Physical methods for treating fever in children.
Cochrane Database Syst Rev. 2003(2):CD004264. PMID: 12804512
M Meremikwu, A Oyo-Ita
BACKGROUND: Health workers recommend bathing, sponging and other physical methods to treat fever in children and to avoid febrile convulsions. We know little about the most effective methods, or how these methods compare with commonly used drugs. OBJECTIVES: To evaluate the benefits and harms of physical cooling methods used for managing fever in children. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group specialized trials register (February 2003), the Cochrane Central Register of Controlled Trials (Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to November 2002), CINHAL (1982 to February 2003), LILACS (February 2003), Science Citation Index (1981 to February 2003), and reference lists of articles. We also contacted researchers in the field. SELECTION CRITERIA: Randomized and quasi-randomized trials comparing physical methods with a drug placebo or no treatment in children with fever of presumed infectious origin. Studies where children in both groups were given an antipyretic drug were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial methodological quality. One reviewer extracted data and the other checked the data for accuracy. Results were expressed as Relative Risk (RR) with 95% confidence intervals (CI) for discrete variables, and weighted mean differences for continuous outcomes. MAIN RESULTS: Seven trials, involving 467 participants, met the inclusion criteria. One small trial (n = 30), comparing physical methods with drug placebo, did not demonstrate a difference in the proportion of children without fever by one hour after treatment in a comparison between physical methods alone and drug placebo. In 2 studies, where all children received an anti-pyretic drug, physical methods resulted in a higher proportion of children without fever at one hour (n=125, RR 11.8, CI 3.39 to 40.8). I; in a third study (n=130), which only reported mean change in temperature, no differences wereas detected. Mild adverse events (shivering and goose pimples) were more common in the physical methods group (3 trials, RR 5.09; CI 1.56 to 16.60). REVIEWER'S CONCLUSIONS: A few small studies demonstrate that tepid sponging helps to reduce fever in children.
Article Published Date : Jan 01, 2003
Fever after maxillofacial surgery: a critical review.
J Maxillofac Oral Surg. 2015 Jun;14(2):154-61
Authors: Christabel A, Sharma R, Manikandhan R, Anantanarayanan P, Elavazhagan N, Subash P
PURPOSE: The aim of this paper is to review the pathophysiology of thermoregulation mechanism, various causes of fever after maxillofacial surgery and the different treatment protocols advised in the literature.
DISCUSSION: Fever is one of the most common complaints after major surgery and is also considered to be an important clinical sign which indicates developing pathology that may go unnoticed by the clinician during post operative period. Several factors are responsible for fever after the maxillofacial surgery, inflammation and infection being the commonest. However, other rare causes such as drug allergy, dehydration, malignancy and endocrinological disorders, etc. should be ruled out prior to any definite diagnosis and initiate the treatment. Proper history and clinical examination is an essential tool to predict the causative factors for fever. Common cooling methods like tepid sponging are usually effective alone or in conjunction with analgesics to reduce the temperature.
CONCLUSION: Fever is a common postoperative complaint and should not be underestimated as it may indicate a more serious underlying pathology. A specific guideline towards the management of such patients is necessary in every hospital setting to ensure optimal care towards the patients during post operative period.
PMID: 26028829 [PubMed]
BMJ Clin Evid. 2014 Jan 31;2014:
Authors: Mewasingh LD
INTRODUCTION: Simple febrile seizures are generalised in onset and have a brief duration. The American Academy of Pediatrics defines this brief duration to be <15 minutes; whereas, in the UK, a maximum duration of 10 minutes is used. Simple febrile seizures do not occur more than once in 24 hours and resolve spontaneously. Complex febrile seizures are longer lasting, have focal symptoms (at onset or during the seizure), and can recur within 24 hours or within the same febrile illness. This review only deals with simple febrile seizures. About 2% to 5% of children in the US and Western Europe, and 6% to 9% of infants and children in Japan, will have experienced at least one febrile seizure by the age of 5 years. A very small number of children with simple febrile seizures may develop afebrile seizures, but simple febrile seizures are not associated with any permanent neurological deficits.
METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments given during episodes of fever in children (aged 6 months to 5 years) with one or more previous simple febrile seizures? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2013 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS: We found 4 RCTs or systematic reviews of RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: intermittent anticonvulsants (clobazam, diazepam, lorazepam), antipyretic drug treatments (paracetamol, ibuprofen), and conservative measures (watchful waiting, physical antipyretic measures [tepid sponging, removing clothes, cooling room, direct fanning of child]).
PMID: 24484859 [PubMed - in process]
Physical methods used by Sudanese mothers in rural settings to manage a child with fever.
Sudan J Paediatr. 2014;14(1):59-64
Authors: Mukhtar HM, Elnimeiri MK
Although the mainstays of antipyretic treatments are drugs such as paracetamol and ibuprofen, physical methods are also used. These include tepid sponging, removing clothes, and cooling the environment with fans to improve ventilation. The objective of this study is to assess the physical methods used by Sudanese rural mothers to manage a child with fever. A cross-sectional descriptive study was designed and conducted within 6 months; it involved 332 mothers of children under five. The data were collected through using a standardized administered questionnaire and focus group discussion and analyzed by statistical package for social science version 15.0 (SPSS). Tepid sponging was used by 47% of the interviewed mothers. 15% of the mothers increased fluid intake, 7% bathed the child and 5% put the child in light clothes. 59% of mothers applied tepid sponging on head, 33.9% on all the body, 3.7% and 2.2% on groin area and axilla, respectively. The majority of mothers (86%) used water from refrigerator or zeir [water clay pot] for applying tepid sponging, 9% used tap water, and 3% used ice water. In conclusion, this study revealed that the common physical treatment method for fever used by mothers was tepid sponging with inappropriate application.
