Tepid Sponging for Fever: Methods and Benefits Explained

Tepid sponging is a fast and effective way of reducing fever in children and adults. Also known as a tepid sponge bath, it can be used both at home and in the hospital for the immediate relief of fever.

Tepid sponging is a readily available alternative to medications in the relief of fever, particularly in cases where very high body temperatures can lead to other problems if not attended to immediately. For example, fever in children less than five years of age can trigger convulsion (referred to as febrile convulsion) even when there is no other known cause of seizure in those children.

Tepid sponging involves dabbing the skin with a tepid-water-soaked towel. This method of controlling fever is readily available to both health workers and caregivers/parents as a quick method of fever relief, especially before anti-pyretic medications are available.

There are some misconceptions about tepid sponging. Many people do not exactly know what tepid water is. While some say it is lukewarm water, others say it is cold water. Other misconceptions include claims that tepid sponging is a cure for fever, or it is no longer an effective option for fever relief.

Due to the above misconceptions about tepid sponging as a method of relieving fever, I am putting up this information about the concept with emphasis on how you can do it at home for your child/dependent/spouse, or at the hospital for your patients.

Requirements for Tepid Sponging for Fever

Tepid sponging as a cheap and effective relief for fever does not require so many materials. Once you have the following, you are good to go.

• A clean towel
• A bowl, preferably plastic
• Water
• Water heater

With as simple as these four materials, you can do tepid sponging for anyone with high-grade fever, to prevent more serious complications before drugs or more definitive treatment of the fever is available.

Steps in Tepid Sponging

While it may look very easy, tepid sponging is not always so especially if you don’t understand the technicalities involved. Here is a step-by-step method.

When I was rotating through the Department of Paediatrics as a medical student, my teacher, Dr. Mrs Aina (Consultant Paediatrician, University of Benin Teaching Hospital), taught me a lot about tepid sponging and how it is done. She also demystified some of the misconceptions surrounding the concept.

Tepid water is not cold water, and it does not offer a permanent cure for fever. However, it can offer immediate relief for fever both in children and adults. Here are the simple steps for preparing a tepid sponge for the relief of fever.

1. Get the required materials as outlined above.
2. Boil water in a boiler and bring it down when it is lukewarm (temperature around 29–32°C).
3. The above water temperature should not burn your skin, neck, or arm when felt.
4. You may also boil the water to boiling point and gradually dilute it with cold water until it becomes lukewarm.
5. Ensure the room is comfortable, and remove excess clothing from the person with the fever.
6. Next, soak your clean towel in the water and then squeeze out excess water on bringing it out.
7. Apply the now tepid sponge on the skin focusing on areas like the forehead, armpits, and limbs.
8. Continue re-soaking and applying on the skin for 15–20 minutes, or stop when the water gets too cold.
9. Lastly, gently dry off the skin with a dry towel and keep the person hydrated.

Scientific Explanation of How Tepid Sponging Works for Fever

Tepid sponging is an effective and non-invasive method of reducing fever in children and adults. It works based on the principle of evaporation and conduction.

Tepid water (lukewarm water) increases water evaporation from the skin by causing vasodilation of the skin’s blood vessels. The skin pores also open in response to the warm temperature from the tepid sponge, allowing water to evaporate from the skin.^[1]Effect of Tepid Sponge on Changes in Body Temperature in Children Under Five Who Have Fever in Dr. Achmad Mochtar Bukittinggi Hospital – Enfermería Clínica

Tepid sponging also sends a stimulating impulse to the hypothalamus through skin receptors signaling it to reduce the body’s temperature set point thus reducing fever. Fever is caused by the body’s release of pyrogens in an attempt to increase metabolism, and recruit inflammatory cells into the bloodstream. This increases the core body temperature.

