Chills Information | Mount Sinai

Rigors; Shivering

Chills refers to feeling cold after being in a cold environment. The word can also refer to an episode of shivering along with paleness and feeling cold.

Fever is an important part of the body’s defense against infection. Most bacteria and viruses that cause infections in humans thrive best at 98.6 degrees F (37 degrees C). Raising the body temperature a few degrees can help the body fight the infection. In addition, a fever activates the body’s immune system to make more white blood cells, antibodies, and other infection-fighting agents.

Considerations

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

Causes may include:

• Exposure to a cold environment
• Viral and bacterial infections

Home Care

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.

When to Contact a Medical Professional

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.

What to Expect at Your Office Visit

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.

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.

Last reviewed on: 2/2/2023

Reviewed 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.

Chills: Causes, Treatments, and Complications

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The term “chills” refers to a feeling of being cold without an apparent cause. Chills can occur with a fever and cause shivering or shaking.

The term “chills” refers to a feeling of being cold without an apparent cause. You get this feeling when your muscles repeatedly expand and contract and the vessels in your skin constrict. Chills can occur with a fever and cause shivering or shaking.

Your body chills can be constant. Each episode can last for as long as an hour. Your chills can also occur periodically and last for several minutes.

Some chills occur after exposure to a cold environment. They can also occur as a response to a bacterial or viral infection that causes a fever. Chills are commonly associated with the following conditions:

• bacterial or viral gastroenteritis
• flu
• meningitis
• sinusitis
• pneumonia
• strep throat
• urinary tract infections (UTIs)
• malaria

If you or your child has a fever with chills, there are some things you can do at home for comfort and relief. Keep reading to learn how to treat a fever with chills and when you should call a doctor.

Home care for adults

Treatment is usually based on whether your chills are accompanied by a fever and the severity of the fever. If your fever is mild and you have no other serious symptoms, you don’t have to see a doctor. Get plenty of rest and drink plenty of liquids. A mild fever is 101.4°F (38.6°C) or less.

Cover yourself with a light sheet and avoid heavy blankets or clothing, which can raise your body temperature. Sponging your body with lukewarm water or taking a cool shower may help reduce a fever. Cold water, however, may trigger an episode of chills.

Over-the-counter (OTC) medications can lower a fever and fight chills, such as:

• aspirin (Bayer)
• acetaminophen (Tylenol)
• ibuprofen (Advil)

As with any medication, carefully follow the instructions and take them as directed. Aspirin and ibuprofen will lower your fever and reduce inflammation. Acetaminophen will bring down a fever, but it won’t reduce inflammation. Acetaminophen can be toxic to your liver if it isn’t taken as directed and long-term use of ibuprofen can cause kidney and stomach damage.

Home care for children

Treating a child with chills and fever depends on the child’s age, temperature, and any accompanying symptoms. In general, if your child’s fever is between 100ºF (37. 8°C) and 102ºF (38.9°C) and they’re uncomfortable, you can give them acetaminophen in tablet or liquid form. It’s important to follow the dosing instructions on the package.

Never bundle feverish children in heavy blankets or layers of clothing. Dress them in lightweight clothing and give them water or other liquids to keep them hydrated.

Never give aspirin to children under the age of 18 because of the risk of Reye’s syndrome. Reye’s syndrome is a rare but serious disorder that can develop in children who are given aspirin while fighting a viral infection.

Call your doctor if your fever and chills don’t improve after 48 hours of home care or if you have any of the following symptoms:

• stiff neck
• wheezing
• severe coughing
• shortness of breath
• confusion
• sluggishness
• irritability
• abdominal pain
• painful urination
• frequent urination or lack of urination
• forceful vomiting
• unusual sensitivity to bright light

According to the Mayo Clinic, you should call your child’s doctor in the case of any of the following:

• a fever in a child younger than 3 months old
• a fever in a child age 3 to 6 months, and the child is lethargic or irritable
• a fever in a child age 6 to 24 months that lasts longer than one day
• a fever in a child age 24 months to 17 years that lasts longer than three days and doesn’t respond to treatment

Your doctor will ask questions about your chills and fever, including:

• Do the chills make you shake, or do you only feel cold?
• What was your highest body temperature that was accompanied by chills?
• Have you had chills just once or have you had repeated episodes of chills?
• How long did each episode of chills last?
• Did the chills begin after exposure to an allergen, or did they begin suddenly?
• Do you have any other symptoms?

Your doctor will perform a physical examination and possibly run diagnostic tests to see if a bacterial or viral infection is causing your fever. Diagnostic tests may include a:

• blood test, including a blood culture to detect bacteria or fungi in the blood
• sputum culture of secretions from the lungs and bronchi
• urinalysis
• chest X-ray to detect pneumonia, tuberculosis, or other infections

Your doctor may prescribe an antibiotic if you’re diagnosed with a bacterial infection, such as strep throat or pneumonia.