PMID: 27493391 [PubMed]
The effect of health education intervention on the home management of malaria among the caregivers of children aged under 5 years in Ogun State, Nigeria.
Eur J Med Res. 2012 May 17;17:11
Authors: Fatungase KO, Amoran OE, Alausa KO
BACKGROUND: Malaria is currently the most important cause of death and disability in children aged under 5 years in Africa. A health education interventional study of this nature is essential in primary control of an endemic communicable disease such as malaria. This study was therefore designed to determine the effect of health education on the home management of Malaria among the caregivers of children under 5 years old in Ogun State, Nigeria.
METHODS: The study design was a quasi-experimental study carried out in Ijebu North Local Government Area of Ogun State. A multistage random sampling technique was used in choosing the required samples for this study and a semi-structured questionnaire was used to collect relevant information. The intervention consisted of a structured educational program based on a course content adapted from the national malaria control program. A total of 400 respondents were recruited into the study, with 200 each in both the experimental and control groups, and were followed up for a period of 3 months when the knowledge and uptake of insecticide treated net was reassessed.
RESULTS: There was no statistically significant differences observed between the experimental and control groups in terms of sociodemographic characteristics such as age (P = 0.99), marital status (P = 0.48), religion (P = 0.1), and income (P = 0.51). The majority in both the experimental (75.0%) and control (71.5%) groups use arthemisinin-based combination therapy as first line home treatment drugs pre intervention. Post health education intervention, the degree of change in the knowledge of referral signs and symptoms in the experimental group was 52.8% (P < 0.0001) while it was 0.2% in the control group (P = 0.93). Tepid sponging improved by 45.0%, paracetamol use by 55.3%, and the use of herbs and other drugs were not significantly influenced in the experimental (P = 0.65 and 0.99) and control group (P = 0.89 and 0.88), respectively. Furthermore, there was a 55.7% (P = 0.001) increase in the proportion of respondents using the correct dose of arthemisinin-based combination therapy in the home management of malaria and 23.9% (P < 0.001) in the proportion using it for the required time.
CONCLUSIONS: The study concludes that there is a shift in the home management of malaria with the use of current and effective antimalarial drugs. It also demonstrated the effect of health education on the promptness of appropriate actions taken among the respondents for early diagnosis and treatment. Early diagnosis and appropriate treatment can be guaranteed if caregivers are knowledgeable on prompt actions to be taken in the home management of malaria.
PMID: 22594678 [PubMed - indexed for MEDLINE]
Non-pharmacological Management of Fever in Otherwise Healthy Children.
JBI Libr Syst Rev. 2012;10(28):1634-1687
Authors: Watts R, Robertson J
BACKGROUND: Fever is a common childhood problem faced in both hospital and community settings. In many cases the fever is associated with mild to moderate self-limiting illnesses. There has been a rapid increase in antipyretic use as the means of managing or treating this adaptive physiological response to infection. The use of alternative means of caring for a febrile child could minimise the amount of antipyretics administered to children and thereby reduce the potential risks.
OBJECTIVE: The objective of this systematic review was to establish what non-pharmacological practices are effective in managing fever in children, three months to 12 years of age, who are otherwise healthy.
INCLUSION CRITERIA: Interventions for inclusion were physiological e.g. maintenance of hydration and rest, and external cooling, either direct e.g. sponging, clothing, or environmental e.g. fans, ambient temperature. Outcomes of interest were effect on fever, increase in comfort, decrease in parental anxiety and reduction in unnecessary use of health services.
SEARCH STRATEGY: The search sought English, Spanish, Portuguese, Mandarin and Italian language studies, published 2001-2011 in 12 major databases.
CRITICAL APPRAISAL, DATA EXTRACTION AND DATA SYNTHESIS: Critical appraisal of and data extraction from eligible studies were undertaken using standardised tools developed by the Joanna Briggs Institute. As statistical pooling of data was precluded, the findings are presented in narrative form.
RESULTS: Twelve randomised controlled trials were included, involving 986 children in total. Only one intervention identified in the review protocol - direct external cooling measures - was addressed by the studies. Eleven studies included sponging as an intervention while one also included clothing (unwrapping). No studies investigated physiological interventions, (e.g. hydration or rest), or environmental cooling measures, (e.g. fans or ambient temperature) as separate interventions. Three of these interventions (encouragement of fluid intake, rest and fans) were reported as part of the standard care provided to participants in several studies or were controlled in the study (ambient temperature). Only two of the four outcomes identified in the review protocol were examined (effect on fever (all 12 studies) and patient comfort). Although tepid sponging alone resulted in an immediate decrease in temperature, this response was of short duration, with antipyretics or antipyretics plus sponging having a more lasting effect. In addition, the observed levels of discomfort of the sponged children were higher than the other groups. For both measures, this effect was not statistically significant in every case.
CONCLUSION: The care of a febrile child needs to be individualised, based on current knowledge of the effectiveness and risks of interventions. The administration of antipyretics should be minimised, used selectively and with caution, even in otherwise healthy children. The results of this systematic review support previous findings that routine tepid sponging does not have an overall beneficial effect. However measures such as encouraging fluid intake and unwrapping the child should be encouraged.
IMPLICATIONS FOR PRACTICE: The two foci of care should be the child and the parents/primary caregiver. For the child, care should aim to support the body's physiological responses i.e. maintain hydration, minimise use of antipyretics. Support the parents to reduce anxiety e.g. by involving them in care and providing appropriate education, particularly in respect to correct dosages of antipyretics.
