The children were then randomized by using a random number table to receive tepid sponging and antipyretic drug or only antipyretic drug. The initial temperature checking time was considered as 0 minutes. If the child belonged to the group of tepid sponging and antipyretic group, syrup/tablets paracetamol 10 mg/kg was administered and was sponged for 15 minutes. Tepid sponging procedure was as follows: Required articles: 5 sponge towels, a steel/enamel basin, Mackintosh, 2 bath towels, thermometer, bath thermometer and tap water (room temperature –0.5°C). After washing hands and checking the temperature of the child, a long mackintosh was spread under the patient. After assuring privacy the dress was removed and the child covered with top sheet. A sponge was then used to dab over the face and neck without touching the eyes and kept at the edge of the basin. A second sponge was used to dab one arm starting from the acromion process and proceeding laterally till the fingers and then medially reaching the axilla. The sponge cloth was left in the axillary pit. The same was done for the other arm. For the legs, a sponge cloth was used to dab from the groin proceeding laterally till the feet and then medially reaching the groin. The sponge cloth was kept on the fold of the groin. The abdomen and back were dabbed with the first sponge kept at the edge of the basin. The procedure was completed in 15 minutes, when the child was dabbed dry. At 15 minutes point, temperature was checked and if it continued to be >101° F, sponging was administered for another 15 minutes. Later temperature was checked at 30, 45, 60, 90 and 120 minutes. Children in the only antipyretic drug group received only paracetamol (10mg/kg) at 0 minutes and subsequently temperature was monitored at similar intervals. The level of discomfort of children was also assessed at the same time points in terms of 3 criteria–crying, restlessness and irritability. It was scored and the total score was converted into percentage and was interpreted as mild, moderate and severe discomfort.

The reduction of body temperature between the treatment groups was analysed using the analysis of covariance method adjusting for the baseline temperature. The level of discomfort was also subjected to statistical tests of significance. STATA software was used for the statistical analysis of the data.

One hundred and fifty children were studied, 73 in the tepid sponging and antipyretic drug group and 77 children in the only antipyretic drug group. The baseline characteristics are shown in Table I. Males outnumbered females in both the groups by an approximate ratio of 2:1. Majority of children in both the groups had respiratory diseases like upper respiratory tract infection, pneumonia etc. A higher number of children in both groups had their initial body temperature between 101° F – 103° F.

TABLE I



Baseline Characteristics of the Study Children	

The mean temperature of both groups at different time intervals is depicted in the graph (Fig.1). It shows a rapid reduction of temperature in the tepid sponging and antipyretic group at 15 minutes. Only antipyretic group had slow but sustained reduction in temperature.

Fig. 1 Mean temperature of the Tepid sponging and antipyretic drug group and Only antipyretic drug group at different time intervals.

The comparative effectiveness of the two methods was assessed based on the analysis of covariance. The results indicate that there is a difference in mean temperature over time between the treatment methods after adjusting for the initial temperature as covariate. The analysis of covariance confirms the rapid reduction of temperature in the combined tepid sponging and antipyretic group as shown in Fig.1. However, by the end of 2 hours both groups had reached the same degree of temperature. There was no difference in ultimate reduction of temperature between the two groups.

The level of discomfort was higher in tepid sponging and antipyretic group than only antipyretic group. It was compared by using a chi-square test and the result showed a statistically significant value (P<0.001). The discomfort in the tepid sponging group was mostly mild.

Administration of tepid sponging for fever has been practised for years. Formally and informally, healthcare personnel have voiced opinion for and against the practice of tepid sponging and questioned its relative effectiveness compared to other methods.

A number of studies have been done to compare the efficacy of these methods. Some of them had shown that tepid sponging with antipyretic drug is more effective than only antipyretic drug(5,6), while others concluded that there was no difference in temperature reduction(3,4). We observed that administration of tepid sponging and antipyretic drug resulted in rapid temperature reduction in the initial 15-30 minutes as compared to antipyretic drug alone; however, by the end of 2 hours both groups had reached the same degree of temperature. There was no difference in ultimate reduction of temperature between the two groups.

Children in the tepid sponging and antipyretic group had a higher level of discomfort than only antipyretic group, although the discomfort was only mild in most cases. These findings are supported by Sharber(4), but certain other studies did not find any significant difference, although they used different criteria for assessing discomfort(6,7). Our findings are also supported by Cochrane Evidence Update. which states: "In trials where all children received paracetamol, those who were treated with tepid sponging in addition to paracetamol were more likely to be clear of fever at 1 hour (relative risk 11.76 (3.39 to 40.79), 2 trials, 125 children). Shivering and goosebumps were more common with tepid sponging (relative risk 5.09 (1.56 to 16.60); 3 trials, 145 children)(8).

Based on our findings and review of literature(9,10), we conclude that apart from the initial rapid temperature reduction, addition of tepid sponging to antipyretic administration does not offer any advantage in ultimate reduction of temperature and may result in additional discomfort.

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6. Mahar AF, Allen SJ, Milligan P, Suthumnirund S, Chotpitayasunondh T, Sabchareon A, et al. Tepid sponging to reduce temperature in febrile children in a tropical climate. Clin Pediatr (Phila) 1994; 33: 227-231.

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