The efficacy of tepid sponge bathing to reduce fever in young children

doi:10.1016/S0735-6757(97)90099-1

The American Journal of Emergency Medicine

Volume 15, Issue 2, March 1997, Pages 188-192

https://doi.org/10.1016/S0735-6757(97)90099-1 Get rights and content

Abstract

Tepid sponge baths distress febrile children, and their efficacy at reducing fever has not been established. This study compared fever reduction and with (1) acetaminophen alone and (2) acetaminophen plus a 15-minute tepid sponge bath. Twenty children, ages 5 to 68 months, who presented to the emergency department or urgent care center with fever of ≥38.9°C were randomized to receive (1) acetaminophen alone or (2) acetaminophen plus a 15-minute tepid sponge bath. All subjects received a 15-mg/kg dose of acetaminophen. Tympanic temperature was monitored every 30 minutes for 2 hours. Subjects were monitored for signs of discomfort (crying, shivering, goosebumps). Sponge-bathed subjects cooled faster during the first hour, but there was no significant temperature difference between the groups over the 2-hour study period (P = .871). Subjects in the sponge bath group had significantly higher discomfort scores (P = .009).

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Cited by (37)

The use of calf compresses for gentle fever reduction- What do we know? A scoping review
2022, Collegian
Citation Excerpt :
Most of them are RCTs, 3 of them are controlled studies, one is a randomised, open parallel group study and another one is quasi experimental study. As shown in the “Aim” and “Outcome” columns of Table 2, several studies aimed to compare the effects on fever of tepid water sponging in combination with an antipyretic (paracetamol = acetaminophen, ibuprofen, aspirin, metamizole) versus an antipyretic alone (Agbolosu et al., 1997; Aksoylar et al., 1997; Aluka et al., 2013; Alves, de Almeida, & de Almeida, 2008; Friedmann & Barton, 1990; Hunter, 1973; Mahar et al., 1994; Sharber, 1997; Steele, Tanaka, Lara, & Bass, 1970; Thomas, Vijaykumar, Naik, Moses, & Antonisamy, 2009) while the study of Klich-Heartt (2003) investigated the effect of additional lemon calf compresses to “standard prescribed medical therapies.” The main conclusion from most of the studies is that antipyretic treatment is sufficient for reducing fever (Agbolosu et al., 1997; Alves et al., 2008; Friedmann & Barton, 1990; Hunter, 1973; Newman, 1985).
Compresses are one of the water treatments of Traditional European Medicine and are used for a variety of indications in patient care. Calf compresses are used for gentle fever reduction. However, little is known about the origin and effectiveness of calf compresses.
We aimed to provide an overview regarding the evidence of the effects of the use of calf-compresses to reduce fever by means of a scoping review.
Five electronic databases and the “Library of the Institute for the History of Medicine” were searched in English and German language. Gray literature was also considered. The "PRISMA Scoping Review Guideline" was applied for the methodological preparation of the review.
45 articles were included and divided into the sections history and origins (eight references), nursing guidance (eight references), trials regarding nursing inpatients (13 trials), and trials regarding patients at the Intensive Care Unit (16 trials). While several articles and trials regarding the use of sponging and other cooling strategies were available, the use of calf-compresses was only found in a minority of German speaking articles. Only two studies demonstrated the use of calf-compresses for gentle fever reduction. Overall, the literature and studies found a support for physical cooling practices mostly along with pharmacologic antipyretics. The way of cooling, cooling application temperatures, duration of applications and the definition of fever at all demonstrate controversy approaches of methods. In clinical trials worldwide, physical cooling to lower fever is associated with side effects and discomfort.
Calf compresses are well established in German-speaking countries. Based on the knowledge gaps identified in this scoping review, further studies would be needed to explore calf compresses in their antipyretic properties and in particular their mode of application including physiological considerations. Observation to fever onset and/or phases could be an identified key useful starting point for future research. Contraindications to a fever-reducing calf wrap must be strictly observed.
Dosing and antipyretic efficacy of oral acetaminophen in children
2013, Clinical Therapeutics
Citation Excerpt :
Six studies used doses of <10 mg/kg; 9 studies, 10 mg/kg; 12 studies, >10–<15 mg/kg; 13 studies, 15 mg/kg; and 2 studies, 20–30 mg/kg. Table V17–57 additionally lists ΔTempmax by time following acetaminophen administration. Figure 3 shows mean ΔTemp for the 5 major dose ranges by time period following drug administration.
A standardized approach to dosing acetaminophen in pediatric populations was published in 1983. That review proposed specific weight-related dosing for infants and children weighing 6 through 95 lb and an age-based schedule for children aged <4 months through 11 years. Subsequent clinical studies evaluating these and alternative doses of acetaminophen supported the recommended 10–15-mg/kg dose.
This article reviewed published and unpublished pediatric antipyretic data to provide a critical assessment of the 10–15-mg/kg oral dose and the current pediatric oral dosing schedules for acetaminophen.
Published literature and unpublished clinical trials that evaluated the antipyretic efficacy of acetaminophen in children were reviewed. The PubMed database was searched using the term acetaminophen or paracetamol, with study criteria limited to randomized, controlled trials; oral dosing; patient age <12 years; and publication between 1982 and August 2012. All of the sponsor’s unpublished antipyretic clinical studies completed between 1980 and August 2012 and involving at least 1 oral-formulation acetaminophen-only treatment arm were identified. Data from published literature containing sufficient detail to verify doses; dosing frequency; and, when necessary, estimates from figures, and from acetaminophen arms of the unpublished studies were analyzed.
Thirteen unpublished trials enrolled 705 children to receive an oral dose of 10–15 mg/kg of acetaminophen. This dose resulted in a rapid onset of temperature reduction, with a maximum temperature decrement of ~3 hours following administration. Results from 40 published clinical trials in which 2332 children received oral acetaminophen for fever support these findings. The most common adverse events reported in any of the reported studies were gastrointestinal in nature and generally mild in intensity.
Data support the recommended 10–15-mg/kg oral dose and demonstrate that the age and weight schedules for over-the-counter acetaminophen proposed in 1983 remain appropriate.
Management of fever in children: Summary of the Italian pediatric society guidelines
2009, Clinical Therapeutics
Objective: This article summarizes the Italian Pediatric Society guideline on the management of the signs and symptoms of fever in children, prepared as part of the National Guideline Program (NGLP).
Methods: Relevant publications in English and Italian were identified through searches of MEDLINE and the Cochrane Database of Systematic Reviews from their inception through December 31, 2007. Based on the consensus of a multidisciplinary expert panel, the strength of the recommendations was categorized into 5 grades (A–E) according to NGLP methodology.
Summary: In the health care setting, axillary measurement of body temperature using a digital thermometer is recommended in children aged <4 weeks; for children aged ≥4 weeks, axillary measurement using a digital thermometer or tympanic measurement using an infrared thermometer is recommended. When body temperature is measured at home by parents or care-givers, axillary measurement using a digital thermometer is recommended for all children. Children who are afebrile when seen by the clinician but are reported to have had fever by their caregivers should be considered febrile. In special circumstances, high fever may be a predictive factor for severe bacterial infection. Use of physical methods of reducing fever is discouraged, except in the case of hyperthermia. Use of antipyretics—paracetamol (acetaminophen) or ibuprofen—is recommended only when fever is associated with discomfort. Combined or alternating use of antipyretics is discouraged. The dose of antipyretic should be based on the child's weight rather than age. Whenever possible, oral administration of paracetamol is preferable to rectal administration. Use of ibuprofen is not recommended in febrile children with chickenpox or dehydration. Use of ibuprofen or paracetamol is not contraindicated in febrile children with asthma. There is insufficient evidence to form any recommendations concerning fever in children with other chronic conditions, but caution is advised in cases of severe hepatic/renal failure or severe malnutrition. Newborns with fever should always be hospitalized because of the elevated risk of severe disease; paracetamol may be used, with the dose adjusted to gestational age. Use of paracetamol or ibuprofen is not effective in preventing febrile convulsion or the adverse effects of vaccines.
FEVER: PATHOGENESIS AND TREATMENT
2009, Feigin and Cherry's Textbook of Pediatric Infectious Diseases, Sixth Edition
Fever: Parental Concerns
2008, Clinical Pediatric Emergency Medicine
Citation Excerpt :
However, some of the patients had received unknown dosages of antipyretics at home and patients who experienced shivering were withdrawn from the study. Sharber [48] found no significant decrease in fever among 10 febrile patients who received acetaminophen compared with 10 febrile patients who received 15 minutes of tepid sponging after receiving acetaminophen. The sample size in this study was very small.
Although fever is a common pediatric complaint, temperatures less than 41.7°C rarely cause neurologic sequelae such as obtundation and death. Most cases of fever in children cause no more than transient discomfort. Fever phobia is an exaggerated misconception about causes and consequences of fever and is very common among parents. Unsubstantiated parental concerns often push health care providers to overtreat fevers and further reinforce the phobia. To decrease this response, it is important to educate health care workers about thermometry, the pathophysiology of fever, the distinction between hyperthermia and fever, and safe evidence-based treatment strategies. Informed practitioners will in turn be better equipped to educate parents.
Fever
2007, Comprehensive Pediatric Hospital Medicine

