bugs, ear pain and insect bites, I assess and treat on site.

For children from one year I come just as I would to any other patient. For babies under one year I talk through what has happened on the phone first — depending on the symptoms I come out, or I tell you that a paediatrician or the hospital is the faster and better route here.

I am a German doctor, but not a paediatrician. What belongs in hospital or with a paediatrician: babies under six months with a fever, chronic or recurring complaints, anything needing laboratory tests, imaging or monitoring, and every emergency in the red box.

Frequently asked questions