Early Signs of Breast Cancer: Changes You Shouldn’t Ignore

A new breast lump is one of the best-known early signs of breast cancer, but it is not the only possible sign. Some breast cancers can cause skin, nipple or breast-shape changes, while others may cause no noticeable symptoms at an early stage.

It is equally important to remember that a breast lump or change does not automatically mean cancer. Many breast changes are caused by benign conditions, hormonal changes, cysts or infections. A new or unusual change should, however, be medically assessed so its cause can be identified. [1] [3]

What are the early signs of breast cancer?

Symptoms vary from person to person, and some people have no symptoms at all in the early stages.

According to the Saudi Ministry of Health and CDC, breast changes that deserve attention include:

• a new lump or thickening in the breast or underarm,
• a change in the size or shape of a breast,
• swelling of part or all of a breast,
• dimpling or puckering of the skin, sometimes described as an orange-peel appearance,
• red, thickened or flaky skin on the breast or nipple,
• a newly inverted nipple,
• unusual nipple discharge, particularly bloody discharge or discharge unrelated to breastfeeding,
• new persistent breast or nipple pain.

These symptoms can also occur in conditions that are not cancer. A new or unusual change should nevertheless be checked by a healthcare professional. [1] [2]

Is a lump always the first sign of breast cancer?

No. A new breast lump is the most common symptom, but breast cancer may first appear as a skin or nipple change, breast swelling, a change in shape, or an abnormal finding on imaging.

Mammography can also detect some breast cancers before they become large enough to be felt, so the absence of a lump does not remove the need for appropriate screening. [3]

To learn when screening is recommended, see: breast cancer screening and mammography: when should it start?.

Can you tell if a breast lump is cancerous by touch?

No. A lump cannot be reliably diagnosed by touch alone.

A common belief is that a cancerous lump must always be hard, painless and fixed in place. Although many breast cancers may feel hard or irregular, the American Cancer Society notes that breast cancer lumps can also be round, soft, tender or painful. [3]

At the same time, most breast lumps are not cancer.

For more detail, see: breast lumps: when are they likely to be benign and when should they be checked?.

Breast skin changes to watch for

Sometimes the first noticeable change is in the skin rather than a lump.

Changes that should be assessed include:

• new skin dimpling or puckering,
• an orange-peel appearance,
• redness or a noticeable change in skin colour,
• skin thickening,
• swelling of part of the breast even when no lump can be felt,
• persistent flaking, rash or skin change around the nipple.

The World Health Organization lists changes in breast size or shape, skin dimpling, redness and nipple or skin changes among possible symptoms of breast cancer. [4]

What nipple changes and discharge can be important?

A new change in the nipple can sometimes be a symptom of breast cancer.

Changes may include:

• a nipple that becomes newly inverted,
• a change in nipple shape or position,
• persistent scaling, thickening or rash around the nipple,
• unusual nipple discharge unrelated to breastfeeding,
• bloody nipple discharge.

Nipple discharge can also occur with benign conditions, so it is not a diagnosis of cancer by itself. Medical assessment can determine the cause. [2] [5]

Is breast pain an early sign of breast cancer?

Breast pain by itself is not usually a typical symptom of breast cancer. Most breast pain is caused by non-cancerous conditions such as hormonal changes, inflammation or problems involving nearby muscles and tissues.

However, new and persistent pain should not simply be ignored, particularly if it is accompanied by another breast change. The Saudi Ministry of Health includes new persistent breast or nipple pain among changes that warrant attention, while the NHS notes that breast pain alone is not usually a breast cancer symptom. [1] [5]

Can a lump in the armpit be related to breast cancer?

Yes. A new lump or thickening in the armpit can be a sign that needs medical assessment.

Lymph nodes in the armpit commonly enlarge because of infection or inflammation, but breast cancer can also spread to nearby lymph nodes. In some cases, enlarged lymph nodes may be noticed before a breast tumour is large enough to feel. [2] [3]

When can breast redness and swelling be important?

Breast redness and swelling can have many causes. Mastitis, for example, can cause redness, warmth, pain and a firm area in the breast, especially during breastfeeding. [6]

A less common form of breast cancer called inflammatory breast cancer can present differently from the typical breast lump. Possible changes include:

• rapid breast swelling,
• marked redness,
• thickened skin,
• an orange-peel appearance,
• a noticeable rapid change in the breast.

Rapid or unusual redness and swelling that does not improve as expected should therefore be assessed, particularly when there is no clear explanation.

When should you see a doctor about a breast change?

Not every breast change is an emergency, but new, persistent or unusual changes should be medically assessed.

The CDC recommends medical assessment for breast signs or symptoms while emphasising that many such changes are caused by conditions other than cancer. [2]

Does every breast lump or change mean cancer?

No. This is important to remember.

The Saudi Ministry of Health and American Cancer Society note that breast changes can be caused by many non-cancerous conditions, including:

• cysts,
• menstrual hormonal changes,
• pregnancy and breastfeeding,
• infections,
• other benign breast conditions.

Because symptoms can overlap, the purpose of seeing a healthcare professional is not to assume the worst. It is to identify the cause rather than guess. [1] [3]

Can breast cancer appear suddenly?

Breast cancer does not usually develop overnight, but a woman may notice a sign suddenly—for example, finding a lump while showering or noticing a skin change in the mirror.

Cancer can also be present before it becomes visible or large enough to feel. In many cases, “sudden” refers to when the change was first noticed rather than when the disease began.

What is the difference between noticing symptoms and breast cancer screening?

If you have a new lump or symptom, the appropriate next step may be a clinical examination and diagnostic imaging rather than simply waiting for your next routine mammogram.

