Tepid Water Sponging and Cold Sponging for Fever

Cold sponging and tepid water sponging are the procedures which use cooling properties of water to bring down the temperature in fever.

Apart from the difference in temperature of the water used, both procedures essentially are the same.

Cold sponging is not preferred nowadays and tepid sponging is done to control the fever.

Both the terms are used interchangeably in the clinical practice.

[Please also go through the NICE guidelines, 2007 which recommend against tepid water sponging]

So when a person is asked to be cold sponged by a physician, in the end, what might actually be happening is tepid water sponging or bath.

The term bath is also used interchangeably with sponging. However, bathing means bathing by sponging. Practically there is no difference.

The terms have been used interchangeably in this article too.

Principle

In case of high fever [>102° F], it is important to control it as the further rise of the temperature may lead to febrile seizures. By using the cold sponge method, you are trying to bring down the temperature of the body.

Sponging helps control body temperature. Studies have shown that sponging a fevered patient down with water is extremely effective in reducing fever.

Water has been known to cool the body twenty times than air due to the evaporation process. Water applied to the body surface evaporates, leaving the surface cooler. This skin surface is able to extract more heat from the inner body and thus reduces overall heat content.

Cold Water Sponging or Tepid Water Sponging?

For cold sponging temperature of water for cold sponging is below 70°F. Usually 65°F.

The temperature of water for tepid sponging is 78°F-90°F.

The studies also have shown that sponging with colder water created no significant difference in temperature reduction.

With the use of cold water, the temperature difference is too severe and the cold water may cause the body to constrict the blood vessels. This, in fact, may cause retention of the heat if the vessels are not dilated enough for heat exchange. So the outer surface of the body would be cooler whereas the internal heat would be retained.

Moreover, the cold water adds to the discomfort and may cause shivering which in fact would result in increased heat.

Therefore, cold sponging is almost never done for fever. It could be part of treatment in acute injuries to reduce swelling but in fever tepid sponging or tepid water bath is the preferred procedure.

But somehow, the phrase has stuck and the physician might just mention cold sponging when she actually wants a tepid bath for the patient.

Procedure of Tepid Water Sponging [or Cold Sponging]

Material Required

• Washbasin
• Tepid water
• Large rubber mackintosh to cover the whole length of the bed
• Bath towel
• Bucket for the collection of wastewater

Procedure

• Before doing, inform the proceeding to the patient.
• Take the patient’s temperature before starting the procedure.
• Remove patient’s clothing from the body.
• Bath the face, upper half of the body and the lower half.
• Place a cool moist cloth over axilla and groin.
• Change the cloth when it is warm.
• Change the water when it is warm by discarding in a bucket.
• Do not wipe and dry with a towel. Let the water stick and evaporate as evaporation causes cooling.
• After whole-body sponging is completed, dry the patient by dabbing with a towel.
• The entire sponging should take 15 to 20 minutes.

Tepid Sponging in a Child

For sponging the child, place her in a bath with 1 to 2 inches of tepid water. If the child starts to shiver, then the water is too cold.

Seat the child in the water. Using a clean washcloth or sponge, spread a film of water over her trunk, arms, and legs.

If the child resists actively just let her sit down and play.

Is Tepid Water Sponging Effective in Reducing Fever?

Sponging produces a more rapid reduction in body temperature. The effect usually is short-lasting and repeated sponging may be needed. For long term effect, the use of antipyretic medicine like acetaminophen should be used.

Cold or tepid water sponging may serve to bring down the fever when the medicine is not available or is to be arranged.

In 2007, NICE guidelines for fever recommended against tepid sponging in children. You can read the guidelines by clicking the following link.

[NICE guidelines for fever in children]