Fever when counts are low
A temperature of 38°C or above during treatment is an emergency. Here is what to do, and why the team reacts so fast.
Why this one matters most
lowers the white blood cells that fight infection. When the is low — a state called — an ordinary germ can spread through the body in hours instead of days.
A fever may be the only sign. Your child can look reasonably well and still be seriously unwell. This is why teams ask you to come in rather than wait and see.
What counts as a fever
A single temperature of 38.0°C (100.4°F) or higher, or 37.5°C (99.5°F) that stays there for an hour.
Take the temperature under the arm or in the ear as your team advised. Do not take it rectally — it can cause tiny tears that let bacteria in.
Do not give paracetamol or ibuprofen before speaking to the team. Paracetamol can mask a fever, and ibuprofen can worsen bleeding when platelets are low.
What to do, in order
1. Call the 24-hour number on your child's treatment card. It is staffed overnight; you are not disturbing anyone.
2. Bring the hospital bag and your child's treatment card or protocol summary.
3. Expect blood cultures and antibiotics within about an hour of arrival. Fast antibiotics are the single thing that most improves outcomes here.
4. Expect to stay at least until cultures and counts are back. Many admissions are short.
Call the team if
- Temperature 38.0°C or above, even once
- Shivering, shaking chills, or a sudden cold clammy feeling
- Unusual sleepiness, confusion, or a child who is hard to rouse
- Fast breathing, grunting, or blue or grey lips
- Redness, pain, or oozing at the site
A hospital bag that stays packed
Treatment card and medication list. Phone and a long charging cable. A change of clothes for you, not just your child.
Comfort items your child chooses themselves. Snacks you can eat one-handed at 3am.
Where this comes from
- Institutional febrile neutropenia pathway. Local thresholds and time-to-antibiotic targets vary. Your unit's pathway overrides this page.
- Paediatric oncology supportive care consensus guidance. General principles on fever, cultures, and empiric antibiotic timing.
Next review due 2027-02-01.