If you have no symptoms, screening remains important because some breast cancers can be detected before any noticeable change develops. [1] [3]

Does checking your breasts prevent breast cancer?

Knowing how your breasts normally look and feel can help you notice a new change, but checking your breasts does not prevent cancer and should not replace recommended mammography or medical evaluation.

Breast awareness helps identify what is unusual for you; determining the cause requires professional assessment. [5]

Can men have the same symptoms?

Breast cancer can also occur in men, although it is much less common. Possible signs include a breast lump, nipple changes or discharge.

Read more in: breast cancer in men: signs that can easily be missed.

Key takeaway

A new lump may be one of the first signs of breast cancer, but the earliest noticeable change may also involve the skin, nipple, breast shape, unusual discharge or the lymph nodes under the arm.

At the same time, most breast changes and lumps are not cancer. Finding a change does not mean you have breast cancer; it means that identifying the cause is better than trying to diagnose it from pain, appearance or touch alone.

Screening also remains important even when you feel well because some breast cancers can be detected before symptoms appear.

For a broader overview, see: breast cancer: from early signs to diagnosis, treatment and screening.

For specialist evaluation and care, visit Oncology at Mouwasat Hospital.

References

1. Saudi Ministry of Health – Breast Cancer
2. CDC – Symptoms of Breast Cancer
3. American Cancer Society – Signs and Symptoms of Breast Cancer
4. World Health Organization – Breast Cancer
5. NHS – Symptoms of Breast Cancer in Women
6. Saudi Ministry of Health – Mastitis

How to Reduce a Child’s Fever: What the Evidence Supports and What the Myths Claim

When a child's temperature rises, parents understandably want to know how to bring the fever down quickly. The safest approach, however, is not to force the thermometer back to 37°C as fast as possible.

Good fever care starts by asking whether the child appears well enough for home care or has warning signs that require medical assessment. The main goals are to keep the child comfortable, maintain hydration and monitor their overall condition. A fever falling after medicine does not prove that the illness is minor, and a fever that does not fall quickly does not by itself mean that the illness is serious. [1]

What is the quickest safe way to manage a child's fever?

If your child is stable and has no warning signs, the fastest appropriate response is not an ice bath, cold compresses or a home remedy. Focus first on comfort, hydration and observation.

1. Confirm the temperature was measured correctly. Repeat an unexpected reading using an age-appropriate thermometer and proper technique.
2. Offer fluids regularly. Continue breastfeeding babies as usual and watch for dehydration.
3. Allow your child to rest. Do not force food if they are not hungry, but continue offering fluids.
4. Use comfortable clothing. Avoid heavy wrapping, but do not aggressively undress your child in an attempt to cool them.
5. If your child is distressed or uncomfortable, an age-appropriate fever medicine may be considered according to medical or pharmacist advice and the approved product instructions.

The NHS recommends regular fluids, continued breastfeeding, monitoring for dehydration and avoiding excessive clothing or bedding during a fever. [2]

What actually helps a child with fever at home?

1. Prioritise hydration

Children can lose more fluid when they have a fever. Offer age-appropriate fluids regularly and continue normal breastfeeding or milk feeds in infants.

Watch for warning signs of dehydration such as a dry mouth, reduced tears, fewer wet nappies or reduced urination, and unusually low activity. Both NICE and the American Academy of Pediatrics emphasise hydration during fever care. [1] [3]

2. Dress for comfort—not to “sweat out” the fever

Do not wrap your child in heavy blankets in an attempt to make them sweat. At the same time, aggressive undressing is not necessary. Use comfortable clothing appropriate for the room temperature.

NICE advises that children with fever should be neither underdressed nor over-wrapped. [1]

3. Watch the child, not only the thermometer

A child with a temperature of 38.5°C who remains alert, drinks and interacts can look very different from another child with a lower temperature who is unusually sleepy, dehydrated or struggling to breathe.

Monitor alertness, breathing, drinking, urination, skin colour and associated symptoms as well as the temperature itself.

If you are unsure whether a reading is actually abnormal, see our guide to normal temperature in children and how the measurement site changes the reading.

When should fever medicine be considered?

NICE recommends considering either paracetamol (acetaminophen) or ibuprofen when a child with fever appears distressed or uncomfortable. Fever medicine should not be used solely to reduce the thermometer reading. [1]

This distinction matters. Fever-reducing medicine can make a child feel better, but it does not necessarily treat the cause of the illness or shorten its duration. [3]

Should paracetamol and ibuprofen be given together?

NICE advises against giving both medicines at the same time. Changing from one medicine to the other or alternating them may only be considered in specific circumstances when distress continues or returns before the next dose is due. The NHS also advises parents not to alternate them unless a doctor or nurse recommends it. [1] [2]

Always check whether another cold, pain or fever product already contains the same active ingredient before giving more than one medicine.

What if my child's temperature does not come down after medicine?

Parents often become more worried when a fever remains high or decreases only slightly after medicine.

Avoid two common mistakes:

• Do not give an extra dose or shorten the dosing interval simply because the thermometer has not fallen as expected.
• Do not assume that a fever falling means the illness is harmless.

NICE specifically advises healthcare professionals not to use a decrease—or lack of decrease—in temperature after antipyretic medicine to distinguish serious from non-serious illness. [1]

Instead, look at your child. Are they more comfortable? Are they drinking? Are they alert and interacting? Is their breathing normal? Have any new warning signs appeared?

For a broader guide to interpreting fever by age and symptoms, see child fever treatment by age, temperature and symptoms.

Do compresses or baths help reduce a child's fever?