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FirstTemp Genius^® tympanic thermometer provided by Sherwood IMS, Carlsbad, CA.

This study was conducted toward completion of a Master of Science degree at the University of Arizona, Tucson. Research was conducted at Tucson Medical Center.

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The efficacy of tepid sponge bathing to reduce fever in young children☆

Abstract

Am J Emerg Med

J Pediatr

Lancet

J Pediatr Health Care

Controversies in pediatrics: What tests are indicated for the child under 2 with fever

Pediatr Rev

Telephone encounters in a university pediatric group practice: a 2-year analysis of after-hour calls

Clin Pediatr

Patterns of illness in the highly febrile young child: Epidemiologic, clinical and laboratory correlates

Pediatrics

Fever phobia: The pediatrician's contribution

Pediatrics

Parental perception and management of school-age children's fevers

Nurse Pract

Fever in childhood: Phobia versus facts

Hosp Pract

Parental fever phobia and its correlates

Pediatrics

Antipyresis and fever

Arch Intern Med

Fever revisited

Pediatrics

A comparison of methods to reduce fever in young children

Ambulatory pediatrics

Tympanic thermometry in surgery and anesthesia

JAMA

A comparison of tympanic and pulmonary artery measures of core temperatures

J Post Anesth Nurs

Infrared ear thermometry

Pediatr Emerg Care