IMPLICATIONS FOR RESEARCH: Given the now well demonstrated discomfort engendered by tepid sponging, its use in treating febrile children is no longer advocated and does not warrant further research. However aspects of other non-pharmacological interventions have not been so well researched e.g. parental response to advice on fluid intake and appropriate clothing.
PMID: 27820389 [PubMed]
Hemodynamic and oxygenation changes in surgical intensive care unit patients with fever and fever lowering nursing interventions.
Int J Nurs Pract. 2011 Dec;17(6):556-61
Authors: Çelik S, Yildirim I, Arslan I, Yildirim S, Erdal F, Yandi YE
The purpose of this study was to determine the effects of fever and nursing interventions to lower fever on hemodynamic values and oxygenation in febrile (temperature greater than 38.3°C) surgical intensive care unit patients. This retrospective study was conducted in 53 febrile patients out of 519 patients admitted to the surgical intensive care unit at a university hospital. Data were obtained from the medical records, laboratory files and nursing notes. Statistical analysis of the data was analyzed by repeated measures analysis of variance and a paired sample t-test. The average hourly urine output (F = 5.46; P = 0.002) and systolic blood pressure (F = 2.87; P = 0.03) were significantly lower after fever onset. Heart rate, respiratory rate, positive end-expiratory pressure settings and FiO(2) settings were unchanged after the development of fever. Diastolic blood pressure and oxygen saturation had non-statistically significant decreases. Nursing interventions for febrile patients consisted of medication administration (69.8%), ice (62.3%) and sponging with tepid water (62.3%). The present results showed that fever was associated with an increase in heart rate, decreased systolic arterial pressure, mean arterial pressure, oxygen saturation and hourly urine output.
PMID: 22103821 [PubMed - indexed for MEDLINE]
Over-investigated and under-treated: children with febrile convulsion in a Malaysian district hospital.
Singapore Med J. 2010 Sep;51(9):724-9
Authors: Lai NM, Tan ML, Quah SY, Tan EL, Foong KW
INTRODUCTION: We conducted a retrospective audit on the inpatient assessment and care of children admitted with febrile convulsion to Hospital Batu Pahat, a district hospital in Malaysia, using the Malaysian national clinical practice guidelines and the American Academy of Paediatrics practice parameters on febrile convulsion as the reference standards.
METHODS: The case notes of 100 consecutive children admitted in 2004 were analysed. The documentation of major clinical features, selection of investigations, the timeliness of antipyresis and frequency of parental education were evaluated.
RESULTS: In general, the major clinical features that were relevant to the presenting problem were adequately documented, although fever was not mentioned as a presenting complaint in one quarter of the cases. On an average, about five investigations were ordered for every patient on admission. There was no major difference in the number of investigations conducted between children who were more severely ill and the rest of the patients. The majority of the investigations did not yield any useful diagnostic information. Only 38 percent of the children received antipyretics and 53 percent were tepid-sponged during fever, with 23 percent having received tepid-sponging without concurrently receiving antipyretics. No parental education on febrile convulsion was recorded in half of the cases.
CONCLUSION: Excessive unjustified investigations, deficient antipyresis when required and inadequate communication with the family of children with febrile convulsion were observed. Awareness of such deficiencies from this audit should lead to regular staff education, monitoring and future audits in order to improve the quality of our clinical care.
PMID: 20938614 [PubMed - indexed for MEDLINE]
Comparative effectiveness of tepid sponging and antipyretic drug versus only antipyretic drug in the management of fever among children: a randomized controlled trial.
Indian Pediatr. 2009 Feb;46(2):133-6
Authors: Thomas S, Vijaykumar C, Naik R, Moses PD, Antonisamy B
OBJECTIVE: To compare the effectiveness of tepid sponging and antipyretic drug versus only antipyretic drug among febrile children.
DESIGN: Randomized controlled trial.
SETTING: Tertiary care hospital.
PARTICIPANTS: 150 children 6 mo - 12 yr age with axillary temperature 101F.
INTERVENTION: Tepid sponging and antipyretic drug (Paracetamol) (n=73) or only antipyretic drug (Paracetamol) (n=77).
MAIN OUTCOME MEASURES: Reduction of body temperature and level of comfort.
RESULTS: The reduction of body temperature in the tepid sponging and antipyretic drug group was significantly faster than only antipyretic group; however, by the end of 2 hours both groups had reached the same degree of temperature. The children in tepid sponging and antipyretic drug had significantly higher discomfort than only antipyretic group, but the discomfort was mostly mild.
CONCLUSION: Apart from the initial rapid temperature reduction, addition of tepid sponging to antipyretic administration does not offer any advantage in ultimate reduction of temperature; moreover it may result in additional discomfort.
PMID: 19242030 [PubMed - indexed for MEDLINE]
Determinants of delay in care-seeking for febrile children in eastern Uganda.
Trop Med Int Health. 2009 Apr;14(4):472-9
Authors: Rutebemberwa E, Kallander K, Tomson G, Peterson S, Pariyo G
OBJECTIVE: To explore factors associated with delay in seeking treatment outside the home for febrile children under five.
METHODS: Using a pre-tested structured questionnaire, all 9176 children below 5 years in Iganga-Mayuge Demographic Surveillance Site were enumerated. Caretakers of children who had been ill within the previous 2 weeks were asked about presenting symptoms, type of home treatment used, timing of seeking treatment and distance to provider. Children who sought care latest after one night were compared with those who sought care later.
RESULTS: Those likely to delay came from the lowest socio-economic quintile (OR 1.45; 95% CI 1.06-1.97) or had presented with pallor (OR 1.58; 95% CI 1.10-2.25). Children less likely to delay had gone to drug shops (OR 0.70; 95% CI 0.59-0.84) or community medicine distributors (CMDs) (OR 0.33; 95% CI 0.15-0.74), had presented with fast breathing (OR 0.75; 95% CI 0.60-0.87), used tepid sponging at home (OR 0.43; 95% CI 0.27-0.68), or perceived the distance to the provider to be short (OR 0.72; 95% CI 0.60-0.87).