Cooling the skin is traditionally used to bring a fever down, but modern guidelines do not recommend physical cooling as the main treatment for routine fever.

NICE does not recommend tepid sponging for treating fever, and the NHS advises against sponging or undressing a child in an attempt to cool them. [1] [2]

Fever is not simply excess heat sitting on the skin. During an infection, the body's temperature regulation changes. Aggressive external cooling may therefore cause discomfort or shivering without treating the underlying cause.

Is a lukewarm bath always wrong?

Not necessarily. A comfortable lukewarm bath may feel pleasant to some children, but it should not be used aggressively to chase a thermometer number. Cold water and ice baths should be avoided because they can cause shivering and discomfort. [3]

Saudi Ministry of Health guidance mentions room-temperature water compresses in the specific context of care after a febrile seizure has stopped. That does not mean compresses are the primary treatment for every childhood fever. [5]

Vinegar, lemon, onion and oils for fever: what does the evidence say?

A home remedy can be popular in search results without being proven safe or effective. Fever care should distinguish evidence-supported measures from traditional practices.

7 common mistakes when trying to lower a child's fever

1. Treating the number instead of the child

Repeatedly checking the thermometer and trying to reach a specific number can distract from more important signs such as alertness, breathing and hydration.

2. Giving fever medicine to a comfortable child only because the number is high

Antipyretic medicines are mainly intended to relieve distress and discomfort rather than simply normalise body temperature. [1]

3. Repeating a dose early because the fever remains high

Do not change the dose or timing based on one temperature reading. Follow approved instructions and professional advice.

4. Accidentally giving two products containing the same active ingredient

Some cold, flu and pain products may contain paracetamol or another ingredient already given separately. Always check the label.

5. Routinely alternating paracetamol and ibuprofen

Alternating medicines can increase the chance of timing or dosing errors and is not a routine approach for every child with fever. [1] [2]

6. Using vinegar, alcohol, ice or very cold water

These practices are either unsupported as routine fever treatment or, in the case of vinegar and rubbing alcohol, can cause direct harm. [6] [7]

7. Delaying medical care because the fever improved after medicine

A falling temperature does not rule out serious illness. Warning signs should be acted on regardless of the response to fever medicine. [1]

Does lowering a fever prevent febrile seizures?

No. This is an important misconception because fear of seizures can lead parents to aggressively cool a child or repeatedly give fever medicine.

NICE states that antipyretic medicines do not prevent febrile seizures and should not be used specifically for that purpose. The American Academy of Pediatrics likewise notes that acetaminophen and ibuprofen may lower fever and improve comfort but do not prevent febrile seizures. [1] [4]

If a seizure occurs, do not try to force medicine into the child's mouth and do not put any object between their teeth. Managing the seizure safely becomes the immediate priority.

See our dedicated guide: febrile seizures in children: what to do in the first few minutes.

When should a child with fever see a doctor?

Seek medical assessment if:

• your baby is younger than 3 months and has a temperature of 38°C or higher,
• your baby is aged 3 to 6 months and has a temperature of 39°C or higher,
• your child is unusually drowsy, difficult to wake or not responding normally,
• there is breathing difficulty or a significant change in skin or lip colour,
• there is a rash that does not fade when pressed,
• a seizure occurs,
• there are significant signs of dehydration,
• the fever has lasted 5 days or longer,
• your child's condition is worsening or you remain concerned even if the temperature itself is not extremely high.

In children older than 6 months, NICE advises that the height of the temperature alone should not be used to identify serious illness. The child's overall condition and accompanying symptoms remain essential. [1]

Key takeaway: faster is not always better

If you are trying to reduce your child's fever quickly, do not let speed lead to vinegar, rubbing alcohol, ice baths, extra medicine or unsupervised alternating of medicines.

Start by checking for warning signs. Then focus on fluids, breastfeeding, rest and comfortable clothing. If your child is distressed, an appropriate fever medicine may be used according to approved instructions and professional advice.

Remember that the response to fever medicine is not a test of how serious an illness is. The real goal is a more comfortable, adequately hydrated child whose overall condition is being monitored—not a thermometer forced back to 37°C.

For specialist assessment, visit Pediatrics at Mouwasat Hospital.

References

1. NICE – Fever in under 5s: assessment and initial management
2. NHS – High temperature (fever) in children
3. American Academy of Pediatrics – Caring for a child with fever
4. American Academy of Pediatrics – Febrile Seizures in Children
5. Saudi Ministry of Health – Febrile Seizures in Children
6. Poison Control – Vinegar safety and fever compresses
7. Poison Control – Rubbing alcohol poisoning and fever
8. The Effect of Lemon Juice with Coconut Oil Compress in Children with Fever – 2026 study

Febrile Seizure First Aid in Children: What to Do in the First Few Minutes

Seeing a child have a seizure during a fever can be frightening. In those first moments, however, the priority is not to force the seizure to stop or immediately cool the child's body. The most important actions are to protect the child from injury, place them safely on their side, time the seizure and know when emergency medical help is needed.

Most febrile seizures are short and do not cause long-term harm. Some situations do require urgent medical attention, particularly when a seizure lasts more than 5 minutes, it is the child's first seizure, breathing is difficult, or the child does not recover normally afterwards. [1] [2] [3]

Febrile seizure first aid: step by step

If your child starts having a seizure, focus on keeping them safe until the seizure stops or emergency help arrives.

1. Move your child to a safe place

Place your child on the floor or another low, safe surface. Move furniture, hard objects and anything sharp out of the way.

