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

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 ¹.

Paracetamol is normally given every 4–6 hours, with doses appropriate for age and weight, and the maximum daily dose should not be exceeded ¹.

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 ¹.

Antipyretics should be used when the child is uncomfortable or distressed, not routinely for all children with fever who are otherwise well ¹.

They should be continued only as long as the child appears distressed, and if monotherapy is ineffective, switching or alternating agents may be considered ¹.

Antipyretics should be stopped once the child is comfortable and not distressed ¹.