In normal cases where pyrogens are not involved, this increase in core body temperature should lead to vasodilation of skin blood vessels leading to evaporation and restoration of body temperature to normal. However, the elaboration of pyrogens signals the body that the high body temperature is “needed” and thus tries to conserve the heat by constricting blood vessels of the skin, reducing blood flow to the skin, and reducing evaporation and heat loss.

Pyrogens act on the preoptic area to increase the set point, setting a new normal/acceptable body temperature above the normal temperature range still in an attempt to conserve more heat within the body.^[2]A hypothalamic circuit that controls body temperature – Proceedings of the National Academy of Sciences (PNAS)

During tepid sponging, the tepid sponge increases skin vasodilation and also triggers the skin thermoreceptors to send signals to the preoptic area alerting it that the body has enough heat and wants to shed off the excess. Thus, stimulating the hypothalamus to reset the setpoint back to normal.^[3]Ibid. Effect of Tepid Sponge on Changes in Body Temperature in Children Under Five Who Have Fever in Dr. Achmad Mochtar Bukittinggi Hospital – Enfermería Clínica

When the set point goes back to normal, the body continues to release excess by increasing water evaporation via the skin. Evaporation cools down the body and reduces body temperature because, during the process, the body loses what we call “latent heat of vaporization”. Water uses excess heat from the body when converted to vapor, thus cooling the body in the process.^[4]How Does Evaporation Cause Cooling? – Sciencing

Effectiveness/Benefits of Tepid Sponging for Fever

Tepid sponge application is indicated for high fever 39°C/102°F and above and could reduce the body’s temperature by 1.4°C/34.5°F in 20 minutes.^[5]Kozier B. Fundamental of Nursing. 7th Ed. Vol.2. Jakarta: EGC; 2008. During fever, this accounts for a significant reduction and fever relief.

Studies have demonstrated the benefits of tepid sponging as an immediate and effective method of controlling fever, especially in combination with medications. A study done among children within 6 months to 6 years showed that giving a febrile baby a tepid sponge bath together with an antipyretic medication is more effective for fever relief than the use of antipyretic alone.^[6]Tepid sponging to reduce temperature in febrile children in a tropical climate – PubMed

The effect of tepid sponging occurs very rapidly, offering a quick relief of fever before oral medications begin to act, or before you get a chance to visit the hospital (e.g., fever occurring at night). In cases where faster routes of drug administration like the intravenous route are not readily available (no materials or drug), an application of a tepid sponge can buy some time and prevent problems from fever.

Lastly, tepid sponging is an effective method of relieving fever for both children and adults, especially in combination with antipyretic medications.

Misconceptions About Tepid Sponging

1. Tepid sponging is outdated: This is not true, as it is still practiced in modern medicine as a quick and effective relief for fever.
2. Cold water is more effective: Cold water is not recommended for relieving fever. Tepid sponging uses only ‘tepid water’, and using cold water can worsen the fever due to the same mechanisms of hypothalamus control of temperature set points. Cold water may result in further vasoconstriction of skin vessels and send signals to the hypothalamus that there is not enough heat, thus further raising the set point.
3. Tepid sponging cures fever: Tepid sponging is not a cure for fever. It only offers a temporary relief for fever similar to what antipyretic medications would do. It is important to identify the underlying cause of the fever and treat it.

Precautions for Tepid Sponging

1. Avoid using cold water, as it can cause shivering which raises body temperature.
2. Do not use tepid sponging for infants without consulting a healthcare provider. This is because improper tepid sponging methods (e.g., using cold water) can worsen the child’s condition. Also, fever in such children could be a pointer to a more serious underlying cause that needs the urgent attention of a doctor.
3. Avoid using too hot water, especially in children, as it could cause skin burns.

Other Interventions for Fever

1. Removing the person’s clothes to allow heat loss.
2. Rehydration by encouraging the person to drink more water.
3. Antipyretics like paracetamol. Over-the-counter syrup or tablet paracetamol could help reduce fever in children before they get professional medical care.