Saudi Ministry of Health guidance and the American Academy of Pediatrics recommend placing the child on their side so saliva or vomit can drain from the mouth rather than enter the airway. [1] [3]

2. Time the seizure

Look at the clock as soon as the seizure begins. During a frightening event, a short seizure can feel much longer than it actually is, so accurate timing is extremely useful for both emergency decisions and medical assessment.

If possible, also observe whether the whole body is involved or only one side, whether another seizure occurs, and how the child behaves afterwards.

3. Do not restrain the movements

Do not hold the child's arms or legs down. Restraining the child will not stop the seizure and may cause injury.

4. Do not put anything in the mouth

A child cannot swallow their tongue. A spoon, cloth, finger or other object in the mouth can injure the teeth or jaw and may obstruct the airway. [2] [3]

5. Stay with your child and watch their breathing

Do not leave the child alone. Observe their breathing and skin colour and continue timing the event until the movements stop.

What should you never do during a febrile seizure?

When is a febrile seizure an emergency?

Seek emergency medical help if:

• this is your child's first seizure,
• the seizure lasts more than 5 minutes,
• another seizure begins before your child has recovered normally,
• your child has difficulty breathing or does not breathe normally after the seizure,
• your child does not regain consciousness normally or remains unusually difficult to wake,
• the seizure affects only one side or one part of the body,
• your child is injured during the seizure,
• fever occurs with worrying features such as neck stiffness, repeated vomiting, a non-blanching rash or a clearly worsening condition.

Saudi Ministry of Health seizure first-aid guidance identifies a first seizure, a seizure lasting longer than 5 minutes, breathing or waking difficulties, another seizure shortly afterwards, and injury during a seizure as reasons to seek emergency care. [2]

What should you do after the seizure stops?

A child may be sleepy or confused for a while after a seizure. This can occur during the normal post-seizure recovery period.

After the movements stop:

1. Keep your child on their side in a safe position.
2. Make sure they are breathing normally.
3. Watch for gradual recovery of alertness and interaction.
4. Do not give food, drink or oral medicine until your child is fully awake and can swallow safely.
5. Write down how long the seizure lasted and what you observed.
6. Arrange medical assessment, especially if it was the first seizure or anything about the event was unusual.

Once your child is fully conscious, fever and discomfort can be managed appropriately. However, reducing the temperature does not reliably prevent another febrile seizure. [4]

For safe fever care after your child has recovered, read: how to reduce a child's fever: what the evidence supports and what the myths claim.

Why do guidelines mention both 5 minutes and 15 minutes?

The two numbers answer different questions:

A simple febrile seizure is typically generalised, lasts less than 15 minutes and does not recur within 24 hours. A complex febrile seizure may last longer, have focal features or recur during the same 24-hour period. [7]

What is a febrile seizure?

A febrile seizure is a seizure that occurs in some young children around the time of an illness causing fever. They occur most commonly from about 6 months to 5 years of age, and the seizure may occasionally be the first sign that the child is becoming ill. [1] [3]

A child may temporarily lose consciousness, become stiff, have jerking movements of the arms and legs, roll their eyes or have a brief change in facial colour.

A very high fever is not always required. Febrile seizures can occur early in an illness, which is one reason aggressively chasing the thermometer number does not reliably prevent them.

Can a febrile seizure cause brain damage?

Although the event can look frightening, short, simple febrile seizures generally do not cause brain damage, paralysis, intellectual disability or long-term neurological problems. [3]

Long, recurrent or focal seizures, or a child who does not recover normally, need urgent medical assessment because further treatment or investigation may be needed.

Does a febrile seizure mean my child has epilepsy?

No. Having a febrile seizure does not mean that a child has epilepsy.

Epilepsy involves a tendency to have seizures that are not explained solely by fever or another temporary trigger, whereas febrile seizures occur in association with a febrile illness in young children.

Children who have experienced febrile seizures have a slightly higher future risk of epilepsy than children who have not, but the large majority do not develop epilepsy. [5]

Can febrile seizures happen again?

Yes. Some children will have another febrile seizure during a future infection, but many will not.

Recent guidance from Cambridge University Hospitals reports recurrence in approximately 4 in 10 children who have experienced a febrile convulsion. Recurrence is more likely when the first event happens at a younger age or when there is a family history of seizures. [5]

A recurrence does not mean that the child has developed epilepsy, and it does not mean that parents failed to reduce the fever quickly enough.

Can lowering the fever early prevent a febrile seizure?

This is one of the most common misconceptions about febrile seizures.

Paracetamol or ibuprofen may improve comfort during a fever, but they do not reliably prevent febrile seizures.

NICE specifically states that antipyretic medicines do not prevent febrile convulsions and should not be used specifically for this purpose. The American Academy of Pediatrics gives the same advice. [3] [4]

Do not give fever medicine to a child without fever solely because they have previously had a febrile seizure, and do not use extra doses or shorten dosing intervals in an attempt to prevent a seizure.

What information will the doctor need after the seizure?

Useful details include:

• How long did the seizure last?
• Did it involve the whole body or only one side?
• Was this the first seizure?
• Did another seizure occur during the same day?
• Did your child return to their usual level of alertness?
• Was there a fever or another sign of infection?
• Was there breathing difficulty, vomiting, neck stiffness or a concerning rash?

If you are unsure whether the temperature itself is abnormal, see: normal temperature in children by measurement site.

For a broader guide to fever severity by age and symptoms, see: child fever treatment by age, temperature and symptoms.

Key takeaway

If your child has a febrile seizure, the most important first-aid steps are to turn them onto their side in a safe place, remove objects that could cause injury, time the seizure, avoid restraining them and never put anything in their mouth.

Seek emergency medical help if the seizure lasts more than 5 minutes, it is the child's first seizure, breathing is difficult, seizures recur, or the child does not recover normally afterwards.

