Chills refers to feeling cold after an exposure to a cold environment. The word can also refer to an episode of shivering, accompanied by paleness and feeling cold.

"Goose bumps" are associated with a feeling of chilliness but are not necessarily associated with chills or fevers. Goose bumps raise the hairs on the body to form a layer of insulation.

Chills may occur at the beginning of an infection and are usually associated with a fever. Chills are caused by rapid muscle contraction and relaxation, and are the body's way of generating heat when it feels that it is cold. Chills often predict the coming of a fever, or an increase in the body's core temperature.

Chills may also represent a very significant and consistent finding in certain diseases such as malaria.

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

Infants tend not to develop obvious chills, but any fever in an infant 6 months or younger should be reported to a health care provider. Fevers in infants 6 months to 1 year should also be reported unless the parent is absolutely certain of its cause.

• Exposure to a cold environment
• Viral and bacterial infections
  • Bacterial gastroenteritis
  • Colds
  • Infectious mononucleosis
  • Influenza
  • Meningitis
  • Pneumonia
  • Strep throat
  • Viral gastroenteritis
  • Urinary tract infections such as pyelonephritis

Fever (which can accompany chills) is the body's natural response to a variety of conditions, such as infection. If the fever is mild (102 degrees Fahrenheit or less) with no side effects, no professional treatment is required. Drink lots of fluids and get plenty of rest.

Evaporation cools the skin and thereby reduces body temperature. Sponging with comfortably warm water (about 70 degrees Fahrenheit) may help in reducing a fever. Cold water, however, is uncomfortable, and may increase the fever because it can trigger chills.

Medications such as acetaminophen are effective for fighting a fever and chills.

Do not bundle up in blankets if you have a high temperature. This will only cause the fever to rise.

HOME CARE FOR A CHILD

If the child's temperature is over 102 degrees Fahrenheit, or if the child is uncomfortable, give pain-relieving tablets or liquid. Non-aspirin containing pain-relievers such as acetaminophen are preferred. Ibuprofen may also be used. Follow the recommended dosage on the package label.

Children who have symptoms of a viral infection should not be given aspirin because of the risk of Reye syndrome.

If the child's temperature is over 103.5 degrees Fahrenheit 1 to 2 hours after giving medication for fever, place the child in a tub of lukewarm water up to the navel. Rub a wet washcloth or towel over the child's body for 20 minutes or for as long as can be tolerated. Add warm water as needed to keep the water temperature constant and keep the child from shivering. Pat (don't rub) the child dry with a towel.

• Dress the child in light clothing, provide liquids, and keep the room cool but not uncomfortable.
• Don't use ice water or rubbing alcohol to reduce a child's temperature. These can cause shock.
• Don't bundle a feverish child in blankets.
• Don't wake a sleeping child to give medication or take a temperature -- sleep is more important.

• There is stiffness of the neck, confusion, significant irritability, or sluggishness.
• There is a significant cough, shortness of breath, abdominal pain or burning, or frequent urination.
• A child younger than 3 months has a temperature of 101 degrees Fahrenheit or more.
• A child between 3 months and 1 year has a fever that lasts more than 24 hours.
• The fever remains above 103 degrees Fahrenheit after 1-2 hours of home treatment.
• The fever does not improve after 3 days, or has lasted more than 5 days.

The health care provider will take your medical history and perform a physical examination.

Medical history questions may include:

• 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 occurrences (episodic)?
• How long does each attack last (for how many hours)?
• Did chills occur within 4 - 6 hours after exposure to something that you or your child are allergic to?
• Did they begin suddenly?
• Do they occur repeatedly? How often (how many days between episodes of chills)?
• What other symptoms are present?

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

Diagnostic tests that may be performed include the following:

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

Powell KR. Fever. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa:Saunders Elsevier;2007:chap 174.

Powell KR. Fever without a focus. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa:Saunders Elsevier;2007:chap 175.