CONCLUSION: Even in the presence of 'free services', poverty is associated with delay to seek care. Drug shops and CMDs may complement government efforts to deliver timely treatment. Health workers need to sensitize caretakers to take children for care promptly. Methods to elucidate time in population-surveys in African settings need to be evaluated.
PMID: 19222823 [PubMed - indexed for MEDLINE]
Tepid sponging plus dipyrone versus dipyrone alone for reducing body temperature in febrile children.
Sao Paulo Med J. 2008 Mar 06;126(2):107-11
Authors: Alves JG, Almeida ND, Almeida CD
CONTEXT AND OBJECTIVE: The role of tepid sponging to promote fever control in children is controversial. We did not find any studies reporting on the effectiveness of tepid sponging in addition to dipyrone. The aim of this study was to compare the effects of tepid sponging plus dipyrone with dipyrone alone for reducing fever.
DESIGN AND SETTING: A randomized clinical trial was undertaken at Instituto Materno-Infantil Professor Fernando Figueira, Recife, Pernambuco.
METHODS: Children from six months to five years old with axillary temperature greater than 38 masculineC in the emergency ward between January and July 2006 were eligible. One hundred and twenty children were randomly assigned to receive oral dipyrone (20 mg/kg) or oral dipyrone and tepid sponging for 15 minutes. The primary outcome was mean temperature reduction after 15, 30, 60, 90 and 120 minutes. Secondary outcomes were crying and irritability.
RESULTS: 106 children finished the study. After the first 15 minutes, the fall in axillary temperature was significantly greater in the sponged group than in the control group (p < 0.001). From 30 to 120 minutes, better fever control was observed in the control group. Crying and irritability were observed respectively in 52% and 36% of the sponged children and in none and only two of the controls.
CONCLUSIONS: Tepid sponging plus dipyrone cooled faster during the first 15 minutes, but dipyrone alone presented better fever control over the two-hour period. Tepid sponging caused mild discomfort, crying and irritability for most of the children.
CLINICAL TRIAL REGISTRATION NUMBER: ACTRN12608000083392.
PMID: 18553033 [PubMed - indexed for MEDLINE]
When the child has a fever.
Drug Ther Bull. 2008 Mar;46(3):17-21
Authors: BMJ Group
Fever in a child is usually due to a self-limiting viral infection, with recovery occurring quickly without intervention. However, fever may also be the presenting feature of severe illnesses such as meningitis, septicaemia, urinary tract infections and pneumonia, and trying to exclude such causes is a key part of management. In a review 17 years ago, we concluded that there was no evidence that reducing fever improved the outcome of childhood infections, but that it probably alleviated distress and discomfort caused by fever. We also advised that parents should give paracetamol only if the child seemed uncomfortable or had previously had a febrile convulsion, and said that tepid sponging may further comfort the child, while recognising evidence that it added little to the effect of paracetamol alone. Does this advice still hold?
PMID: 18337462 [PubMed - indexed for MEDLINE]
Body temperature management after severe traumatic brain injury: methods and protocols used in the United Kingdom and Ireland.
Resuscitation. 2006 Aug;70(2):254-62
Authors: Johnston NJ, King AT, Protheroe R, Childs C
OBJECTIVE: To establish whether there is consensus in the management of body temperature in patients with severe traumatic brain injury (TBI) admitted to hospitals in the United Kingdom and Ireland for neurosurgical intensive care.
METHODS: Permission was granted from the Society of British Neurosurgeons (SBNS) and the Local Research Ethics Committee to undertake the survey. A senior member of nursing staff from all adult neurosurgical units, excluding our own, was contacted by telephone.
RESULTS: All 33 adult neurosurgical centres participated. Six units had a formal written protocol for the management of body temperature. For the remainder (27 units), interest was expressed in a protocol for temperature management particularly for those patients with intractable hyperthermia/fever. Administration of the antipyretic paracetamol was the most common 'first-line' treatment (13 units). Other 'first-line' methods were: circulating air-cooling blankets (9 units), water-filled cooling blankets (6 units), tepid sponging or wet soaks (2 units), convection fans (2 units) and administration of cold fluids via the gut or circulation (1 unit). When 'first-line' methods failed to bring about a fall in temperature, different combinations of these methods were used.
CONCLUSIONS: From this survey, it is evident that there is no consensus in the approach to temperature management in neurosurgical intensive care patients with severe TBI. Review and rationalisation of systems of care may be required in an effort to develop evidence-based nationwide guidelines.
PMID: 16828961 [PubMed - indexed for MEDLINE]
Intermittent clobazam therapy in febrile seizures.
Indian J Pediatr. 2005 Jan;72(1):31-3
Authors: Rose W, Kirubakaran C, Scott JX
OBJECTIVE: To evaluate the efficacy of intermittent clobazam therapy in preventing the recurrence of febrile seizures and to assess its safety.
METHODS: The study was a prospective, randomized, double-blind placebo-controlled trial conducted in the Department of Child Health, Christian Medical College Hospital, Vellore between July 2001 and September 2002. Neurologically normal children between 6 months and 3 years of age with a history of febrile seizures and no evidence of acute CNS infection or EEG abnormality were included into the study. 19 children in a clobazam group and 20 in the placebo group were randomly allocated. Temperature reduction measures with paracetamol and tepid sponging were advised to all children. In addition the dispensed medication was to be administered at the onset of fever and continued for 48 hours irrespective of the duration of fever. The children were then monitored for seizures and adverse effects of clobazam. The children were followed up for a mean period of 9.9 months. The analysis was done on the number of febrile episodes in both the groups.
