It can feel particularly stressful when you're woken by your toddler's cry in the middle of the night and you realize they're burning up. Gulp, it's a fever.

It’s natural to be worried about why your child has a fever, how it will affect the entire family's Zzzs and what it means for their recovery and wellbeing. But there is a bit of good news: A fever is not only common, it means your child's body is able to fight off a virus or some type of bacteria, explains Mahvash Madni, M.D., a pediatrician based in New York and spokesperson for the American Academy of Pediatrics (AAP). Fevers are “the body's defense mechanism; the immune system realizing that there's something that shouldn't be there,” she adds.

Even though fevers happen to protect us, it’s understandable that you want to put a quick end to it and make your toddler comfortable, especially through the night. Here’s what to know as you navigate through the sickness and long nights.

What is considered a fever in toddlers? 

A fever is defined as any temperature above 100.4 degrees F.[1] Temperatures can reach as high as 105 degrees, says Dr. Madni. “There’s sometimes confusion that 99° is [a] low-grade [fever], but really that's not considered a fever.” 

Though uncommon, febrile seizures can occur when young children have a fever that rises sharply and quickly, which can cause convulsions. The fever itself doesn't necessarily need to be "high" to cause a seizure, though. And although this can be alarming, luckily they don't usually cause any harm and typically pass within a minute.[2] “Certain viruses, such as the herpes family of viruses, are more prone to cause seizure activity,” says Dr. Madni. “There's also a genetic component, so most of the time you have to be genetically prone to [febrile seizures],” to be at risk. 

If your child experiences a febrile seizure, gently place them on the floor or ground on their side. Loosen or remove any clothing that's near their head and neck, then watch them for about five minutes. Make sure they are breathing normally and if the seizure lasts for more than five minutes or they are having trouble breathing, call 911. It's important that you don't put anything in their mouth during a seizure, as it could cause them to choke. 

Why fevers tend to spike at night — especially in toddlers and young children 

If your child has a fever, it may be a symptom of a viral or bacterial infection, like a cold, the flu or an ear infection, says Dr. Madni. In general, fevers are especially common in toddlers and young children because their immune systems are meeting many of these pathogens, or particular bacterial or viral strains, for the first time.[3] If your child has a fever, it may be a symptom of a viral or bacterial infection, like a cold, the flu or an ear infection, says Dr. Madni. 

And, “fevers do tend to spike at night”, she says. This is because everyone’s body temperature naturally rises in the evening. A sick child’s immune response is also kicking into overdrive, especially at night because as the body tries to fight the illness, the hypothalamus, the temperature-regulating part of the brain, increases their body temp. 

How to accurately take your toddler’s temperature 

Getting an accurate temperature reading (despite having a squirmy toddler) is super important when figuring out what to do next, says Dr. Madni. The first step is to use a thermometer, and to make sure you have different types of thermometers at home.

That said, the best way to take your toddler’s temperature is whichever way they are most comfortable, says Dr. Madni. While a rectal thermometer may be considered the most accurate, as your kid gets a bit older and becomes more aware of their body, they may be uncomfortable, shy or fussy. You’ll then want to switch to another thermometer type for their comfort. An oral thermometer is the second most accurate, and you’d want to use it as soon as you think your child might have a fever, she says. You’ll want to continue to retest throughout the day, as “fevers and body temperatures rise in the later hours of the evening and in the middle of the night, whether [you’re] sick or well,” says Dr. Madni. However, if your child is sleeping comfortably or acting normally, you can let them be and just keep a close eye on them — no need to recheck if it will disturb them. 

If you don't have a thermometer, and your child is fussy and burning up hot when you touch their forehead, it's probably safe to assume they have a fever of some kind. While the forehead check won't let you know their exact temperature, it can give you an idea of whether they have a fever or not. 

How to break your toddler's fever at night 

You know the power of a good night’s rest, so getting your sick toddler to sleep is important, but when they’re fussy, uncomfortable, achy and feverish, it’s not always so simple. 

Remember that the fever is a symptom of an illness your kid’s immune system is fighting.[4] “The reasons to treat the fever wouldn't be to get rid of the fever per se, but maybe to lower it or keep it at bay so that your child just feels better overall,” says Dr. Madhi. To help your child find comfort, here are some remedies you can consider to help break their fever in the night:

Give them medicine before bed — and again, as needed

Toddlers can take ibuprofen and acetaminophen, so you may want to consider dolling out a dose of Children’s Motrin or Tylenol before bed to weaken the fever and reduce any aches and pains or general discomfort.[5] In fact, you can alternate between the two medications (meaning you can give one first and then you can give the other, in an alternating fashion) since they're not the same medicine,” says Dr. Madni. Just make sure to wait every four hours between doses of acetaminophen and every 6 to 8 hours for ibuprofen, she adds. 

And should you wake them in the middle of the night to keep up with these meds? It actually may not be necessary. You can absolutely check on them, but if they are sleeping soundly, you'll want to avoid poking and prodding them to wake them up, says Dr. Madni. However, if they're awake and fussy, it's a good idea to go ahead and give them some more medication when the time is right. 

Dress them appropriately

When picking out PJs for your feverish kiddo, opt for light layers, says Dr. Madni. Try “one light layer, and then you can have a blanket nearby in case layers need to be removed or added." As far as material goes, the clothing itself should be lightweight and breathable, especially because they may break the fever overnight and start sweating.[6] 

Keep them hydrated

Kiddos lose a lot of fluid when they have a fever — they're sweating and tend to breath harder, which means they can become dehydrated easily. If left untreated, the lack of fluid can send a child to the hospital.[7] Encourage your child to drink water as much as possible, and try natural electrolyte drinks like Kinderlyte or Pedialyte — and Pedialyte popsicles are also a good choice for feverish kiddos. These options have electrolytes to replenish lost fluids, explains Dr. Madni.[8]

Let them sleep if they can

Sleep is super important to help them fight off whatever bug has decided to pay a visit. During sleep, specific infection-fighting proteins and antibodies are released throughout the body, and lack of rest can actually interfere with this important part of the process.[9] Remember that, “If they're sleeping soundly, that's actually a good sign that they're feeling comfortable enough to get that sleep,” says Dr. Madni. “They might even break their fever overnight [and] wake up feeling better.”

When to call your provider about your toddler's nighttime fever

If your child has a low-grade fever, it's always okay to call your child’s pediatrician for advice — they can help put your mind at ease, help you come up with a gameplan to kick the fever or suggest you bring them in for an evaluation. If your child is doing well with Motrin or Tylenol, it's also okay to ride it out until the morning when you can talk with your provider. However, if your child has one of the symptoms below, definitely seek advice or attention right away:

  • If their fever reaches above 104°F. The AAP recommends calling your child’s provider if their fever repeatedly goes beyond 104. It’s important to also call the doctor if they experience a febrile seizure.[10]

  • They are showing signs of dehydration. If your child hasn't been urinating or is having less frequent bathroom breaks, that can signal dehydration, says Dr. Madni. 

  • Severe lethargy. A fever coupled with extreme fatigue and sweating or shivering can also indicate something more serious could be going on. So, anytime you have an “unarousable [kid], a child that really just doesn't wanna respond to you, call your provider right away,” says Dr. Madni.[11] 

A sick kiddo is no fun, but hang in there! Your child's provider can help determine the cause of the fever and a plan of action so everyone gets to feeling better — STAT.