In a febrile pediatric patient with tachycardia and tachypnea but no signs of increased work of breathing, which skin finding supports fever as the cause?

• A. Warm and moist
• B. Cool and dry
• C. Cold and clammy
• D. Pale and mottled

Answer: (C)

Fever drives an increased metabolic rate, so the body relies on sweating to shed heat. When fever is present and sweating is occurring, the skin can feel cool and damp from evaporative cooling. This cool, clammy skin can therefore support fever as the cause of the tachycardia and tachypnea in a child who does not show signs of increased work of breathing. In contrast, dry or pale skin would suggest dehydration or poor perfusion from another process, while warm, moist skin is also possible with fever but the cool, clammy finding specifically points to the diaphoresis phase that accompanies fever.