OBJECTIVE This article summarizes the Italian Pediatric Society guideline on the management of the signs and symptoms of fever in children, prepared as part of the National Guideline Program (NGLP). METHODS Relevant publications in English and Italian were identified through searches of MEDLINE and the Cochrane Database of Systematic Reviews from their inception through December 31, 2007. Based on the consensus of a multidisciplinary expert panel, the strength of the recommendations was categorized into 5 grades (A-E) according to NGLP methodology. SUMMARY In the health care setting, axillary measurement of body temperature using a digital thermometer is recommended in children aged <4 weeks; for children aged > or =4 weeks, axillary measurement using a digital thermometer or tympanic measurement using an infrared thermometer is recommended. When body temperature is measured at home by parents or care-givers, axillary measurement using a digital thermometer is recommended for all children. Children who are afebrile when seen by the clinician but are reported to have had fever by their caregivers should be considered febrile. In special circumstances, high fever may be a predictive factor for severe bacterial infection. Use of physical methods of reducing fever is discouraged, except in the case of hyperthermia. Use of antipyretics-paracetamol (acetaminophen) or ibuprofen-is recommended only when fever is associated with discomfort. Combined or alternating use of antipyretics is discouraged. The dose of antipyretic should be based on the child's weight rather than age. Whenever possible, oral administration of paracetamol is preferable to rectal administration. Use of ibuprofen is not recommended in febrile children with chickenpox or dehydration. Use of ibuprofen or paracetamol is not contraindicated in febrile children with asthma. There is insufficient evidence to form any recommendations concerning fever in children with other chronic conditions, but caution is advised in cases of severe hepatic/renal failure or severe malnutrition. Newborns with fever should always be hospitalized because of the elevated risk of severe disease; paracetamol may be used, with the dose adjusted to gestational age. Use of paracetamol or ibuprofen is not effective in preventing febrile convulsion or the adverse effects of vaccines.

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.

OBJECTIVES Fever is common in children and causes misconceptions among parents. Many investigators have called for improved parental education to dispel "fever phobia." Our objectives were to assess parental and health care provider understanding of fever, its treatment, and beliefs about its consequences, as well as to identify parental sources of information about fever. METHODS Self-administered surveys were distributed to 3 parent groups and 4 health care provider groups. Parent groups included parents of children with fever presenting to the emergency department (ED)(fever group, n = 209), parents of children with an injury presenting to ED (injury group, n = 160), and parents of healthy school children (school group, n = 141). Provider groups included pediatric ED physicians (n = 16), pediatric ED nurses (n = 39), general pediatricians (n = 26) and family physicians (n = 79). RESULTS Parent groups considered a temperature of 37.9 degrees C to be a fever, 39.1 degrees C to be a high fever, and 39.9 degrees C to be a dangerous fever. Parents were most concerned about discomfort, seizures and dehydration, and parents in the "fever group" worried more about dehydration (p = 0.01) and brain damage (p = 0.03) than other parents. Most physicians were concerned about dehydration and seizures, but family physicians were most likely to express concerns about brain damage (40.5%) and death (34.1%). CONCLUSIONS Fever phobia exists among parents and health care providers and is most likely in parents of febrile children and family physicians. Health care providers varied in their knowledge of fever and its treatment. Greater education of health care workers is required in order to provide families with appropriate information.

