Dengue Fever in Children: Symptoms and Warning Signs in Singapore
Dengue is spread by mosquitoes and common in Singapore. In a child it usually starts with a sudden high fever, headache, body aches, and sometimes a rash, often mistaken for a regular viral fever at first. The warning signs that matter most tend to appear as the fever comes down, not while it is at its highest. Here's what to watch for, which fever medicine to avoid, and when to go to A&E.
What dengue looks like in a child
Dengue is spread by the bite of an infected Aedes mosquito and is common in Singapore. Symptoms usually start 4 to 7 days after the bite, with a sudden high fever that can reach 39 to 40°C.
Alongside the fever, a child may have a headache, pain behind the eyes, muscle and joint aches, nausea or vomiting, and sometimes a flat, red rash. In the first day or two, this can look like any other viral fever, which is why dengue is often only confirmed with a blood test.
Warning signs of severe dengue
The signs that matter most usually appear around day 3 to 7 of the illness, as the fever comes down, and for the 1 to 2 days after. Not while it is at its highest. A child may seem to be getting better as the temperature drops, then develop warning signs shortly after. Babies and children can develop severe dengue, so it is worth watching closely for a couple of days even once the fever has settled.
Call 995 now if your child has a fever and any of these:
- !A seizure lasting more than 5 minutes (give rectal diazepam if a doctor has prescribed it, and still call)
- !Struggling to breathe (skin pulling in under the ribs, nostrils flaring, or grunting), pauses in breathing, or lips turning blue or grey
- !Cannot be woken, or floppy and not responding to you
- !A rash of small red or purple spots that does not fade when you press a glass on it
- !Swelling of the lips, tongue, or face, with any difficulty breathing
- !Cold, clammy, or mottled skin, with drowsiness or restlessness
Go to the nearest 24-hour A&E or children's emergency now if:
- !Blood in vomit
- !Blood in stool, which can look black
- !Easy bruising
- !Unusually restless or irritable
- !Passing much less urine than usual
- !Breathing fast
- !Refusing to drink
- !Cold, clammy hands and feet, even if your child seems alert
- !A baby under 3 months with a temperature of 38.0°C or above
- !A first febrile seizure, even if it has stopped
- !After a seizure: confused, still drowsy after 30 minutes, or more than one seizure in a day
- !A stiff neck, or crying in pain when bending the head forward
- !Unusually drowsy or hard to wake, but can be woken
- !Dengue warning signs as the fever comes down: tummy pain, repeated vomiting, bleeding gums or nose, or very tired
- !No urine or wet nappy for 12 hours or more
- !No tears when crying, sunken eyes, or a very dry mouth
- !Cannot keep any fluids down
- !Green vomit
- !A temperature above 40°C that is not coming down, and your child seems unwell
Medicine to avoid: no ibuprofen or aspirin
If dengue is a possibility, avoid ibuprofen, aspirin, and other NSAIDs, including diclofenac suppositories. Dengue can lower platelet levels, and these medicines can increase the risk of bleeding on top of that.
Paracetamol is the medicine to use for fever and discomfort while dengue is being checked. If your child has already had ibuprofen before dengue was suspected, mention this to the doctor rather than worrying about it at home.
→ What is ibuprofen, and when should it be avoided?
→ Paracetamol dosage calculator
Caring for your child at home
- Offer small, frequent drinks.
- Watch how often your child passes urine.
- Let your child rest.
- Give paracetamol only, and keep within the daily limit.
- Do not give ibuprofen, aspirin, or diclofenac.
- Protect your child from mosquito bites while unwell, so the virus does not spread to others at home.
When to go to A&E
If dengue is possible, see your GP early in the illness. A blood test is most useful in the first few days. If your child has a fever that has lasted more than 3 days without a clear cause, call your GP or polyclinic. A blood test can check for dengue as well as other causes, and an early test that comes back normal does not rule dengue out, so a repeat test may be suggested if the fever continues.
For any of the warning signs above, call 995 or go straight to A&E as the lists show, particularly if they appear as the fever is coming down rather than at its peak.
→ What happens when you take a feverish child to A&E
→ Fever with rash in a child: what to check first
→ Fever and dehydration: signs to watch for and what to offer
Frequently asked questions
How do I know if my child's fever could be dengue, and not just a normal viral fever?+
There is no way to tell from the fever alone, especially in the first day or two. A sudden high fever with a headache, pain behind the eyes, muscle and joint aches, or a rash raises the possibility, particularly if there have been dengue cases reported nearby. A blood test is the only way to confirm it, which is one reason doctors test for dengue when a child has a fever with no obvious cause.
Can I give my child ibuprofen if I think it might be dengue?+
No. Ibuprofen, aspirin, and other NSAIDs (including diclofenac, including as a suppository) can increase the risk of bleeding if your child has dengue, because dengue itself can lower platelet levels. Use paracetamol for fever and discomfort instead while this is being checked.
When do dengue warning signs usually appear?+
Usually around day 3 to 7 of the illness, as the fever comes down, and for the 1 to 2 days after. Not while it is at its highest. This is a common point of confusion for parents, since a child may seem to be improving as the temperature drops, then develop warning signs shortly after. Keep watching closely for a couple of days even after the fever appears to settle.
Is a rash with dengue dangerous?+
A flat, red rash is a common feature of dengue and is not on its own a sign of severe dengue. What matters more is the bleeding-type signs, such as small red or purple spots that look like pinpricks and do not fade when pressed, easy bruising, or bleeding from the gums or nose.
Does every child with dengue need to be admitted to hospital?+
No. Many children with dengue are monitored at home or as outpatients with regular review, especially if they are drinking well and have no warning signs. Children with warning signs, or whose blood tests show concerning trends, are more likely to be admitted for closer monitoring.
How is dengue diagnosed in Singapore?+
With a blood test. An NS1 antigen test can detect dengue from early in the illness, often from the first day of fever, while a full blood count tracks platelet count and hematocrit, which tend to change as dengue progresses. A normal result on day one does not rule dengue out, so a repeat test a day or two later is common if dengue is still suspected.