Chills

Chills (shivering) may occur at the start of an infection. They are most often associated with a fever. Chills are caused by rapid muscle contraction and relaxation. They are the body's way of producing heat when it feels cold. Chills often predict the coming of a fever or an increase in the body's core temperature.

Chills are an important symptom with certain diseases such as malaria.

Chills are common in young children. Children tend to develop higher fevers than adults. Even minor illness can produce high fevers in young children.

Infants tend not to develop obvious chills. However, call your health care provider about any fever in an infant 6 months or younger. Also call for fevers in infants 6 months to 1 year unless you are sure of the cause.

"Goose bumps" are not the same as chills. Goose bumps occur due to cold air. They can also be caused by strong emotions such as shock or fear. With goose bumps, the hair on the body stick up from the skin to form a layer of insulation. When you have chills, you may or may not have goose bumps.

Causes may include:

• Exposure to a cold environment
• Viral and bacterial infections

Fever (which can accompany chills) is the body's natural response to a variety of conditions, such as infections. If the fever is mild, 102°F (38.8°C) or less, with no side effects, you do not need to see a provider for treatment. You can treat the problem at home by drinking lots of fluids and getting plenty of rest.

Evaporation cools the skin and reduces body temperature. Sponging with lukewarm water, about 70°F (21.1°C), may help reduce a fever. Cold water may increase the fever as it can trigger chills.

Medicines such as acetaminophen, aspirin, or ibuprofen are helpful in fighting a fever and chills.

DO NOT bundle up in blankets if you have a high temperature. DO NOT use fans or air conditioners either. These measures will only make the chills worse and may even cause the fever to rise.

HOME CARE FOR A CHILD

If the child's temperature is causing the child to be uncomfortable, give pain-relieving tablets or liquid. Non-aspirin pain-relievers such as acetaminophen are recommended. Ibuprofen may also be used. Follow the dosage guidelines on the package label.

Note: DO NOT give aspirin to treat fever in a child younger than 19 years old because of the risk for Reye syndrome.

Other things to help the child feel more comfortable include:

• Dress the child in light clothing, provide liquids, and keep the room cool but not uncomfortable.
• DO NOT use ice water or rubbing alcohol baths to reduce a child's temperature. These can cause shivering and even shock.
• DO NOT bundle a child with a fever in blankets.
• DO NOT wake a sleeping child to give medicine or take a temperature. Rest is more important.

Call the provider if:

• Symptoms such as stiffness of the neck, confusion, irritability, or sluggishness are present.
• Chills are accompanied by a bad cough, shortness of breath, abdominal pain or burning, or frequent urination.
• A child younger than 3 months has a temperature of 101°F (38.3°C) or more.
• A child 3 months to 1 year has a fever that lasts more than 24 hours.
• The fever remains above 103°F (39.4°C) after 1 to 2 hours of home treatment.
• The fever does not improve after 3 days, or has lasted more than 5 days.

The provider will take your medical history and perform a physical exam.

You may be asked questions such as:

• Is it only a cold feeling? Are you actually shaking?
• What has been the highest body temperature connected with the chills?
• Did the chills happen only once, or are there many separate episodes?
• How long does each attack last (for how many hours)?
• Did chills occur within 4 to 6 hours after exposure to something that you or your child is allergic to?
• Did chills begin suddenly? Do they occur repeatedly? How often (how many days between episodes of chills)?
• What other symptoms are present?

The physical exam will include the skin, eyes, ears, nose, throat, neck, chest, and abdomen. Body temperature will likely be checked.

Tests that may be ordered include:

• Blood (CBC or blood differential) and urine tests (such as urinalysis)
• Blood culture
• Sputum culture
• Urine culture
• X-ray of the chest

Treatment depends on how long the chills and accompanying symptoms (especially fever) have lasted.

Rigors; Shivering

American Academy of Pediatrics website. Fever. www.healthychildren.org/English/health-issues/conditions/fever/Pages/default.aspx. Accessed February 6, 2023.

Hall JE, Hall ME. Body temperature regulation and fever. In: Hall JE, Hall ME, eds. Guyton and Hall Textbook of Medical Physiology. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 74.

Leggett JE. Approach to fever or suspected infection in the normal host. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 264.

Nield LS, Kamat D. Fever. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 201.

Updated by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.