My 2 year old has a fever. at what point should i treat it?

What the evidence says

There is no magic number that means you must give medicine. Canadian Paediatric Society's Caring for Kids resource explains that the height of a fever does not tell you how serious the illness is - a mild infection can cause a high fever, and a serious one can cause no fever at all. What matters more is how your child looks and acts.

So the real question is not 'what temperature' but 'is my child uncomfortable.' If your two-year-old is fussy, achy, can't settle to sleep, or is refusing fluids because they feel awful, that is a good time to give acetaminophen or ibuprofen to ease the discomfort. If they have a fever but are still playing, drinking, and acting mostly like themselves, medicine is optional - you do not have to treat the number.

International guidelines back this up. A German clinical practice guideline states that the decision to lower fever with medicine should be based only on how much the child is suffering, not given routinely just to bring the temperature down. UK NICE guidance similarly says fever-reducing medicines should not be used routinely with the sole aim of lowering body temperature in a child who is otherwise well, and that they do not prevent febrile seizures.

For a two-year-old specifically, Health Canada's own parent-facing guidance (via HealthLinkBC and CPS) says older toddlers can usually be managed at home as long as they are drinking enough and seem well, but should see a doctor if the fever lasts more than 48 to 72 hours, or sooner if warning signs appear - trouble breathing, unusual sleepiness, a stiff neck, a rash that doesn't fade with pressure, signs of dehydration, or a seizure.

One caution on medicine choice: ibuprofen should only be used with plenty of fluids and is not recommended for babies under 6 months without talking to a doctor first. Never give aspirin to a child with a fever because of the risk of a rare but serious condition called Reye syndrome.

Bottom line: watch your child, not just the thermometer. Comfort-driven treatment, good fluids, and light clothing are the mainstay; call your doctor if the fever drags on past 48-72 hours or your child seems increasingly unwell.