How to Control Fever and Shivering in Children

Caring for a sick child with a fever ranks among the most common and stressful rites of passage for parents. Add a shivering toddler to the mix and concern levels often skyrocket.

Dealing with a sick toddler is no fun — for you or your little one. (Image: FatCamera/iStock/GettyImages)

Fever and shivering typically occur due to an infection and pose no risk to your child's health in and of themselves. They develop as part of the body's natural response to combat an infection. When a fever and shivering make your child uncomfortable or distressed, however, there are steps you can take to control these symptoms.

Why Fever and Shivering Occur

Before deciding what to do about your child's fever and shivering, it's helpful to understand how and why they occur. The brain possesses a temperature control center that regulates the balance of heat generation versus loss to keep body temperature within a normal range.

When an infection occurs, substances called pyrogens often flood the bloodstream and trigger an increase in the body temperature set point. This change means the body intentionally works to increase body temperature. The resulting fever combats the infection by slowing the growth of viruses and bacteria, and increasing the numbers of immune cells to fight these germs. Pretty clever, right?

Shivering is a speedy way of generating heat via brief muscle contractions throughout the body that cause involuntary shaking. These mini muscle contractions generate heat and raise body temperature to the new set point. This is why shivering commonly occurs as a fever develops and tapers off once the higher body temperature has been reached — the body's way of saying, "Mission accomplished!"

Monitor your child for other signs of infection. (Image: Westend61/Westend61/GettyImages)

Deciding How to Treat

Minor viral infections cause most fevers in children. The American Academy of Pediatrics (AAP) states that the primary concerns when caring for a child with a fever — with or without shivering — are making sure your little one stays well hydrated by providing plenty of fluids and monitoring for signs and symptoms of a serious infection (discussed later).

If your child seems reasonably comfortable and is otherwise healthy, treating a fever provides no medical benefit and will not shorten the duration of their illness. However, if the fever is higher than 101 degrees Fahrenheit and your child seems uncomfortable, taking steps to reduce the fever might make your child more comfortable.

Controlling Symptoms Without Medication

Some home-care measures can help control a fever and shivering and make your child more comfortable.

  • Provide extra fluids. Drinking extra fluids helps prevent dehydration, which can lead to a further increase in the fever. Cold or frozen liquids, such as ice pops or iced drinks, help reduce body temperature and keep your child hydrated.

  • Avoid bundling. Although your instinct might be to bundle up a shivering child, this can actually drive up a child's fever. Dress your child in lightweight clothing or PJs and use a lightweight blanket to cover your little one. These measures can help reduce fever since body heat is lost through the skin.

  • Sponge or bathe in a tepid bath. Sponging your child's skin with lukewarm water — not cool or cold

    or putting them in a lukewarm bath (with toys to keep them entertained) can help lower body temperature. The water enhances loss of body heat through the skin. A lukewarm sponge or regular bath sometimes triggers shivering in a child with a fever. If this happens, try warming the water a bit more.

  • Apply cool compresses. Applying a cool compress to the forehead or giving your child a cooling pack to hold against the body might make your child more comfortable. Using a cooling pack shaped like a stuffed animal or wrapping one in a favorite blanket usually appeals to young children.

Fever-Reducing Medication

Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are effective at lowering fever in children. Follow the dosing instructions carefully and consult your doctor before giving either of these medications to a child younger than two years.

Acetaminophen is given every four to six hours and ibuprofen every six to eight hours. These medications typically lower fever within a couple of hours. If your child is sleeping, the AAP recommends not waking them up just to give fever medication.

Some healthcare providers recommend alternating acetaminophen and ibuprofen to reduce high fevers. But because this regimen can be confusing, it might lead to an accidental overdose. Check with your pediatrician before alternating acetaminophen and ibuprofen to treat your child's fever.

Note that the AAP strongly recommends avoiding use of aspirin to treat fever in children because of an increased risk of developing Reye syndrome — a rare but potentially life-threatening condition that primarily affects the liver and brain.

When to Seek Medical Help

Call your doctor if you are concerned about your child's fever, with or without shivering. This is especially important if the fever lasts more than 24 hours in a child younger than two years or three days or longer in children two years or older.

The AAP recommends contacting your doctor right away if your child:

  • Is

    younger than three months with a fever of 100.4 degrees Fahrenheit or higher

  • Has a fever that spikes to 104 degrees Fahrenheit or higher repeatedly

  • Experiences a seizure or seems very sick, drowsy or fussy

  • Seems to be getting worse or experiences signs or symptoms that might indicate a serious infection such as a rash, repeated nausea and vomiting, stiff neck, a severe headache, difficulty breathing, or severe throat or ear pain

  • Is taking steroid medication or has a preexisting illness, such as sickle cell disease, cancer or an immune system disorder

If any of these circumstances apply and you cannot reach your doctor, seek medical care from the nearest urgent care clinic or emergency room.

Reviewed and revised by: Tina M. St. John, M.D.

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