AIM The purpose of this paper is to critically analyse the current state of the science literature in order to develop an accurate conception of fever. RATIONALE The measurement of body temperature and treatment of fever have long been considered to be within the domain of nursing practice. What body temperature constitutes 'fever', however, is often not clear from nursing protocols or the literature. METHODS Literature for this concept analysis was obtained by computerized searches of PubMed, CINAHL and BIOSYS for the years 1980-2004. Additional sources were obtained after reviewing the bibliographies of the literature identified by the initial search. The Wilsonian method of concept analysis provided the framework for the analysis. FINDINGS Fever has characteristically been recognized as a cardinal sign of illness and has traditionally had negative connotations for patient well-being. Substantive advances over the past 20 years in immunology and neurophysiology have expanded understanding of the process of fever. This new knowledge has shifted the perception of fever as part of the acute-phase response to one of an adaptive nature. This knowledge has yet to be fully translated into changes in the fever management practices of nurses. CONCLUSIONS Consistent usage of terminology in relation to fever should lead to improved and evidence-based care for patients, and to fever management practices consistent with current research. It is important to use clear language about fever and hyperthermia in discussions and documentation between nurses and among disciplines. By creating clarity in our language, we may help to achieve praxis.

We evaluated knowledge of and approach to childhood fever in parents before and after attending a single reinforced educational session on the subject given by the pediatrician during a visit with their sick child. The study group consisted of 155 consecutive parents of children who visited the pediatrician for treatment of low-grade fever (<38.5 degrees C) once during the period of July 1999-2000, and again, within 6 months later. The parents received the standard short explanation for fever at the first visit and a reinforced educational session which included discussion supported by written and pictorial material at the second. At the follow-up examination, performed 3-7 days after each visit, the parents completed a questionnaire on their approach to the management of childhood fever, and the responses to the two questionnaires were compared. High-grade fever was correctly defined by 75% of the parents after the reinforced education session compared to 46% before, and over 95% of the parents correctly treated fever after the reinforced session compared to only 50% before. Knowledge of the correct utilization of health services was also improved after the intervention. All these differences were statistically significant. This study suggests that parental knowledge of fever management in children can be significantly improved by a reinforced educational session.

OBJECTIVES The aim of the present review was to determine whether the best available evidence supports the types and timing of the various nursing interventions that are commonly used to reduce fever in non-critically-ill children, and to what extent the outcomes are influenced by these nursing actions. METHODS Studies included were randomised or quasi-randomised controlled trials that involved non-critically-ill children with a fever aged between 3 months and 16 years. The search strategy sought to identify both published and unpublished research reports in the English language and covered all major databases up to 1998. The methodological quality of each study was assessed by two independent reviewers using a piloted critical appraisal checklist. Despite all studies being randomised, heterogeneity precluded conduction of a meta-analysis; therefore, evidence was synthesised using narrative summaries. RESULTS Ten studies were assessed as being of sufficient quality to be included in the review. These studies addressed two of the intervention categories identified in the protocol:(i) administration of antipyretics (paracetamol); and (ii) direct cooling measures on the outcome measure (reduction of or prevention of increase in fever). The review found little benefit from sponging in temperate climates and usually at the expense of the child's comfort. There may be situations in high environmental temperatures and high humidity, or where there is a need for immediate temperature reduction, in which sponging may be warranted. Risks were identified when paracetamol was administered on a sustained basis over even a short period of time and above a relatively low total daily dosage. There was a lack of evidence to support the administration of antipyretics to reduce the incidence of febrile convulsions. There is a need for parental education that focuses on knowledge of the body's protective physiological responses and how to support these responses. CONCLUSION The primary purpose for intervening when a child has a fever is to increase the child's comfort. This consideration should be weighed against any harm that might result from intervening. There was a lack of evidence to support the routine use of sponging. The administration of paracetamol should be used selectively and with caution. In summary, care needs to be individualised, based on current knowledge of the effectiveness and risks of interventions.

Although various forms of therapy have been used, since antiquity, to lower the temperature of febrile patients, it is still not known whether the benefits of antipyretic therapy outweigh its risks. Justifications for the use of antipyretic drugs, and the evidence pertaining to these rationales, are examined. Antipyretic therapy in sepsis, and adverse effects of antipyretic medications, are also reviewed.

