External cooling or sponging is usually not necessary to reduce fever. Give paracetamol/acetaminophen first. Sponge first immediately only in emergencies such as heatstroke, delirium or any fever over 106° F (41.1° C). The combination of tepid water sponging and administration of antipyretic drugs appears to lower temperature slightly more rapidly during the first 30 min, though it causes more discomfort.
Sponging should be done with lukewarm water (85° to 90° F [29° to 32° C]). Use slightly cooler water for emergencies. Sponging works much faster than immersion, so keep wetting the skin surface. Cooling comes from evaporation of the water. If child shivers, raise the water temperature or wait for the acetaminophen to take effect. Don't expect to get the temperature below 101° F (38.3° C) with sponging. Adding rubbing alcohol to the water is not recommended as it can be breathed in and cause change in sensorium.
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