Chills and fever are signs that something is wrong. If chills and fever persist after treatment, see your doctor to determine the underlying cause.

If a fever goes untreated, you may experience severe dehydration and hallucinations. Children ages 6 months to 5 years may also have fever-induced seizures, which are known as febrile seizures. These seizures don’t typically cause long-term health problems.

Treatment of fever and chills | Haleon HealthPartner

Treating Fever and Chills

Here we discuss how to treat fever and chills caused by the flu or SARS.

Treatment steps for fever and chills

IDENTIFY

Use appropriate diagnostic questions to confirm that fever and chills are due to influenza or SARS.

INFORM

• Tell the patient how to minimize transmission of influenza or SARS to others
• Counsel the patient about flu- or SARS-related symptoms that may require additional medical attention

RECOMMEND

Along with the necessary advice, recommend or suggest drugs according to the individual needs of the patient.

Patient information

Since the influenza virus causes significant morbidity and even death every year, ¹ Patients should be informed about how to reduce the risk of infection and how to stop the spread of the virus. These measures include: ²

• covering the mouth with a tissue when coughing and sneezing;
• washing hands regularly and thoroughly;
• habit of not touching the face;
• annual vaccination;

It should also be clarified that only a doctor prescribes medicines for influenza, in case of severe influenza, but drug and non-drug treatment of such unpleasant symptoms as fever and chills is possible. ⁴

Treatment of fever should not only reduce fever but also relieve discomfort

⁵

• Non-pharmacological treatment

  Non-drug ways to relieve fever

  • Drink more to stay hydrated
  • Monitor symptoms continuously
  • Air temperature must be neutral, approximately 25°C
  • Do not dress too warmly or too lightly; wear comfortable clothes
  • Keep calm

• Medical therapy

  Medications to relieve fever

  The main over-the-counter pain and fever medications are paracetamol and NSAIDs (ibuprofen and acetylsalicylic acid). ⁵

  Paracetamol has been shown in clinical studies to relieve fever ^5-8 as a symptom of influenza, it is considered the first line therapy in adults and children. ^5.9

  Ibuprofen is also suitable for use in children older than 3 months, ¹⁰ but may be associated with more adverse events and drug interactions than paracetamol. ¹¹ Preparations containing acetylsalicylic acid are not recommended for the treatment of fever in children (due to the risk of developing Reye’s syndrome). ⁴

Fever and chills requiring referral

Fever and accompanying chills are symptoms of various illnesses, not just the flu.

The patient should be referred to a physician immediately if the pharmacist or caregiver observes the following:

• Paleness; patchy skin lesions; skin, lips or tongue are blue or ashy
• No response to social cues
• Patient has difficulty walking or staying awake
• Decreased activity
• Signs of acute respiratory distress syndrome such as nasal flaring, increased respiratory rate, wheezing in the chest, groaning and moderate or severe chest retraction
• Palpitations
• Reduced skin turgor
• Body temperature above 39°C in children aged 3-6 months or body temperature above 38°C in children <3 months of age
• Fever with rash
• Flu-like symptoms that improve but then recur with fever and worse cough ¹³

Treatment of fever and chills: summary

Once a patient’s fever and chills are determined to be due to influenza or SARS, pain/antipyretic drugs can be recommended to relieve symptoms, with paracetamol being suggested as first-line therapy. ^5.9

Causes of severe chills with colds and flu, how to treat this condition

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Severe chills , main causes and treatment

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Severe chills, underlying causes and treatment

Author, editor and medical expert

Klimovich Elina V.

Editor

Harutyunyan Mariam Arutyunovna

Content:

• Reasons
• Why chills without fever?
• How to deal with chills
• Can chills be prevented?
• References

Contents of the article Reasons Why does chills appear without fever? What to do with chills Can chills be prevented? References

Chills in an adult are due to spasm of the superficial vessels of the skin and are accompanied by trembling, in which individual muscle fibers begin to contract, and a sensation of goosebumps due to contraction of the muscles that raise the hairs on the arms and legs. At the same time, a person feels cold, tries to wrap himself in a blanket or curl up. In this way the body tries to warm up ^4.5 .

Causes

Chills are most often observed against the background of fever ³ which accompanies almost all infectious diseases ⁴ is a universal reaction of the organism ⁴ . When microbes and viruses penetrate it, the body “protects itself” by raising the body temperature ^2.3 .

Since more heat is generated during muscle contractions ⁶ , it means that the more pronounced the chill, the higher the body temperature ² . Light chilling is characteristic of 38 – 39 ⁰ C, “teeth chattering” and severe trembling – for fever in the range of 39 ⁰ – 40 ⁰ C. Terrific chills, covering the whole body, occur at temperatures above 40 ⁰ C ^3.6 .

Chilliness and fever may occur in various infectious diseases, such as colds, flu ³ or when a focus of purulent inflammation forms in any organ, for example, in the heart, kidneys, pleura, lungs or veins ⁷ . Symptoms are caused by pyrogens, or substances that can affect the thermoregulatory center in the brain. Pyrogens can be biologically active substances that secrete bacteria, viruses and other pathogens ³ .

