Fever is one of the most common symptoms of illness in children. Although most fevers are usually self-limiting, parents are often very concerned about lowering them. Fever is an elevation in set point such that the body temperature is regulated at a higher level. The efficacy of antipyretic medications in reducing fever is well documented. However, the value of cooling measures, such as tepid sponge baths, is not supported by research.
A recent study by Sharber (1997) compared fever reduction and amount of discomfort with acetaminophen alone and acetaminophen plus a 15 minute tepid sponge bath. Twenty children between 5 and 68 months of age were randomally assigned to one of these two groups. The children's temperatures, using an infrared tympanic thermometer, were recorded initially and at 30 minute intervals during the 2 hour study period. The tepid sponge baths, lasting 15 minutes, were administered 30 minutes after the acetaminophen dose. The children were monitored for signs of discomfort-crying, shivering, and goosebumps-at 15 minute intervals throughout the study period and at 3 minute intervals during the bath.
Sharber's study found the sponge bathed children cooled faster during the first hour but there was no significant temperature difference between the groups over the 2 hour study period. The children in the sponge bath group had significantly higher discomfort scores than those who were not sponge bathed.
The results of this study can be explained by the understanding that external cooling may produce heat loss but may also activate heat-conserving and producing mechanisms. These mechanisms--vasoconstriction, shivering, and goosebumps-contribute to discomfort.
This research confirms the findings of another study that sponging or tepid baths are ineffective in treating febrile children either when used alone or in combination with antipyretics, and they cause considerable discomfort (Newman, 1985). For children who have febrile seizures, administration of antipyretics and/or cooling measures does not prevent recurrences. Since sponge bathing is uncomfortable, nurses need to carefully assess whether or not this method of fever reduction is indicated.
In addition, it is important for nurses to understand how fever differs from hyperthermia. In hyperthermia, the set point is already normal. For this reason, antipyretics are of no value and cooling measures such as sponge bathing are indicated. Nurses need to be able to explain to children and their families why or why not sponge bathing is indicated.
Newman, J: Evaluation of sponging to reduce body temperature in febrile children, Canadian Medical Association Journal 132:641-642, 1985.
Sharber J: The efficacy of tepid sponge bathing to reduce fever in young children, American Journal of Emergency Medicine 15:188-192, 1997.
See Chapter 22 in Essentials of Pediatric Nursing, 5th edition.
See Chapter 27 in Nursing Care of Infants and Children, 5th and 6th editions.
March 15, 2002
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