Why does a child with fever and shakiness talk to themselves?

Why Children Talk to Themselves During Fever with Shakiness

A child talking to themselves during fever with shakiness is likely experiencing febrile delirium, which requires immediate medical evaluation to rule out serious conditions like encephalopathy or meningitis.

Potential Causes

• Febrile delirium/encephalopathy: High fever (>38.5°C) can cause temporary altered mental status in children, including talking to themselves, confusion, or hallucinations 1

• Seizure activity: The "shakiness" may represent seizure activity, which can be accompanied by altered mental status. Febrile seizures are common in children between 6 months and 5 years of age 2

• Central nervous system infection: Meningitis or encephalitis can present with fever, altered mental status, and abnormal movements 1, 3

• Toxic-metabolic disturbances: Severe dehydration, electrolyte imbalances, or hypoglycemia associated with fever can cause neurological symptoms 3

Warning Signs Requiring Immediate Medical Attention

• Altered consciousness: Drowsiness, confusion, or talking to self may indicate encephalopathy 1

• Seizure activity: Shaking, trembling, or rhythmic movements with altered awareness 2

• Signs of meningeal irritation: Neck stiffness, severe headache, photophobia (though these may be absent in young children) 3

• Toxic appearance: Extreme pallor, poor perfusion, or hypotension 1

Evaluation Approach

Immediate Assessment

• Determine if the child appears toxic or ill, as this significantly changes management 4
• Check vital signs, including accurate temperature measurement (rectal preferred in young children) 4
• Assess level of consciousness, responsiveness, and interaction 1

Further Evaluation Based on Clinical Presentation

• For mild symptoms with good general condition:

  • Monitor temperature, hydration status, and mental status 5
  • Provide antipyretics (acetaminophen is first-line) 5

• For concerning symptoms (persistent altered mental status, seizure activity, toxic appearance):

  • Urgent medical evaluation is required 1
  • Consider lumbar puncture to rule out meningitis, especially in children under 1 year 2
  • Laboratory tests may include complete blood count, electrolytes, glucose, and blood cultures 1

Management Considerations

• Fever control: Use acetaminophen (not aspirin, which is contraindicated in children under 16 years due to risk of Reye's syndrome) 1

• Hydration: Ensure adequate fluid intake to prevent dehydration 1, 5

• Monitoring: Close observation for worsening of neurological symptoms 5

• When to seek emergency care: If the child has persistent altered mental status, difficulty breathing, extreme lethargy, inability to be consoled, or seizure activity 1

Important Pitfalls to Avoid

• Dismissing neurological symptoms: Talking to self or confusion during fever should not be dismissed as normal behavior 1

• Focusing only on fever: The underlying cause of fever must be identified, especially when neurological symptoms are present 3

• Delaying evaluation for meningitis: In a child with fever and altered mental status, meningitis must be ruled out promptly 3

• Overlooking serious infections: Many children with serious bacterial infections may appear relatively well between fever spikes 4