Cold Sweats and Chills With a Child's Fever: What They Mean
Chills and cold sweats are part of how the body raises and lowers its temperature during a fever, and are usually not a sign of anything dangerous on their own. Here's why they happen, what to do (and not do), and the signs that need a closer look.
Why fever causes chills and sweating
A fever happens because the body's internal thermostat resets to a higher temperature than normal. Chills and shivering are the body's way of generating heat to reach that new, higher target, which is why your child can feel cold or start shivering even while their temperature is rising. This usually happens as a fever is climbing.
Sweating happens for the opposite reason. When the thermostat drops back toward a lower setting, for example once medicine starts working or an infection begins to settle, the body releases heat through sweat to cool down. A warm, sweaty child as the fever breaks is expected.
Cold, clammy skin is different. If it comes with restlessness, drowsiness, tummy pain or little urine, it is not expected, especially around day 3 to 7 of a fever. In Singapore this can be a dengue warning sign, and it can appear just as the fever comes down. Get help now (see below). Dengue warning signs in children
Shivering with chills is not a seizure. A shivering child stays aware and responds to you. A child having a seizure does not respond, and may stiffen or jerk. Febrile seizure: what to do
Both are part of normal temperature regulation, not separate illnesses on top of the fever.
What to do when your child has chills or sweats
- During chills or shivering, a light blanket is fine until it passes. Remove it once your child warms up or starts sweating.
- During sweating, change your child out of damp clothes and bedding so they stay comfortable and do not get cold afterward.
- Offer a sip of water either way. Sweating adds to fluid loss on top of the fever itself.
- Keep the room at a comfortable temperature, around 25°C, with light clothing rather than heavy layers.
What not to do
- Do not use cold water baths, ice packs, or alcohol or vinegar rubs to try to cool a shivering child down faster. Cold water can cause shivering, which generates heat and can push the core temperature higher.
- Do not bundle your child up tightly to "sweat the fever out". Trapping heat this way can raise the temperature further and adds to fluid loss.
- Do not judge your child's temperature by their hands and feet alone. Check the chest or back of the neck instead, since hands and feet often feel cooler during a fever regardless of how high the temperature is.
When to look closer
Chills and sweating on their own are usually not a concern. Call your GP or polyclinic the same day if:
- Shivering keeps coming back.
- The fever keeps spiking back up despite medicine.
Cold, clammy or mottled skin, or a child who is very drowsy, needs help now, not a GP visit. Use the lists below.
→ Fever and dehydration: signs to watch for and what to offer
→ Fever not coming down with paracetamol: what to do
→ Fever at night: when should parents worry?
When to get help now
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:
- !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
Frequently asked questions
Why does my child feel cold and shiver when they have a fever?+
During a fever, the body resets its internal temperature target higher. Shivering is the body generating heat to reach that new target, which is why your child can feel cold or shiver even as their temperature is climbing. This is a normal part of how a fever develops.
Is sweating a sign the fever is breaking?+
Often, yes. Sweating happens as the body releases heat to bring the temperature down toward a lower target, for example after medicine starts working or as an infection settles. A warm, sweaty child as the fever breaks is expected. Cold, clammy skin with restlessness, drowsiness, tummy pain or little urine is not, especially around day 3 to 7 of a fever. In Singapore this can be a dengue warning sign, so get help now.
Should I cover my child with a blanket if they have chills?+
A light blanket while the shivering passes is fine, but remove it once your child warms up or starts sweating. Avoid piling on heavy layers to try to warm them up, as this can trap heat and push the temperature higher.
My child's hands and feet are cold but their body feels hot, is that normal?+
Yes, this is common during a fever. Blood flow shifts toward the body's core, so hands and feet can feel cool even while the chest and back feel hot. Check how warm your child feels at the chest or back of the neck rather than their hands and feet to judge their temperature.
When should I worry about chills or sweating with a fever?+
Chills or sweating on their own are rarely a concern. See your GP or polyclinic the same day if shivering keeps coming back, or if the fever keeps spiking back up despite medicine. Call 995 if your child has cold, clammy or mottled skin with drowsiness or restlessness. Go to the nearest 24-hour A&E or children's emergency if your child is unusually drowsy, or has tummy pain, repeated vomiting or bleeding gums as the fever comes down.