RESULTS: There were a total of 110 episodes of fever during the study period. Mean number of febrile episodes in the clobazam group was 3.1 and in placebo group 2.56. Six (12.5%) of the 48 episodes in placebo group and one (1.7%) of 60 episodes in clobazam group had seizure recurrence. This was statistically significant (p = 0.01). Drowsiness and weakness were present equally in both clobazam and placebo groups whereas ataxia was present only in the clobazam group, the difference being statistically significant (p=0.04).
CONCLUSION: Intermittent clobazam therapy is an effective measure in the prevention of recurrence of febrile seizures. The ataxia due to clobazam was much lower than that reported with diazepam.
PMID: 15684445 [PubMed - indexed for MEDLINE]
Home treatment of 'malaria' in children in rural Gambia is uncommon.
Trop Med Int Health. 2003 Oct;8(10):884-94
Authors: Clarke SE, Rowley J, Bøgh C, Walraven GE, Lindsay SW
Home treatment with antimalarials is a common practice in many countries, and may save lives by ensuring that more malaria cases receive prompt treatment. Through retrospective surveys we found that home treatment of young children with antimalarials was uncommon in rural Gambia. Few families kept medicines in the home in case of illness, 28% kept paracetamol and only 8% kept chloroquine. Less than 10% of cases of childhood 'malaria' had been treated with chloroquine at home, and 69% of those giving home medication did not know the correct dosage for a child. The most common course of treatment was the use of paracetamol and/or tepid sponging to reduce fever, before the child was taken to a government health facility. Treating a child with antimalarials at home was more costly than other forms of treatment. The low cost associated with the use of health services for children and the limited availability of antimalarials outside major towns contribute to the high use of government health services. This shows that that home treatment cannot be assumed to be the predominant mode of malaria treatment throughout Africa, and highlights the need for country-specific policies based on accurate local knowledge of treatment practices in both rural and urban areas.
PMID: 14516299 [PubMed - indexed for MEDLINE]
Physical methods for treating fever in children.
Cochrane Database Syst Rev. 2003;(2):CD004264
Authors: Meremikwu M, Oyo-Ita A
BACKGROUND: Health workers recommend bathing, sponging and other physical methods to treat fever in children and to avoid febrile convulsions. We know little about the most effective methods, or how these methods compare with commonly used drugs.
OBJECTIVES: To evaluate the benefits and harms of physical cooling methods used for managing fever in children.
SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group specialized trials register (February 2003), the Cochrane Central Register of Controlled Trials (Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to November 2002), CINHAL (1982 to February 2003), LILACS (February 2003), Science Citation Index (1981 to February 2003), and reference lists of articles. We also contacted researchers in the field.
SELECTION CRITERIA: Randomized and quasi-randomized trials comparing physical methods with a drug placebo or no treatment in children with fever of presumed infectious origin. Studies where children in both groups were given an antipyretic drug were included.
DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial methodological quality. One reviewer extracted data and the other checked the data for accuracy. Results were expressed as Relative Risk (RR) with 95% confidence intervals (CI) for discrete variables, and weighted mean differences for continuous outcomes.
MAIN RESULTS: Seven trials, involving 467 participants, met the inclusion criteria. One small trial (n = 30), comparing physical methods with drug placebo, did not demonstrate a difference in the proportion of children without fever by one hour after treatment in a comparison between physical methods alone and drug placebo. In 2 studies, where all children received an anti-pyretic drug, physical methods resulted in a higher proportion of children without fever at one hour (n=125, RR 11.8, CI 3.39 to 40.8). I; in a third study (n=130), which only reported mean change in temperature, no differences wereas detected. Mild adverse events (shivering and goose pimples) were more common in the physical methods group (3 trials, RR 5.09; CI 1.56 to 16.60).
REVIEWER'S CONCLUSIONS: A few small studies demonstrate that tepid sponging helps to reduce fever in children.
PMID: 12804512 [PubMed - indexed for MEDLINE]
Tepid sponging and paracetamol for reduction of body temperature in febrile children.
Med J Aust. 2002 Feb 04;176(3):130
Authors: Bernath VF, Anderson JN, Silagy CA
PMID: 11936311 [PubMed - indexed for MEDLINE]
Antipyretics in children.
Indian J Pediatr. 2002 Jan;69(1):69-74
Authors: Chandra J, Bhatnagar SK
Fever is an important symptom of underlying disease condition and in general is considered harmful in pediatric age group as it may lead to febrile seizures, stupor, dehydration increase work of breathing, discomfort and tachycardia. The increase metabolic demands stress the patient with marginal cardiac and cerebral vascular supply. The hypothalamus controls the body temperature. The fever results due to resetting of the hypothalamus that occur from the prostaglandins produced by the pyrogens. Fever is treated variedly by the pediatricians. The physical therapy offers a simple and cost effective way of lowering the body temperature. The drugs as paracetamol, nimesulide and ibuprofen lower the temperature by inhibiting the prostaglandin synthesis. Paracetamol is considered the safest of all the antipyretic drugs. It is recommended that a combination of physical therapy such as tepid sponging and paracetamol is best way of controlling temperature.
PMID: 11876124 [PubMed - indexed for MEDLINE]
External cooling in the management of fever.