OBJECTIVES Fever is one of the most common reasons that parents seek medical attention for their children. Parental concerns arise in part because of the belief that fever is a disease rather than a symptom or sign of illness. Twenty years ago, Barton Schmitt, MD, found that parents had numerous misconceptions about fever. These unrealistic concerns were termed "fever phobia." More recent concerns for occult bacteremia in febrile children have led to more aggressive laboratory testing and treatment. Our objectives for this study were to explore current parental attitudes toward fever, to compare these attitudes with those described by Schmitt in 1980, and to determine whether recent, more aggressive laboratory testing and presumptive treatment for occult bacteremia is associated with increased parental concern regarding fever. METHODS Between June and September 1999, a single research assistant administered a cross-sectional 29-item questionnaire to caregivers whose children were enrolled in 2 urban hospital-based pediatric clinics in Baltimore, Maryland. The questionnaire was administered before either health maintenance or acute care visits at both sites. Portions of the questionnaire were modeled after Schmitt's and elicited information about definition of fever, concerns about fever, and fever management. Additional information included home fever reduction techniques, frequency of temperature monitoring, and parental recall of past laboratory workup and treatment that these children had received during health care visits for fever. RESULTS A total of 340 caregivers were interviewed. Fifty-six percent of caregivers were very worried about the potential harm of fever in their children, 44% considered a temperature of 38.9 degrees C (102 degrees F) to be a "high" fever, and 7% thought that a temperature could rise to >/=43.4 degrees C (>/=110 degrees F) if left untreated. Ninety-one percent of caregivers believed that a fever could cause harmful effects; 21% listed brain damage, and 14% listed death. Strikingly, 52% of caregivers said that they would check their child's temperature </=1 hour when their child had a fever, 25% gave antipyretics for temperatures <37.8 degrees C (<100 degrees F), and 85% would awaken their child to give antipyretics. Fourteen percent of caregivers gave acetaminophen, and 44% gave ibuprofen at too frequent dosing intervals. Of the 73% of caregivers who said that they sponged their child to treat a fever, 24% sponged at temperatures </=37.8 degrees C (</=100 degrees F); 18% used alcohol. Forty-six percent of caregivers listed doctors as their primary resource for information about fever. Caregivers who stated that they were very worried about fever were more likely in the past to have had a child who was evaluated for a fever, to have had blood work performed on their child during a febrile illness, and to have perceived their doctors to be very worried about fever. Compared with 20 years ago, more caregivers listed seizure as a potential harm of fever, woke their children and checked temperatures more often during febrile illnesses, and gave antipyretics or initiated sponging more frequently for possible normal temperatures. CONCLUSIONS Fever phobia persists. Pediatric health care providers have a unique opportunity to make an impact on parental understanding of fever and its role in illness. Future studies are needed to evaluate educational interventions and to identify the types of medical care practices that foster fever phobia.fever, fever phobia, child, children, antipyretics, sponging, health care practices.

The Analyzer of Space Plasma and Energetic Atoms (ASPERA) on board the Mars Express spacecraft found that solar wind plasma and accelerated ionospheric ions may be observed all the way down to the Mars Express pericenter of 270 kilometers above the dayside planetary surface. This is very deep in the ionosphere, implying direct exposure of the martian topside atmosphere to solar wind plasma forcing. The low-altitude penetration of solar wind plasma and the energization of ionospheric plasma may be due to solar wind irregularities or perturbations, to magnetic anomalies at Mars, or both.

Occlusion of coronary vessels is now frequently treated by reperfusion using thrombolytics, angioplasty, or coronary artery bypass surgery. On reperfusion, however, acutely ischemic cells may be damaged by the action of oxygen radicals on cell membranes, and by calcium ion flux. By understanding the mechanisms behind reperfusion injury, the critical care nurse can assess and plan for actual and potential patient care problems.