Sometimes it is not infectious agents that act as pyrogens, but substances that are formed in the body itself during tissue damage and decay – inflammation, bruises, hemorrhages ^2.3 .

Even if you feel cold, trembling in the body, and the thermometer shows a temperature above 37 ⁰ C, the cause may not be inflammation or even an infection, but the following conditions:

• Nervous strain. With neurocirculatory dystonia (neurosis), chills often begin in the evening or at night. It can be provoked by emotional stress ¹⁶ .
• Hormonal imbalance. Chilling in women on the background of elevated temperature (37-38 ⁰ C) is a frequent symptom of menopause ^3.7 or premenstrual syndrome ¹⁸ .
• Diseases of the blood. Symptoms resembling infectious fever with shivering may be a sign of hemolytic anemia or lymphoma ¹⁴ .
• Hyperthermia. Overheating of the body occurs after intense physical overexertion, if the ambient temperature is above 26.7 ⁰ C ¹⁴ . Under such conditions, heat transfer is disturbed, and excess heat accumulates in the body ⁵ . Overheating affects athletes participating in competitions in a country with an unusual climate, while not observing the correct drinking regimen, as well as people suffering from obesity ¹⁴ .

What causes chills without fever?

Chilling can also occur against the background of normal and even low body temperature ^1,2,14 . During hypothermia – for example, when staying in the cold for a long time or immersing in cold water, ^1.2 – the vessels constrict so that the body does not lose heat. For example, trained swimmers with enough body fat to retain heat typically don’t feel shivering in cold water. But thin people with low levels of physical activity in similar conditions quickly lose blood circulation, develop severe trembling, turning into chills, and body temperature may even drop ¹⁴ .

Other causes of chills without fever include:

• hypoglycemia – low blood glucose – in patients with diabetes ⁹ ;
• hypothyroidism – deficiency of thyroid hormones ¹⁵ ;
• hypertensive crisis – a sharp and significant rise in blood pressure ⁸ .

Shaking without fever may occur if there is a long time between taking antipyretic drugs. These drugs quickly bring down the temperature, but if they are used incorrectly, a side effect sometimes occurs – muscle contraction, that is, trembling in the body. To avoid such phenomena, consult a specialist, he will tell you how to take antipyretics correctly ¹⁴ .

What to do in case of chills

In case of hypothermia, it is enough to warm up – put on warm clothes, drink hot tea or milk ¹ . If during flu or cold against the background of fever (above 38 ⁰ C) and chills, the state of health worsens, the legs and hands become cold, and the skin is “marbled”, it is likely that the body temperature will rise, which means that measures need to be taken ^{2 ,10} . First of all, consult a doctor in a clinic or call a doctor at home.

To alleviate unpleasant symptoms, when you feel chills, you should:

1. Wrap yourself in a blanket and keep warm. No need to be afraid that the temperature will start to rise even faster. The body does not lose its ability to resist external heat during fever ² .
2. Wipe the body with warm water at a temperature of 41 ⁰ C and above. Evaporating from the surface of the skin, the water will remove heat and contribute to its gradual cooling. But remember that you can not wipe the skin with cold water: sudden cooling causes even greater muscle and vascular spasm, increases chills and accelerates the rise in temperature ¹⁰ . Antipyretic ¹⁰ should be taken 30 minutes before the rubdown.

If you rub down without taking an antipyretic, chills may appear – due to trembling in the body, the temperature will rise again ¹⁷ .

RINZASIP® with vitamin C

To combat fever and other symptoms of colds (ARVI) and flu, paracetamol-based preparations are intended, for example, the combined RINZA® and RINZASIP®, which can be used by adults and adolescents from 15 years of age, and RINZASIP ® for children from 6 years old ^{11 .12} .

• RINZA® tablets contain paracetamol, phenylephrine, chlorphenamine and caffeine. The drug is ready for action 10 minutes after taking ¹³ , reduces muscle and joint pain, reduces fever ¹¹ . RINZA® also facilitates breathing in case of swelling of the airways, helps to reduce sore throat, itching of the eyes and nose ¹¹ .
• RINZASIP® drink powders with vitamin C contain, in addition to paracetamol, phenylephrine, pheniramine and caffeine, ascorbic acid. RINZASIP® with vitamin C in orange, lemon or blackcurrant flavor reduces cold symptoms and improves body resistance ¹² .

Attention! You can take antipyretic drugs for no more than 5 days ^11.12 . If fever, trembling and coldness persist or recur, a specialist should be consulted to find out the cause of this condition ⁴ .

Can chills be prevented?

To avoid the occurrence of this symptom, it is necessary first of all to act on its causes – to avoid situations in which it occurs, for example, hypothermia or training in conditions of high air temperature ¹⁴ . It is also important to strengthen the immune system and start treating a cold at its first symptoms.