Clin Infect Dis. 2000 Oct;31 Suppl 5:S224-9
Authors: Axelrod P
Although physical methods of cooling are the treatment of choice for hyperthermia, their value in the treatment of fever remains uncertain. Methods involving convection and evaporation are more effective than those involving conduction for the treatment of hyperthermia. These same methods, combined with antipyretic medication, are preferable to immersion as treatment for fever in young children but are generally not practical in adults. Febrile children treated with tepid-water sponging plus antipyretic drugs are more uncomfortable that those treated with antipyretic drugs alone, although they exhibit slightly more rapid reductions in temperature. When febrile, seriously ill patients are externally cooled and are sedated or paralyzed with drugs that suppress shivering, they may have a more rapid reduction of fever and reduced energy expenditure than if treated with antipyretic drugs alone. A risk/benefit assessment of the consequences of such treatment is not yet possible.
PMID: 11113027 [PubMed - indexed for MEDLINE]
Physical treatment of fever.
Arch Dis Child. 2000 Mar;82(3):238-9
Authors: Purssell E
Fever is a common symptom of childhood illness, and much time and effort is spent in the pursuit of reducing high temperature. Although antipyretic drugs are the main form of treatment, this report considers the part that physical treatments might play in reducing the temperature of febrile children. Such treatments include tepid sponging, removing clothing, and cooling the environment. Of these treatments, tepid sponging has been studied most extensively, as an addition to paracetamol, but seems to offer little advantage over paracetamol alone. It is likely that other methods might be equally ineffective because they all rely on similar methods of heat loss.
PMID: 10685930 [PubMed - indexed for MEDLINE]
What parents think of fever.
Fam Pract. 1998 Dec;15(6):513-8
Authors: Blumenthal I
OBJECTIVES: We aimed to assess knowledge, perception and management of fever by parents.
METHODS: We conducted a questionnaire survey among 392 parents of children attending locally a paediatric clinic at The Royal Oldham Hospital. The main outcome measures were answers to questions covering a variety of aspects of the knowledge, perception and management of fever by parents.
RESULTS: Almost half the parents used a liquid crystal forehead thermometer. Most could not use a glass thermometer. Thirty per cent did not know normal body temperature and would have treated children with a temperature below 38 degrees C. Sixty-four per cent treated fever with both paracetamol and tepid sponging. Most parents awakened children at night for antipyretics. Eighty-one per cent thought that untreated fever was most likely to cause fits or brain damage and 7% thought it could cause death.
CONCLUSION: Parents perceive fever as being dangerous. They have a poor knowledge and measure it inaccurately. Needless consultations and hospital admissions could be avoided by a change in perception.
PMID: 10078789 [PubMed - indexed for MEDLINE]
Efficacy of tepid sponging versus paracetamol in reducing temperature in febrile children.
Ann Trop Paediatr. 1997 Sep;17(3):283-8
Authors: Agbolosu NB, Cuevas LE, Milligan P, Broadhead RL, Brewster D, Graham SM
A block randomized clinical trial to compare the efficacy of tepid sponging with the use of paracetamol in febrile children was undertaken at the Queen Elizabeth Central Hospital, Blantyre. Eighty children aged between 6 and 54 months with axillary temperatures of between > or = 38.5 degrees C and < or = 40 degrees C and a clinical diagnosis consistent with upper respiratory tract infection and/or malaria were block randomized to receive either oral paracetamol (15 mg/kg) or tepid sponging. Children receiving tepid sponging were sponged from head to toe (except the scalp) by leaving a thin layer of water on the body. If the body became dry it was repeated and continued until the axillary temperature fell to < 38.5 degrees C. Axillary temperature and assessment of discomfort (convulsions, crying, irritability, vomiting and shivering) were recorded every 30 minutes for 2 hours. A significantly greater and more rapid reduction of fever was demonstrated with paracetamol than with tepid sponging. Tepid sponging without antipyretics is often used to reduce fever, but our results suggest that this is effective only during the 1st 30 minutes. Paracetamol is clearly more effective than tepid sponging in reducing body temperature in febrile children in a tropical climate.
PMID: 9425385 [PubMed - indexed for MEDLINE]
Effect of paracetamol on parasite clearance time in Plasmodium falciparum malaria.
Lancet. 1997 Sep 06;350(9079):704-9
Authors: Brandts CH, Ndjavé M, Graninger W, Kremsner PG
BACKGROUND: Routine antipyretic therapy in children with infectious diseases has long been the source of controversy. Each year, in addition to antimalarial medication, millions of children with Plasmodium falciparum malaria receive paracetamol to reduce fever. However, the usefulness of this practice has not been proven.
METHODS: In a randomised trial in Lambaréné, Gabon, 50 children with P falciparum malaria were treated with intravenous quinine, and received either mechanical antipyresis alone, or in combination with paracetamol. Rectal body temperature and parasitaemia were recorded every 6 h for 4 days. Plasma concentrations and inducible concentrations of tumour necrosis factor (TNF) and interleukin-6 were measured every 24 h. In addition, production of oxygen radicals was measured in both groups.
FINDINGS: The mean fever clearance time was 32 h for children treated with paracetamol and 43 h for those who received mechanical antipyresis alone; however, this 11 h difference was not significant (95% CI -2 to 24 h; p = 0.176). Parasite clearance time was significantly prolonged in patients who received paracetamol with a difference of 16 h (8-24 h; p = 0.004). Plasma concentrations of TNF and interleukin-6 were similar in both groups during the study. However, the induced concentrations of TNF, and the production of oxygen radicals, were significantly lower in children treated with paracetamol than those who received mechanical antipyresis alone.
INTERPRETATION: These data suggest that paracetamol has no antipyretic benefits over mechanical antipyresis alone in P falciparum malaria. Moreover, paracetamol prolongs parasite clearance time, possibly by decreased production of TNF and oxygen radicals.
PMID: 9291905 [PubMed - indexed for MEDLINE]
Reliability of health information for the public on the World Wide Web: systematic survey of advice on managing fever in children at home.
