4. Use tap or lukewarm water (29° to 32° C) to
sponge. Remove clothing's, cover the child with
towel sponge and dry his face.
Apply the compresses to forehead,
nape of neck, armpits and groin.
Treatment of Fever
TEPID SPONGING
5. Proceed to sponge body starting with the front
then to the back.
Generally you should not sponge a child for more
than 30 minutes at a stretch. Stop sponging when
shivering occurs. When your child shivers, cover
him up and wait a while before resuming
sponging.
Usually sponging will bring down the fever by
one to two degrees in 30-45 minutes.
Treatment of Fever
6. Encouraging the child to take plenty of fluids.
Dressing the child in light clothing to allow heat
exchange.
Room environment is kept cool and well-
ventilated to allow the ambient
temperature to help bring
the fever down.
Treatment of Fever
Other Measures
7. There are various reasons why we do not
recommend using tepid sponging:
there is a lack of evidence to support its routine
use in temperate climates, because the sponging
does not produce a sustained drop in temperature
It can lead to vasoconstriction, which can result
in a further rise in a child’s temperature.
Treatment of Fever
8. If performed too quickly, sponging can cause a
child to shiver and have an increase in metabolic
rate.
The process is also very time-consuming
for a nurse or caregiver.
Treatment of Fever
9. Sponging is preferred over
acetaminophen or
ibuprofen if:
The child is known to be
allergic to, or is unable to
tolerate, antipyretic drugs
(a rare case).
Treatment of Fever
10. It is advisable to combine sponging with:
acetaminophen or ibuprofen if:
- Fever is making the child extremely
uncomfortable.
- He is vomiting and may not be able to keep the
medication in his stomach.
Treatment of Fever
12. The American Academy of Pediatrics has
recommended that children (through 21 years of
age) not take aspirin if they have chickenpox or
influenza (any cold, cough or sore throat
symptoms).
Treatment of Fever
Avoid Aspirin
13. Children older than 2 months of age can be given
any one of the acetaminophen products. All have
the same dosage.
Acetaminophen doses of 10 to 15 mg/kg per dose
given every 4 to 6 hours orally are generally
regarded as safe and effective. Typically, the onset
of an antipyretic effect is within 30 to 60
minutes; approximately 80% of
children will experience a decreased
temperature within that time.
Treatment of Fever
Acetaminophen (APAP)
15. Nausea, upper stomach pain, itching, loss of
appetite.
Dark urine, clay-colored stools.
Jaundice (yellowing of the skin or eyes).
Treatment of Fever
Side Effects
16. All ibuprofen products are now available without
a prescription. Give the correct dosage every 6 to
8 hours as needed.
Greater than 6 months to 12 years:
5 mg/kg/dose for temperature less than (39.2
degrees C) orally every 6 to 8 hours as needed.
10 mg/kg/dose for temperature greater than or
equal to (39.2 degrees C) orally every 6 to 8 hours
as needed.
Treatment of Fever
Ibuprofen Products
17. Ibuprofen is a non-selective inhibitor of an
enzyme called cyclooxygenase (COX), which is
required for the synthesis of prostaglandins via
the arachidonic acid pathway. COX is needed to
convert arachidonic acid to prostaglandin H2
(PGH2) in the body. This PGH2 is then converted
to prostaglandins. The inhibition of COX by
ibuprofen therefore lowers the level of
prostaglandins made by the body.
Treatment of Fever
Mechanism of action
18. The prostaglandins that are formed from PGH2
are important mediators of sensations such as
pain and processes such as fever and
inflammation. The antipyretic effects may arise as
a result of action on the hypothalamus leading to
vasodilation, an increased peripheral blood flow
and subsequent heat dissipation.
Treatment of Fever
Mechanism of action
19. Nausea (feeling sick)
Vomiting (being sick)
Diarrhea.
Indigestion (dyspepsia)
Tummy (abdominal) pain.
Treatment of Fever
Common side effects of
ibuprofen
20. According to WHO paracetamol is the drug of
first choice.
Ibuprofen is a useful 2nd line drug.
No other NSAID including Nimesulide should be
prescribed for children with high grade fever
(WHO 1990).
Treatment of Fever
Choice of Antipyretic
21. Combining these medicines is not recommended for
the following reasons:
No added benefit in reducing fever compared with
either product used alone. (Reason: both drugs have
the same mechanism of action.)
Can cause dosage errors and poisoning (especially if
you give one product too frequently).
No need to control fever this closely.
Treatment of Fever
22. Use both if the fever is over 104° F (40° C) and
unresponsive to one medicine alone.
Give a fever medicine every 4 hours (acetaminophen
every 8 hours and ibuprofen every 8 hours).
Only alternate medicines for 24 hours or less, than
return to a single product.
Treatment of Fever
Alternative therapy