Most simple febrile seizures do not cause brain damage and do not mean that a child has epilepsy. Fever-reducing medicines also do not reliably prevent future febrile seizures.

For specialist assessment and follow-up, visit Pediatrics at Mouwasat Hospital.

References

1. Saudi Ministry of Health – Febrile Seizures in Children
2. Saudi Ministry of Health – Seizure First Aid
3. American Academy of Pediatrics – Febrile Seizures in Children
4. NICE – Fever in under 5s: assessment and initial management
5. Cambridge University Hospitals – Febrile Convulsions
6. American Academy of Pediatrics – Seizure First Aid for Children
7. Royal Cornwall Hospitals – Febrile Convulsions Clinical Guideline

Child Fever Treatment by Age, Temperature and Associated Symptoms

A fever is one of the most common reasons parents become concerned about a child, but child fever treatment should not be based on the thermometer reading alone.

The child's age, breathing, alertness, ability to drink and associated symptoms can be more important than trying to bring the temperature down as quickly as possible.

When Is a Child's Temperature Considered High?

Temperature readings can vary depending on the child's age and how the temperature is measured, so a number should always be interpreted in context.

A temperature of 38°C (100.4°F) or higher is particularly important in young infants. NICE classifies babies younger than 3 months with a temperature of 38°C or higher as being at high risk of serious illness. [1]

For babies aged 3 to 6 months, a temperature of 39°C or higher is considered at least an intermediate-risk feature. [1]

For more detail about measuring temperature, see: Normal Child Temperature: Why the Measurement Site Changes the Reading.

A Temperature of 39°C Does Not Mean the Same Thing at Every Age

Watch the Child, Not Only the Thermometer

Parents may naturally focus on repeatedly checking the temperature, but the child's condition provides essential information.

Pay attention to:

• Alertness and interaction.
• How easily the child wakes.
• Breathing effort.
• Fluid intake or feeding.
• Urine output.
• Skin and lip color.
• New or unusual rashes.
• Severe pain, repeated vomiting or neck stiffness.

NICE specifically advises that in children older than 6 months, the height of body temperature alone should not be used to identify serious illness. [1]

Does a Fever Coming Down After Medicine Mean the Illness Is Mild?

No.

NICE advises clinicians not to rely on whether a temperature falls after an antipyretic to distinguish serious from non-serious illness. [1]

What Can Be Done at Home for a Child With Fever?

If the child's age and symptoms make home monitoring appropriate and there are no warning signs, care focuses on comfort, fluids and observation.

Fluids

Offer fluids regularly. For a breastfed baby, breast milk remains the most appropriate fluid. [1]

Comfortable clothing

Do not over-wrap a child with fever, but do not deliberately underdress them either. Keep clothing comfortable and appropriate for the environment. [1]

Monitor the child

Watch fluid intake, urine output, breathing, alertness and activity, and check on a feverish child during the night. [1]

For more detailed practical guidance, see: How to Reduce a Child's Fever Safely Without Common Home-Care Mistakes.

Does Every Child With Fever Need Fever-Reducing Medicine?

No. Fever medicine is not simply a treatment for a number on the thermometer.

NICE recommends considering either paracetamol (acetaminophen) or ibuprofen for children with fever who appear distressed, rather than using an antipyretic solely to lower body temperature. [1]

However, medication suitability depends on age, weight, medical conditions, hydration and the concentration of the specific product.

Paracetamol (acetaminophen)

Paracetamol is used to reduce discomfort associated with fever in children, but the correct amount depends on factors including the child's weight and product concentration. The American Academy of Pediatrics highlights medication dosing errors as an important safety concern and recommends confirming appropriate dosing, particularly in young children. [2]

Ibuprofen

Ibuprofen can also be used in appropriate children, but it has age, weight and medical-condition restrictions and is not automatically suitable for every child. Discuss its use with the child's doctor or pharmacist when unsure. [3]

Can paracetamol and ibuprofen be given together?

NICE advises against giving both at the same time. Switching or alternating medicines should not be done routinely without appropriate guidance from a healthcare professional. [1]

What about aspirin?

Do not give aspirin to a child on your own. It should only be used when specifically prescribed for an appropriate medical condition.

Vinegar, Ice or Cold Water: Do You Need Aggressive Fever-Lowering Methods?

There is no need to chase the thermometer reading with harsh cooling measures or unproven home remedies.

NICE does not recommend tepid sponging as a routine fever treatment, and the American Academy of Pediatrics advises against methods such as alcohol baths, ice packs and aggressive cooling. [1] [4]

Do Fever Medicines Prevent Febrile Seizures?

No.

NICE states that antipyretic medicines do not prevent febrile convulsions and should not be used specifically for that purpose. [1]

The Saudi Ministry of Health explains that febrile seizures typically occur between 6 months and 5 years of age and that having a febrile seizure does not mean a child has epilepsy. [5]

A first seizure or any seizure associated with fever requires appropriate medical assessment.

For first-aid guidance, see: Febrile Seizures in Children: What to Do in the First Few Minutes.

What Causes Fever in Children?

Fever is a symptom rather than a disease. Infection is the most common cause, often viral, although bacterial infections and other conditions can also cause fever.

Associated symptoms may help the clinician identify the source, including:

• Cough, runny nose or sore throat.
• Ear pain.
• Vomiting or diarrhea.
• Pain or burning with urination.
• Rash.
• Severe pain or neck stiffness.

Fever with cough does not automatically mean bacterial infection or a need for antibiotics. If cough is the main symptom, see: Child Cough Treatment by Cough Type, Age and Associated Symptoms.