BMJ. 1997 Jun 28;314(7098):1875-9
Authors: Impicciatore P, Pandolfini C, Casella N, Bonati M
OBJECTIVE: To assess the reliability of healthcare information on the world wide web and therefore how it may help lay people cope with common health problems.
METHODS: Systematic search by means of two search engines, Yahoo and Excite, of parent oriented web pages relating to home management of feverish children. Reliability of information on the web sites was checked by comparison with published guidelines.
MAIN OUTCOME MEASURES: Minimum temperature of child that should be considered as fever, optimal sites for measuring temperature, pharmacological and physical treatment of fever, conditions that may warrant a doctor's visit.
RESULTS: 41 web pages were retrieved and considered. 28 web pages gave a temperature above which a child is feverish; 26 pages indicated the optimal site for taking temperature, most recommending rectal measurement; 31 of the 34 pages that mentioned drug treatment recommended paracetamol as an antipyretic; 38 pages recommended non-drug measures, most commonly tepid sponging, dressing lightly, and increasing fluid intake; and 36 pages gave some indication of when a doctor should be called. Only four web pages adhered closely to the main recommendations in the guidelines. The largest deviations were in sponging procedures and how to take a child's temperature, whereas there was a general agreement in the use of paracetamol.
CONCLUSIONS: Only a few web sites provided complete and accurate information for this common and widely discussed condition. This suggests an urgent need to check public oriented healthcare information on the internet for accuracy, completeness, and consistency.
PMID: 9224132 [PubMed - indexed for MEDLINE]
Evaluation of sponging and antipyretic medication to reduce body temperature in febrile children.
Acta Paediatr Jpn. 1997 Apr;39(2):215-7
Authors: Aksoylar S, Akşit S, Cağlayan S, Yaprak I, Bakiler R, Cetin F
Two hundred and twenty-four children aged 6 months to 5 years, with rectal temperatures greater than or equal to 30 degrees (104 degrees F), were randomly treated with sponging alone or with medication including a single oral dose of aspirin 15 mg/kg, or paracetamol 15 mg/kg, or ibuprofen 8 mg/kg. Twenty-three children were excluded from the final analysis because they did not complete the study. Demographic characteristics of the patients were found to be comparable in all groups. Rectal temperatures were recorded every 30 min for a 3 h period. During the first 30 min of intervention, sponging was found to be more effective than all of the three medications. After 60 min, the effects of each medication became superior to sponging with tepid water in reducing body temperature. Twenty-three children were excluded from the final analysis because they did not complete the study. Comparing the effect of the three different medications, it was seen that the antipyretic efficacy of aspirin and ibuprofen were significantly more than paracetamol 3 h after intervention (P < 0.05). For the management of fever over 39 degrees C, it is therefore recommended to give children an antipyretic drug, preferably ibuprofen, and at the same time to begin sponging to provide a rapid and sustained antipyresis
PMID: 9141257 [PubMed - indexed for MEDLINE]
Parental reactions to febrile seizures in Malaysian children.
Med J Malaysia. 1996 Dec;51(4):462-8
Authors: Deng CT, Zulkifli HI, Azizi BH
The reactions of 117 parents to the febrile seizure experienced by their children; and their fears and worries were investigated. A standard questionnaire was used and clinical information was abstracted from the notes. In 88.9% of the cases, the adult present at the seizure was one of the parents usually the mother. Most of the parents (66.7%) did tepid sponging to bring the fever down but a third tried to open the clenched teeth of the child. The adults present placed the child supine in 62.9%, on the side in 9.5% and prone in 6.0%. Over half of the parents brought the child to a private clinic first before bringing to hospital. A fifth of the children were given antipyretics by the parent or the doctor and an anticonvulsant was given in 7.7% of cases. Interestingly, in 12% of children traditional treatment was given for the seizure. Three quarters of the parents knew that the febrile seizure was caused by high fever (which we have taken as the correct knowledge of febrile seizure). However "ghosts" and "spirits" were blamed as the cause of the seizure by 7% of parents. Factors significantly associated with correct knowledge were higher parental education and higher family income. The most common fear expressed was that the child might be dead or might die from the seizure (70.9%). Fear of death was associated with low paternal education. We concluded that the majority of our parents had reacted appropriately to a febrile seizure and their knowledge of the cause of febrile seizure was generally correct. Their fears and worries were similar to those elsewhere. However, traditional beliefs and practices may have to be taken into consideration during counselling.
PMID: 10968035 [PubMed - indexed for MEDLINE]
Cooling hyperthermic and hyperpyrexic patients in intensive care.
Nurs Crit Care. 1996 Nov-Dec;1(6):278-82
Authors: Shackell S
It is important for the Critical Care Nurse to respond quickly and appropriately to a rise in body temperature in a critically ill patient. A high temperature can impair both external and internal respiration, thus reducing oxygenation, cardiac output, lowering blood pressure and stimulating vasoconstriction. Accurate nursing assessment determines the appropriate cooling intervention. Hyperthermia involves a dysfunction of thermoregularity responses and responds best to physical cooling methods. Hyperpyrexia involves normal thermoregularity responses responding at a higher level. Hyperpyrexia responds best to central cooling interventions such as antipyretic therapy. Tepid sponging and ice cool packs are not recommended as they induce shivering and vasoconstriction. The need for more comprehensive research studies into cooling those receiving intensive care is needed.
PMID: 9594131 [PubMed - indexed for MEDLINE]
National survey of pediatric fever management practices among emergency department nurses.
