Hello christine.williams29, I saw your question posted on may 22 only now ( July 1). Though, clearly late, the answer may be useful to few in public fourm. Fever above 104 is high grade. This will be frightening to parent and pediatricians alike. If after giving paracetamol two things should happen. The child s activity should go up. Temperature should come down for few hours. Even if it rises again,doesn t matter. Then this is an illness which will get resolved on its own ( viral fevers ) or with drugs. Second step is to decide whether the child may require antibiotics. Antibiotics are given for bacterial infections. ( Strictly speaking it includes the anti viral and anti fungal drugs we have and rarely used in otherwise healthy children) What are the evidence of bacteria? 1. Skin : boils, cut wounds with pus 2. Jointis: Arthritis: pain ful joints , not able to move 3. Eye: lids swollen with pus (stye) 4. Nose: 10 days leaking nose or nasal tip redness 5. Mouth: Tooth cavities infected, gums swollen and painful and our tonsillits 6. Neck: Big glands which are painful, just below the jaw bone, below the ear , back and sides of the neck 7. Chest: evidence of pneumonia . Very fast breathing ( as if the child had participated in a running race). This can be seen by parents, but can be confirmed only persons with training. Sputum brought out by cough is yellow in colour 8. Urine painful so urine microscopic examination performed by a competent person shows pus cells or urine coulture is positive for bacteria with a colony count of 100,000 9. Blood in the stools. 10. Blood test positive for infections: eg. Typhoid. If there are no additional symptoms, we can wait. We need to do periodic growth assesment. Your child weight, height, head circumference, chest circumference, mid arm circumference should be appropriate for the age. If a person has loans, he cannot save. Similarly if a child has disease, it will not grow. Conversely if the growth of the child is normal then all is well. There are what is known as collagen vascular disorders they present as recurrent episodes of fever. Blood ESR will tell whether they may be present or not. Here in India Tuberculosis tests will be done with best wishes arulalan