Does Teething Cause a High Fever?

Teething may be associated with a very slight rise in temperature, but the Saudi Ministry of Health advises medical consultation if a child's temperature reaches 38°C or higher rather than assuming the fever is caused by teething. [6]

My Child Has a Fever Now: Home Monitoring, Doctor or Emergency?

Symptoms With Fever Can Matter More Than the Number

Seek medical advice or assessment when a child with fever:

• Is very young, particularly under 3 months.
• Has difficulty breathing or unusually fast breathing.
• Is unusually drowsy or difficult to wake.
• Is not drinking or feeding adequately or shows signs of dehydration.
• Develops a non-blanching rash.
• Has a seizure.
• Has repeated vomiting, severe pain or neck stiffness.
• Appears to be getting worse or remains unusually unwell.
• Has prolonged fever or the caregiver remains concerned.

The American Academy of Pediatrics also emphasizes how the child looks and behaves and the presence of associated symptoms when deciding when a pediatrician should be contacted. [4]

Mouwasat Hospital's Pediatric Department provides comprehensive care for infants, children and adolescents, including general and specialized pediatric services.

Bottom Line: Do Not Chase the Number and Forget the Child

Safe child fever treatment starts with the child's age and an accurate temperature measurement, followed by careful attention to breathing, hydration, alertness and associated symptoms.

Fever medicine may be appropriate to improve comfort in selected children, but it does not treat the underlying cause and should not be used solely to force the temperature back to normal.

In a young infant or any child with warning signs, medical assessment matters more than trying another method to lower the temperature at home.

Frequently Asked Questions About Fever in Children

Is 39°C dangerous for a child?

It depends on age and associated symptoms. In children older than 6 months, temperature alone does not determine severity. In a baby aged 3–6 months, 39°C or higher is an important risk feature requiring medical assessment. [1]

Does every temperature above 38°C need fever medicine?

No. Fever medicine is generally used to improve comfort rather than simply reduce the number. However, a baby younger than 3 months with a temperature of 38°C or higher needs urgent medical assessment. [1]

What is the best fever medicine for children?

There is no single best choice for every child. Paracetamol or ibuprofen may be appropriate in certain children, but medicine selection and dosing depend on age, weight, medical history and product concentration. Confirm the appropriate choice and dose with a doctor or pharmacist.

Should I alternate paracetamol and ibuprofen?

Do not routinely give both together or alternate them without medical guidance. [1]

Do fever medicines prevent febrile seizures?

No. Antipyretic medicines do not prevent febrile seizures. [1]

If the fever comes down after medicine, does that mean the illness is mild?

No. The response to fever medicine cannot reliably distinguish serious from non-serious illness. [1]

Can teething cause a temperature of 38°C or 39°C?

Teething may cause only a slight rise in temperature. The Saudi Ministry of Health advises medical consultation if the temperature reaches 38°C or higher. [6]

References

1. NICE – Fever in under 5s: Assessment and Initial Management
2. American Academy of Pediatrics – Acetaminophen Dosing Tables for Fever and Pain in Children
3. American Academy of Pediatrics – A Parent's Guide to Over-the-Counter Medicines for Children
4. American Academy of Pediatrics – Fever Without Fear
5. Saudi Ministry of Health – Febrile Seizures
6. Saudi Ministry of Health – Teething in Children

A Child’s Normal Temperature Isn’t One Number: Why the Measurement Site Matters

When a thermometer shows 37.5°C or 38°C, the natural question is whether this is a normal temperature for a child or a fever. The number alone, however, does not tell the full story.

A child's age, the site where the temperature was measured, the type of thermometer, the measurement technique, activity level and even a recent bath can affect the reading.

For that reason, a temperature of 37.5°C measured under the arm should not automatically be interpreted in the same way as 37.5°C measured in the ear or mouth. There is also no reliable formula for adding or subtracting a fixed number of degrees to convert a reading from one measurement site to another. [1] [4]

What is a normal temperature for a child?

There is no single temperature that is normal for every child at every moment. The American Academy of Pediatrics notes that normal body temperature varies with a child's age, activity level and time of day. The NHS describes the average normal temperature in babies and children as approximately 36.4°C, while noting that normal variation occurs. [1] [3]

For parents, the measurement site is particularly important because different parts of the body can produce slightly different readings.

The Canadian Paediatric Society provides the following reference ranges according to measurement site: [5]

These are reference ranges rather than rigid conversion or diagnostic rules. A temperature should always be interpreted alongside the measurement site, the child's age and the child's overall condition.

Why does the measurement site change the reading?

Different thermometers estimate body temperature from different parts of the body. The American Academy of Pediatrics considers rectal temperature the most accurate, followed by forehead measurements. Oral and ear measurements can also be accurate when performed correctly, while armpit temperatures are generally less accurate and are often used for screening. [1]

NICE takes a less invasive approach for routine temperature measurement in children younger than 5. It recommends an electronic thermometer in the armpit for infants younger than 4 weeks and either an axillary thermometer or infrared ear thermometer for children aged 4 weeks to 5 years. [2]

These recommendations are not necessarily contradictory. They reflect the balance between measurement accuracy, practicality and safe routine use.

What is a normal temperature under the armpit?

Armpit, or axillary, measurement is widely used in babies and young children because it is simple and non-invasive. The Canadian Paediatric Society lists an approximate normal axillary range of 36.5–37.5°C. [5]

Technique matters. The thermometer tip should sit against the skin in the centre of the armpit, with the child's arm held firmly against the body until the thermometer completes the measurement. The NHS recommends digital armpit measurement for children younger than 5 years. [3]

Which temperature method is best for each age?