J Emerg Nurs. 1994 Dec;20(6):505-10
Authors: Thomas V, Riegel B, Andrea J, Murray P, Gerhart A, Gocka I
INTRODUCTION: Management of pediatric fever is controversial. Although many nursing texts advocate aggressive fever management, research provides evidence that fever is a normal physiologic process with beneficial effects. We sought to describe emergency nurses' pediatric fever management practices, their rationales for practice, and their practice consistency.
METHODS: A researcher-developed tool was mailed to a systematic random sample of approximately 5% of ENA members. Surveys were mailed to 1136 nurses nationally; 731 surveys were returned (64% response rate).
RESULTS: Temperature at which nurses initiate fever interventions varied from 37.8 degrees C (100 degrees F) to 40.6 degrees C (105 degrees F). Most frequently identified rationales for intervention were prevention of fever increase (83.3%), fever reduction (76.9%), comfort (74.7%), and seizure prevention (65.3%). Most nurses (79.8%) employ tepid sponging to reduce fever; 31% sponge routinely. Nurses reported sponging for temperatures higher than 38.9 degrees C (102 degrees F) to 40.6 degrees C (105 degrees F). Rationales for sponging included seizure prevention (58%), rapid cooling (56.8%), and treatment of fevers unresponsive to antipyretics (45.6%). Factors influencing rationales for practice included departmental standards of care (67.2%), physician practices (65.8%), and common sense (64.2%).
DISCUSSION: The results of this nationwide survey demonstrate that fever management practices vary. ED nurses are practicing in a manner consistent with that advocated in many nursing texts but not necessarily the research literature. We believe that clinical trials of commonly used fever treatments are indicated. Standards of care could then be revised to reflect the research literature.
PMID: 7745904 [PubMed - indexed for MEDLINE]
Tepid sponging to reduce temperature in febrile children in a tropical climate.
Clin Pediatr (Phila). 1994 Apr;33(4):227-31
Authors: Mahar AF, Allen SJ, Milligan P, Suthumnirund S, Chotpitayasunondh T, Sabchareon A, Coulter JB
The effectiveness of tepid sponging, in addition to antipyretic medication, in the reduction of temperature in febrile children living in a tropical environment, was assessed in a prospective, randomized, open trial. Seventy-five children aged between 6 and 53 months who attended the casualty department of the Children's Hospital, Bangkok, Thailand, with fever (rectal temperature > or = 38.5 degrees C) of presumed viral origin were randomized to received either tepid sponging and oral paracetamol (sponged group) or paracetamol alone (control group). Rectal temperature and the occurrence of crying, irritability, and shivering were recorded over the following 2 hours. A greater and more rapid fall in mean rectal temperature occurred in the sponged group than in the control group. Temperature fell below 38.5 degrees C sooner in children in the sponged group than in control children (P < 0.001). At 60 minutes, 38 (95.0%) of the controls still had a temperature of 38.5 degrees C or greater, compared with only 15 children (42.9%) in the sponged group (P < 1 x 10(-5). Crying was associated with sponging, but shivering and irritability occurred in only one child who was being sponged. It is concluded that tepid sponging, in addition to antipyretic medication, is clearly more effective than antipyretic medication alone in reducing temperature in febrile children living in a tropical climate.
PMID: 8013170 [PubMed - indexed for MEDLINE]
School teachers as primary health care workers.
East Afr Med J. 1990 Feb;67(2):65-8
Authors: Olukoya AA, Ogunyemi MA
Staff of preschool and primary schools in Lagos attended a one week course run by the Institute of Child Health and Primary Care to teach them some Primary Health Care skills so that they can recognize common illnesses in children and provide some preliminary care before referral. The course was well rated by participants and follow up showed that the skills had been useful to them and their various establishments. The model is recommended for replication elsewhere.
PMID: 2361448 [PubMed - indexed for MEDLINE]
Mechanism of action of physical antipyresis in the rat.
J Appl Physiol (1985). 1988 Mar;64(3):1076-8
Authors: Banet M
To study the mechanism of action of physical antipyresis, core temperature was measured in two groups of rats in which heat loss was increased by cold exposure and by cooling an inferior cava heat exchanger, respectively, both before and after infection with Salmonella enteritidis. Cold exposure did not influence core temperature. On the other hand, cooling the heat exchanger caused a fall in core temperature of approximately 0.7 degree C, to 37 degrees C in normothermia and to 38.5 degrees C 24 h after the infection. These lower core temperatures were then regulated against any further increase in heat loss until the thermoregulatory metabolic capacity of the animals was exhausted and a hypothermia developed. It is concluded that in infectious fever the threshold temperature of shivering increases as much as core temperature. Furthermore it is suggested that physical antipyresis, such as sponging with tepid water, induces a moderate but regulated fall in temperature to about the threshold of shivering and that its efficacy may increase with ambient temperature.
PMID: 3366729 [PubMed - indexed for MEDLINE]
Simple febrile convulsions.
JACEP. 1976 May;5(5):347-50
Authors: Tomlanovich MC, Rosen P, Mendelsohn J
Simple febrile convulsions occur in otherwise normal children, aged six months to five years, with extracranial infection. Cerebrospinal fluid examination should be done on all children with their first febrile convulsion to rule out an underlying organic disease, especially purulent meningitis. Initial treatment includes antipyretics, tepid sponging and intramuscular phenobarbital. If a seizure recurs, the usual anticonvulsant measures should be carried out and, if prolonged, the patient should receive appropriated doses of diazepam or phenobarbital, intravenously. Patients with suspected epileptic convulsive disorders precipitated by fever, or those with seizures thought to be associated with underlying organic disease, should be hospitalized for further evaluation or treatment or both. Patients with simple febrile convulsions have a benign disorder and can be safely treated as outpatients.
PMID: 1271594 [PubMed - indexed for MEDLINE]