Tepid Sponging is NOT Recommended for Children with Febrile Seizures
Do not use tepid sponging in children experiencing febrile seizures—it causes discomfort without providing meaningful benefit and is explicitly not recommended by established guidelines. 1
Why Tepid Sponging Should Be Avoided
The Joint Working Group of the Royal College of Physicians and British Paediatric Association explicitly states that physical methods such as fanning, cold bathing, and tepid sponging are likely to cause discomfort and are not recommended for managing fever in children with febrile seizures. 1
Evidence Against Tepid Sponging:
Causes significant discomfort: Children who undergo tepid sponging experience higher levels of distress, including crying, irritability, shivering, and general discomfort compared to those treated with antipyretics alone. 2, 3
Limited and short-lived effect: While tepid sponging may produce an immediate temperature reduction, this effect lasts only approximately 30 minutes and does not provide sustained fever control. 2, 3
Inferior to pharmacologic treatment: Paracetamol (acetaminophen) demonstrates significantly greater and more rapid fever reduction compared to tepid sponging, with more durable effects. 3
No evidence of preventing seizure recurrence: There is no evidence that controlling fever through any method—including tepid sponging—influences the recurrence of febrile seizures. 1
What You Should Do Instead
During the Acute Seizure:
- Position the child on their side to protect the airway and prevent aspiration. 4
- Remove harmful objects from the environment and protect the head from injury. 4
- Never restrain the child or place anything in the mouth during active seizure activity. 4
- Administer benzodiazepines if the seizure lasts >5 minutes: lorazepam 0.05-0.1 mg/kg IV (maximum 4 mg) or rectal diazepam if IV access unavailable. 4
For Fever Management:
- Use paracetamol (acetaminophen) as the preferred antipyretic for comfort and to prevent dehydration. 1
- Ensure adequate fluid intake to prevent dehydration. 1
- Remove excessive clothing/unwrap the child if overdressed, which is a reasonable comfort measure. 2
Critical Caveats
Antipyretics do NOT prevent febrile seizures: While paracetamol is recommended for comfort, neither paracetamol nor ibuprofen reduces the risk of febrile seizure occurrence or recurrence. 4, 5, 6, 7
Focus on the underlying infection: The priority is identifying and treating the source of fever, not aggressively reducing temperature. 1, 4
Reassure parents about prognosis: Simple febrile seizures have an excellent prognosis with no long-term effects on IQ, academic performance, or neurocognitive function, and the risk of developing epilepsy is approximately 1% (similar to the general population). 4, 5
Common Pitfall to Avoid
Do not use tepid sponging based on outdated practices or parental expectations—the evidence clearly demonstrates it causes unnecessary distress without clinical benefit and is no longer advocated in modern pediatric care. 2, 8