What are the recommended first-line treatments for managing fever in children under 5 years, and when should antipyretics be used?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

The recommended first-line treatments for managing fever in children under 5 years are the use of antipyretic drugs such as paracetamol or ibuprofen, depending on parental preference, co-morbidities, or contraindications .

Paracetamol is normally given every 4–6 hours, with doses appropriate for age and weight, and the maximum daily dose should not be exceeded .

Ibuprofen is given every 8 hours, with doses tailored to age and weight, and should be used with caution if the child is dehydrated or hypovolaemic .

Antipyretics should be used when the child is uncomfortable or distressed, not routinely for all children with fever who are otherwise well .

They should be continued only as long as the child appears distressed, and if monotherapy is ineffective, switching or alternating agents may be considered .

Antipyretics should be stopped once the child is comfortable and not distressed .

Educational content only. Always verify information and use clinical judgement.