Although rectal measurements are considered highly accurate by some organisations, they are more invasive. NICE does not recommend routine oral or rectal temperature measurement in children aged 0 to 5 years. If a rectal measurement is considered necessary, parents should use an appropriate technique and follow medical advice. [1] [2]

Should you add a degree to an armpit temperature?

No fixed amount should automatically be added to an armpit temperature.

A common rule of thumb is to add 0.5°C or even 1°C to an underarm reading to estimate the child's “real” temperature. This can create false precision.

Mayo Clinic explains that readings can differ depending on where temperature is measured, but there is no exact way to add or subtract a fixed degree value to make readings from different parts of the body match. When following a child's temperature over time, it is more useful to compare measurements taken in the same way. [4]

Therefore, if a child's temperature is 37.7°C under the arm, do not automatically convert it to 38.2°C or 38.7°C. Record it as 37.7°C axillary and interpret it with the child's age, symptoms and overall condition.

Why can a child's temperature change between readings?

Small changes do not always mean the illness itself has suddenly changed. Temperature readings can be affected by:

• a very warm room,
• heavy clothing or blankets,
• recent physical activity,
• a recent bath,
• incorrect thermometer positioning,
• incorrect placement of an ear thermometer,
• sweat or environmental temperature when using some forehead devices,
• hot or cold drinks before an oral measurement.

The NHS recommends allowing a child to cool down for a few minutes before repeating the temperature if they have just had a bath, been very active, been heavily wrapped or stayed in a very warm room. [3]

What if the thermometer reading does not match how my child looks?

1. Check the technique: Make sure the thermometer is positioned and used according to the manufacturer's instructions.
2. Repeat the reading correctly: When monitoring trends, use the same measurement site where possible.
3. Assess the child, not only the thermometer: Breathing, alertness, hydration, skin colour and associated symptoms all matter.

If fever is confirmed, read our detailed guide to child fever treatment by age, temperature and symptoms.

What do temperatures of 35.5, 36, 37.5, 38 and 39°C mean?

NICE specifically advises that in children older than 6 months, the height of the temperature alone should not be used to identify serious illness. The child's appearance and accompanying symptoms remain crucial. [2]

Does normal temperature change with age?

Normal temperature can vary somewhat with age, activity and time of day. In everyday home monitoring, however, parents do not need to memorise a different “normal number” for every age.

Age is more important because it affects which measurement method is appropriate and how urgently fever should be assessed.

For example, 38°C carries a very different level of concern in a 2-month-old baby than it does in an otherwise well 5-year-old child. [2]

When should you seek medical advice for a child's temperature?

Seek prompt medical assessment if:

• your baby is younger than 3 months and has a temperature of 38°C or higher,
• your baby is aged 3 to 6 months and has a temperature of 39°C or higher,
• your child appears seriously unwell or is unusually difficult to wake,
• there is difficulty breathing or a significant change in skin or lip colour,
• there is a rash that does not fade when pressed,
• your child has a seizure,
• there are significant signs of dehydration,
• repeated temperature readings are clearly abnormal or your child's condition worries you despite repeating the measurement correctly.

If a seizure occurs with fever, see our guide to febrile seizure first aid and what to do in the first few minutes.

If my child has a fever, should I lower the number as quickly as possible?

The goal of fever care is not to force the thermometer back to 37°C at all costs. The child's comfort, hydration, overall condition and the cause of the fever matter more than chasing a particular number.

A temperature falling after fever medicine does not prove that the underlying illness is minor, and a temperature that does not fall quickly does not by itself diagnose a serious illness.

For safe home care and common cooling mistakes to avoid, see: how to reduce a child's fever safely.

Key takeaway

A child's normal temperature cannot be interpreted separately from the way it was measured. Armpit, ear, mouth, forehead and rectal measurements can produce different readings, while age, technique, activity and environmental conditions can also influence the result.

Do not automatically add 0.5°C or 1°C to an armpit temperature. Record the measurement site, make sure the thermometer is being used correctly and repeat an unexpected reading before interpreting it alongside your child's age and overall condition.

For specialist assessment of fever or other concerning symptoms, visit Pediatrics at Mouwasat Hospital.

References

1. American Academy of Pediatrics – How to Take Your Child's Temperature
2. NICE – Fever in under 5s: assessment and initial management
3. NHS – How to take your baby's temperature
4. Mayo Clinic – Thermometers: Understand the options
5. Canadian Paediatric Society – Fever and temperature taking

GERD Symptoms: From Heartburn to Cough and Difficulty Swallowing

GERD symptoms vary from person to person. Heartburn behind the breastbone and regurgitation of stomach contents into the throat or mouth are among the most common symptoms, but some people may also experience cough, hoarseness, nausea, chest pain, or difficulty swallowing.

Not every symptom that occurs in someone with reflux is necessarily caused by GERD. Understanding which symptoms are typical, which may have several possible causes, and which require medical assessment can help avoid incorrect self-diagnosis.

What Are the Most Common GERD Symptoms?

The most common symptoms of gastroesophageal reflux disease are heartburn and regurgitation. Heartburn is typically felt as a burning sensation behind the breastbone, while regurgitation occurs when stomach contents travel back into the esophagus, throat, or mouth. [1]

Other symptoms may include:

• Chest discomfort or burning.
• A sour or bitter taste in the mouth.
• Belching.
• Nausea.
• Difficulty swallowing or pain when swallowing.
• Chronic cough.
• Hoarseness.
• Throat irritation.

When Do GERD Symptoms Usually Occur?

Symptoms may become more noticeable:

• After a large meal.
• After eating foods or drinking beverages that personally trigger reflux.
• When lying down soon after eating.
• When bending forward.
• During the night in some people.

