The main aim in treating fever, therefore, shifts from clinical and medical concern to one of patient comfort. Providing this comfort should be balanced against the potential negative sequel of fever treatment: dulling a physiologically positive response to infection, diverting parental and medical attention away from concentrating on the cause of the fever rather than the fever itself, and even the possibility of increased nosocomial infections and serious poisoning(2,3). Some authors maintain that febrile seizures actually occur with increased frequency in children who have been exposed to sponging(4), possibly due to intense vasoconstriction diverting blood centrally and leading to a sudden or marked rise in core temperature. Vigorous attempts at antipyresis have failed to prevent recurrence of febrile seizures.

This being said, the article by Thomas, et al.(5) in this month’s Indian Pediatrics revisits the interesting question of how best to reduce fever. Utilization of axillary temperature as their primary endpoint reflects common practice, but it must be remembered that although a temperature gradient exists from axillary to oral to rectal temperature on a population basis; within an individual, patient correlation between axillary and core temperature is very poor(6). Thus their endpoint may not truly reflect changes in core temperature. Secondly, these authors used a dose of 10 mg/kg of paracetamol despite the fact that 15 mg/kg is the recommended antipyretic dose(7). Thirdly, the change of 0.4°F which they used for their power calculations is probably not of great clinical significance.

Thomas, et al. show that tepid sponging added nothing to the antipyretic effect of paracetamol after two hours; even though a more rapid initial fall in temperature was noted. Furthermore, they stress that tepid sponging was uncomfortable for patients. Their findings and conclusions support the idea that the aim of therapy in febrile children should be to concentrate on the investigation and treatment of the cause of the fever while ensuring adequate hydration, minimal loose clothing and patient comfort. At a more universal level, their findings could be used to try and counter the fever phobia which seems to be consuming not only parents but the medical community as well!

Funding: None.

Competing interests: None stated.

1. Kluger MJ. Fever revisited. Pediatrics 1992; 90: 846-850.

2. Heubi JE, Barbacci MB, Zimmerman HJ. Therapeutic misadventures with acetaminophen: hepatoxicity after multiple doses in children. J Pediatr 1998; 132: 22-27.

3. Ulinki T, Bensman A. Renal complications of non-steroidal anti-inflammatories. Arch Pediatr 2004; 11: 885-888.

4. Berg AT. Are febrile seizures provoked by a rapid rise in temperature? Am J Dis Child 1993; 147: 1101-1103.

5. Thomas S, Vijaykumar C, Naik R, Moses PD, Antonisamy B. Comparative effectiveness of tepid sponging and antipyretic drug versus only anitpyretic drug in the management of fever among children: A randomized controlled trial. Indian Pediatr 2009; 46: 133-136.

6. Falzon A, Grech V, Caruana B, Magro A, Attard-Montalto S. How reliable is axillary temperature measurement? Acta Paediatr 2003; 92: 309-313.