common question most patients with fever ask us is whether they can have their regular

bath. If we say Yes, eyebrows are raised, seeking confirmation. It appears that there exists
a lot of confusion about bathing in the presence of a febrile illness.

Fever, as everyone knows, is the elevation of the body temperature as a result of release of
certain mediators in response to an infection/injury/insult. Fever is invariably accompanied
by sweating, a feeling of being sick, lack of interest in work and loss of appetite etc. Fever
being a manifestation of the body's fight against an 'enemy,' as far as possible it should not
be or need not be 'treated'. However, when fever itself becomes a problem, as when it
causes a lot of discomfort , induces vomiting or seizures, it must be brought down.

Bathing for a febrile patient should be viewed from two angles. One, bath as a treatment for
reducing the elevated temperature and two, bath as a regular, cleansing act.

Tepid sponging is a time honoured and well known method of reducing the elevated
temperature. Tepid sponging is useful as an immediate but transient measure in bringing
down the temperature and it should always be supplemented with drugs like paracetamol
for a longer antipyretic effect1. Studies have shown no significant differences in patient
groups treated with antipyretics compared to those treated with placebo2 even with regard
to outcome. There is no hard evidence to suggest that reduction of temperature by tepid
sponging adversely affects the disease process. But tepid sponging is sometimes perceived
as a discomfort, especially by children3,4 and it may not be ideal for patients under
intensive care, as it may induce vasoconstriction and shivering5). As against tepid sponging,
cold sponging can cause constriction of the cutaneous vessels and may even increase the
core temperature. Therefore, tepid sponging (and not cold sponging) can be used as a
method of reducing temperature, but it can cause some discomfort to the patients, specially
children.

Coming to bathing as a regular, cleansing activity, it can be said that bathing with luke
warm water need not be discouraged in febrile patients. To reduce the level of discomfort,
they can be advised to have their bath whenever the temperature has settled down from its
peak. Bathing with luke warm water will certainly help in reducing the stink of sweat and
will give some freshness. Bathing at the height of fever, particularly with cold water, is
probably not advisable. Also patients who are sick, bed ridden and elderly may be given a
warm sponge bath and a regular bath or cold sponging is not advisable in these patients.