OBJECTIVES:The purpose of this survey was to study the beliefs, expectations, and satisfaction of Canadian parents regarding fever and the treatment of their febrile children.METHODS:A survey was developed exploring caregiver beliefs and treatment strategies, as well as expectations and satisfaction with medical care. Some items were modeled after previous studies to allow comparison. Caregivers with febrile children were recruited from 2005 to 2007 at 3 urgent care centers and emergency departments in Edmonton, Canada: a pediatric emergency department (n = 376), an urban urgent care center (n = 227), and a suburban urgent care clinic (n = 173).RESULTS:High and rapidly rising temperature, as well as physical symptoms associated with fever, caused concern in most parents surveyed. Seventy-four percent of parents felt that the elevated temperature from fever was dangerous and 90.3% always try to treat it. Forty degrees Celsius was the most commonly sited threshold for danger. Identifying the cause (80.6%) and seriousness (87.4%) of fever were the most com-mon stressors identified. Caregivers expected to receive information about the child's illness and appropriate treatment. The parents most often wanted information about febrile seizures and the potential dangers of febrile illness. Only 16.7% of caregivers expected anti-biotics. Nearly 92% of subjects were usually satisfied with medical care.CONCLUSIONS:Fever phobia continues to be a significant issue for Canadian parents. As a result, they treat fever aggressively and often seek medical attention. Good communication is important for medical staff caring for febrile children and typically leads to satisfied parents.

Acetaminophen-associated liver toxicity remains a serious concern, but guidance regarding dose selection is ambiguous, and the literature describing acetaminophen efficacy and toxicity in pediatrics is limited. Clinical investigation and reporting are needed. This study investigates caregiver satisfaction with 2 commonly prescribed dose levels. This nonrandomized, open-label, outpatient study included 37 moderately febrile pediatric patients prescribed acetaminophen at either 10 or 15 mg/kg every 4 hours. Patient caregivers indicated how well the acetaminophen reduced fever by completing a 5-point Likert scale. A 2-sample t test determined whether a statistically significant difference in satisfaction scores existed. Sufficient statistical power was achieved, and the mean satisfaction scores for both groups were not significantly different. Although further studies using more precise and objective end points are needed to provide optimal evidence-based guidance for acetaminophen pediatric dose selection, the findings in this study suggest that prescribers should consider a starting dose of only 10 mg/kg for moderately febrile pediatric patients.

OBJECTIVE To compare ketoprofen with acetaminophen in febrile children in terms of proportion of achieved temperatures below 37.8°C and time of temperature reduction. METHODS 316 patients (6 months-12 years) with fever were randomly assigned to receive a single dose of acetaminophen or ketoprofen orally. Tympanic temperature was measured at the time of antipyretic administration and at 15, 30, 60, 120,180, 240 min thereafter. RESULTS A higher proportion of patients in the ketoprofen group achieved a temperature below 37.8°C during the 4 h follow up (95% CI, 3.03-12.99, p < 0.001). Treatment with ketoprofen was more likely to achieve temperature below 37.8°C compared to acetaminophen with odds ratio 6.25.(95% CI, 3.03-12.99, p < 0.001). Ketoprofen was superior at temperatures ≥39°C (p < 0.001). Ketoprofen group showed significantly lower mean temperatures at times 15 min (95% CI, 0.95-3.36; P < 0.001), 30 min (95% CI, 3.87-6.59; P < 0.001), 60 min (95% CI, 6.99-10.14; P < 0.001), 120 min (95% CI, 1.66-5.49; P < 0.001), 180 min (95% CI, 0.47-5.73; p < 0.05), and 240 min (95% CI, 3.87-6.59; p < 0.05). The mean temperature reductions at times 15, 30 and 60 min were larger in ketoprofen group (p < 0.001). Ketoprofen was superior to acetaminophen for less time with fever in the first 4 h (p < 0.001). CONCLUSIONS It seems reasonable to use ketoprofen first in need of rapid fever reduction.