The Saudi Ministry of Health notes that reflux symptoms may worsen after overeating and while bending or lying down. [2]

What Does GERD Chest Discomfort Feel Like?

GERD-related heartburn is often described as a burning sensation in the middle of the chest behind the breastbone and may rise toward the throat. [1]

It may occur after eating or worsen when lying down or bending over, and it can occur together with a sour taste or regurgitation.

However, chest pain has many possible causes. A person should not assume that new or significant chest pain is simply acid reflux.

What GERD Symptoms Can Affect the Throat?

Some people experience throat or voice symptoms alongside more typical reflux symptoms. These can include:

• Hoarseness.
• Chronic cough.
• Throat irritation.
• Frequent throat clearing.
• A sensation of a lump in the throat in some patients.

These symptoms alone do not prove that reflux is the cause. GERD guidelines recommend evaluating other possible causes of extraesophageal symptoms before attributing them to reflux. [3]

Allergies, sinus and nasal disorders, respiratory disease, and laryngeal conditions can produce similar symptoms.

Can GERD Cause Cough or Phlegm?

GERD can be associated with chronic cough in some people. Medical sources also recognize hoarseness and other throat or lung-related symptoms among possible extraesophageal manifestations. [1]

However, cough has many possible causes, so cough alone is not enough to diagnose GERD.

Phlegm is not one of the classic symptoms of GERD. Some patients may notice increased throat secretions or frequent throat clearing, but allergies, respiratory infections, or postnasal drainage should also be considered.

Can GERD Cause Shortness of Breath or Choking?

GERD may coexist with respiratory or laryngeal symptoms in some patients, and reflux has been associated with chronic cough, asthma, and voice symptoms. [4]

However, shortness of breath should not automatically be attributed to GERD. It has many potential causes involving the heart, lungs, airways, infections, and other conditions.

Some patients may also describe nighttime throat irritation or a choking sensation, but recurrent or significant breathing difficulty requires medical assessment rather than assuming reflux is responsible.

Can GERD Cause Dizziness or Headaches?

Dizziness and headache are not typical GERD symptoms.

They may occur in someone who also has GERD, but their presence does not establish reflux as the cause. Recurrent or severe dizziness or headaches should therefore be evaluated separately rather than automatically being linked to acid reflux.

Are Anxiety and Stress Symptoms of GERD?

Anxiety and stress are not diagnostic symptoms of GERD, but they may worsen reflux symptoms or make them more noticeable in some individuals.

The Saudi Ministry of Health lists anxiety and stress among factors that may trigger reflux symptoms. [2]

This distinction matters: stress may be a trigger or symptom amplifier, but it is not evidence by itself that a person has GERD.

How Should Different GERD Symptoms Be Interpreted?

Can GERD Occur Without Heartburn?

Yes. Not everyone with GERD experiences classic heartburn. NIDDK notes that some adults with GERD may instead experience chest pain, nausea, swallowing problems, chronic cough, or hoarseness. [1]

When only atypical symptoms are present, however, determining whether reflux is truly responsible can be more difficult because the same symptoms can arise from several other conditions.

When Do GERD Symptoms Need Treatment?

Occasional mild reflux may improve with lifestyle measures. Recurrent, troublesome, or persistent symptoms deserve medical assessment and an appropriate treatment plan.

For a detailed look at management options, read: GERD Treatment: Available Options and When to See a Doctor.

For a broader overview of the condition, see: GERD: Symptoms, Causes, Diagnosis and Treatment.

When Should You See a Doctor for GERD Symptoms?

Medical evaluation is recommended when reflux symptoms are frequent or persistent, swallowing becomes difficult, nausea or vomiting continues, unexplained weight loss develops, or symptoms do not improve despite treatment. [2]

NIDDK also recommends medical assessment for symptoms such as:

• Chest pain.
• Difficulty swallowing or pain when swallowing.
• Persistent vomiting.
• Vomiting blood or material that resembles coffee grounds.
• Black or bloody stools.
• Unexplained weight loss.
• Symptoms that do not improve with treatment and lifestyle changes.

Mouwasat Hospital's Gastroenterology & Endoscopy Department provides evaluation, diagnosis and treatment for digestive disorders including reflux-related symptoms.

Frequently Asked Questions About GERD Symptoms

Can GERD cause nausea?

Yes. Nausea can occur in some people with GERD, although it is not the most typical symptom. [1]

Can GERD cause a cough?

GERD can be associated with chronic cough, but cough has many other possible causes and cannot diagnose GERD by itself.

Can GERD cause phlegm?

Phlegm is not a classic GERD symptom. Throat secretions and frequent throat clearing may occur, but allergies, respiratory infections, and postnasal drainage should also be considered.

Can GERD cause shortness of breath?

Respiratory symptoms may coexist with reflux in some patients, but shortness of breath has many possible causes and should not automatically be attributed to GERD.

Can GERD cause dizziness?

Dizziness is not a typical symptom of GERD. Frequent or significant dizziness should be assessed for other possible causes.

Can GERD cause choking at night?

Nighttime reflux may cause throat irritation or unpleasant sensations in some people, but recurrent choking or breathing difficulty during sleep can have other causes and should be medically evaluated.

Can GERD cause chest pain?

GERD can cause chest pain or burning, but new or severe chest pain should not automatically be assumed to be acid reflux.

References

1. NIDDK – Symptoms & Causes of GER & GERD
2. Saudi Ministry of Health – Gastroesophageal Reflux Disease Awareness
3. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease
4. Saudi Gastroenterology Association Consensus on the Diagnosis and Treatment of GERD