OBJECTIVES The purpose of this study was to assess the safety and dynamics of the onset of antipyretic efficacy of intravenous (IV) acetaminophen versus oral (PO) acetaminophen in the treatment of endotoxin-induced fever. METHODS This randomized, double-blind, double-dummy, single-dose study was conducted at a single center in the United States in healthy volunteer adult males with an endotoxin-induced fever to assess the antipyretic efficacy and safety of IV acetaminophen 1 g versus PO acetaminophen 1 g over 6 hours. Subjects who achieved a sufficient fever response to a test dose of reference standard endotoxin were randomly assigned to receive either IV acetaminophen and PO placebo (n = 54) or PO acetaminophen and IV placebo (n = 51). The primary efficacy outcome was the weighted sum of temperature differences from baseline at time T0 through T120 minutes. Safety evaluations included adverse event (AE), physical exam, and laboratory assessments. RESULTS Of 105 subjects receiving study medication, 24 vomited within 2 hours postdose (PO acetaminophen, n = 15; and IV acetaminophen, n = 9) and were excluded from the modified intent-to-treat population that consisted of 36 and 45 subjects treated with PO and IV acetaminophen, respectively. While this was done to not confer an advantage to the IV formulation, a sensitivity analysis including these subjects did not change the overall efficacy results. Statistically significant results favoring IV acetaminophen were observed for the primary endpoint (weighted sum of temperature differences over 120 minutes, p = 0.0039) and also at each time point from T30 to T90 minutes, although the maximum mean observed temperature difference was only 0.3°C. The study drugs were well tolerated. The AE frequency was comparable between the IV and PO groups. CONCLUSIONS A single dose of IV acetaminophen is as safe and effective in reducing endotoxin-induced fever as PO acetaminophen. IV acetaminophen may be useful where patients are unable to tolerate PO intake or when an earlier onset of action is desirable.

Many pediatricians recommend, and many parents administer, alternating or combined doses of ibuprofen and acetaminophen for fever. Limited data support this practice with standard US doses. This study compared the antipyretic effect of 3 different treatment regimens in children, using either ibuprofen alone, ibuprofen combined with acetaminophen, or ibuprofen followed by acetaminophen over a single 6-hour observation period. Febrile episodes from children aged 6 to 84 months were randomized into the 3 treatment groups: a single dose of ibuprofen at the beginning of the observation period; a single dose of ibuprofen plus a single dose of acetaminophen at the beginning of the observation period; or ibuprofen followed by acetaminophen 3 hours later. Ibuprofen was administered at 10 mg/kg; acetaminophen at 15 mg/kg. Temperatures were measured hourly for 6 hours using a temporal artery thermometer. The primary outcome was temperature difference between treatment groups. Adverse-event data were not collected in this single treatment period study. Sixty febrile episodes in 46 children were assessed. The mean (SD) age of the children was 3.4 (2.2) years, and 31 (51.7%) were girls. Differences among temperature curves were significant (P < 0.001; the combined and alternating arms had significantly better antipyresis compared with the ibuprofen-alone group at hours 4 to 6 (hour 4, P < 0.005; hours 5 and 6, P < 0.001). All but one of the children in the combined and alternating groups were afebrile at hours 4, 5, and 6. In contrast, for those receiving ibuprofen alone, 30%, 40%, and 50% had temperatures >38.0 °C at hours 4, 5, and 6, respectively (hour 4, P = 0.002; hours 5 and 6, P < 0.001). During a single 6-hour observation period for these participating children, combined and alternating doses of ibuprofen and acetaminophen provided greater antipyresis than ibuprofen alone at 4 to 6 hours. ClinicalTrials.gov identifier: NCT00267293.

HASH(0x2afee0736c80)

Poison control centers have been shown to be a cost-effective alternative to healthcare visits for poisoning exposures, yet emergency departments (ED) and urgent care centers (UCC) continue to be frequently accessed for poisoning exposures in young children. We sought to identify predictors of young children who obtain healthcare for a nontoxic poisoning exposure. Poisoning exposure cases for children </=5 years old who sought ED, UCC, or clinic care between 2001 and 2005 from an urban regional pediatric hospital system were identified from poisoning ICD-9 codes in the hospital administrative data and from a poisoning designation in the National Electronic Injury Surveillance System (NEISS) data. Cases (n = 2,494) were reviewed and categorized as either toxic or nontoxic. Toxic exposures were those with more than minimal potential for clinical effects. Most cases were between 1 and 2 years old, male, White, enrolled in Medicaid, sought ED care, had no referring physician, and brought to the facility by a parent/guardian. Logistic regression analysis revealed that the odds of seeking healthcare for a nontoxic poisoning exposure were significantly greater if the child was African American, enrolled in Medicaid, had a non-medication related poisoning, and was brought to the healthcare site by a parent/guardian. Healthcare costs and unnecessary use of healthcare resources for nontoxic poisoning exposures could be reduced by educating parents and providers of children at high risk for inappropriate healthcare visits for nontoxic poisonings to initially contact the poison control center (1-800-222-1222).

BACKGROUND Retail clinics are an increasingly popular source for medical care. Concerns have been raised about the effect of these clinics on the cost, quality, and delivery of preventive care. OBJECTIVE To compare the care received at retail clinics for 3 acute conditions with that received at other care settings. DESIGN Claims data from 2005 and 2006 from the health plan were aggregated into care episodes (units that included initial and follow-up visits, pharmaceuticals, and ancillary tests). After 2100 episodes (700 each) were identified in which otitis media, pharyngitis, and urinary tract infection (UTI) were treated first in retail clinics, these episodes were matched with other episodes in which these illnesses were treated first in physician offices, urgent care centers, or emergency departments. SETTING Enrollees of a large Minnesota health plan. PATIENTS Enrollees who received care for otitis media, pharyngitis, or UTI. MEASUREMENTS Costs per episode, performance on 14 quality indicators, and receipt of 7 preventive care services at the initial appointment or subsequent 3 months. RESULTS Overall costs of care for episodes initiated at retail clinics were substantially lower than those of matched episodes initiated at physician offices, urgent care centers, and emergency departments ($110 vs.$166,$156, and $570, respectively; P < 0.001 for each comparison). Prescription costs were similar in retail clinics, physician offices, and urgent care centers ($21,$21, and $22), as were aggregate quality scores (63.6%, 61.0%, and 62.6%) and patient's receipt of preventive care (14.5%, 14.2%, and 13.7%)(P > 0.05 vs. retail clinics). In emergency departments, average prescription costs were higher and aggregate quality scores were significantly lower than in other settings. LIMITATIONS A limited number of quality measures and preventive care services were studied. Despite matching, patients at different care sites might differ in their severity of illness. CONCLUSION Retail clinics provide less costly treatment than physician offices or urgent care centers for 3 common illnesses, with no apparent adverse effect on quality of care or delivery of preventive care. PRIMARY FUNDING SOURCE California HealthCare Foundation.

BACKGROUND Due to long waits for primary care appointments and extended emergency department wait times, newer sites for episodic primary care services, such as urgent care centers, have developed. However, little is known about these centers. The purpose of this study is to provide information about the organization and functioning of urgent care centers based on a nationally representative U.S. sample. METHODS We conducted a mail survey with telephone follow-up of urgent care centers identified via health insurers' websites, internet searches, and a trade association mailing list. Descriptive statistics are presented. RESULTS Urgent care centers are open beyond typical office hours, and their scope of services is broader than that of many primary care offices. While these characteristics are similar to hospital emergency departments, such centers employ significant numbers of family physicians. The payer distribution is similar to that of primary care, and physicians' average salaries are comparable to those for family physicians overall. Urgent care centers report early adoption of electronic health records, though our findings are qualified by a lack of strictly comparable data. CONCLUSION While their hours and scope of services reflect some characteristics of emergency departments, urgent care centers are in many ways similar to family medicine practices. As the health care system evolves to cope with expanding demands in the face of limited resources, it is unclear how patients with episodic care needs will be treated, and what role urgent care centers will play in their care.

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.