Effect of Warm Water Foot Bath Therapy on Body Temperature among

Children with Fever

Shaima Shaban Mohamad1; Sanaa Mahmoud Ahmed2; Asmaa Hamed Tawfic 1; Amna Nagaty
Aboelmagd1

1
Lecturer of Pediatric Nursing – Minia University, Cairo- Egypt
2
Assistant Professor of Pediatric Nursing – Minia University, Cairo- Egypt

Corresponding author's email address: [email protected]

Abstract

Fever in children is a traditional warning for parents. The current study aimed to
evaluate effect of warm water foot bath therapy on body temperature among children
with fever. A quasi-experimental design was utilized. A purposeful sample of 100
children with fever in an outpatient clinic at Misr El-Hora general hospital participated
in the current study. One tool used, child age, sex, diagnosis, use of antipyretics, use
of antibiotics, baseline body temperature, and after application body temperature. The
results revealed that near to three-quarters of the children in the study group return
their body temperature to normal level versus more than one-third of the children in
the control group after application with a statistically significant difference. The mean
body temperature among children in the study group in the baseline was 38.7 ± .417
versus 38.6 ± .587 among children in the control group decreased to 37.4 ± .496 versus
37.8 ± .554 oC after application of warm water foot bath therapy respectively, with
statistically significance difference. The current study concluded that applying warm
water foot bath therapy in children with fever is effective in reducing body temperature
than plain water compresses with statistically significant differences. Provide the
hospital with written protocol on methods of warm water foot bath therapy to be
applied in the hospitals was recommended.

Keywords: Children; Fever; Foot Bath; Warm Water

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 Introduction

Fever in children is a common problem for the parents and a significant cause
of laboratory investigation and hospital admission is now one of the most prevalent
concerns of emergency care (Barbi, Marzuillo, Neri, Naviglio, and Krauss, 2017).
The word "Fever" is simply a high body temperature of more than 36.5°C to
37.5°axillary than the natural physiological range (Prajitha, Athira, and Mohanan,
2018). Fever is the body's innate reaction to combat foreign substances like
microorganisms and toxins. Fever is a biochemical phenomenon of beneficial effect
on infection management, rather than a primary disease (Pereira, and Sebastian,
2018).

Fever can be the result of various causes, such as an infectious or pathological

mechanism, an exercise in severity, or a reaction to the use of certain medications.
Most fevers, including bacterial, fungal, and yeast infections, are typically the result
of microbial infections (Gould, 2017).

Initially, fever control is symptomatic, but it is the actual cause that can be
identified and control begun as soon as possible. Body temperature mitigation is the
essential component of administration and can be achieved with the use of a tepid
sponge, the use of ice bags, or agriculture, is a comfortable, well-ventilated, and warm-
water football climate. Rest and comfort are essential mechanisms of help in order to
decrease metabolic rate and allow more oral fluids to prevent dehydration (Fernando,
2016).

Warm application to the feet allows the blood congested to flow into distal
areas of the body and into the vessels of the foot and leg that are stretched. As a hot
water foot bath is placed 15-20 minutes in the feet, the vessels tend to extend and
improve circulation, neutralize acids and destroy bacteria. The increased circulation of
the blood resets hypothalamic heat flow points from higher to lower heat (Sunar,
2017).

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 The quasi-experimental trials performed by Ishita, Sunita, and Ahmed
(2014), on 60 children using a fever-induced non-probable sampling technique assess
the effectiveness of warm water foot bath therapy. The study found that after warm
water foot bath treatment, the temperature decreased.

Sunar (2017) performed an experimental study to determine the effects of hot

water foot baths in fever patients and Retnam and Sophia (2018) experiments on hot-
water foot baths with body temperature reduction. Hot-Water footbath treatment has
been shown to decrease the body temperature in fever-related patients effectively.

Pediatric nurses are responsible for supporting and maintaining their patients'
wellbeing and health. A core aspect of this is to provide efficient and evidence-based
services for patients. Pediatric nurses play a vital role in the control of fever in infants,
as both the first responders to patient fever diagnosis in the stationary surroundings
and as the person in charge of the administration of antipyretic medications (Clark,
2019).

Significance of the study:

Fever is a common condition, frequently recognized as a major cause of

hospital visits or pediatric visits for patients under 15 years of age. While the majority
of fevers can be treated quickly with the appropriate care, a severe underlying
condition, such as an acute infection, needs urgent assessment and treatment (Berardi,
Ferreri, Hume, Newton, & Rollins, 2015). Fever is a child's reaction to some
pneumonia, diarrhea, malaria, metabolism, and malnutrition that, according to WHO
estimates, is usually responsible for approximately 10 million child deaths before 5
years of age (WHO and Mathers 2016).

The largest incidence of fever in children aged 3 to 36 months of age is from 6

to 12 febrile episodes per year. The most prevalent illness in 50% of all febrile episodes
is an autonomous upper respiratory tract viral infection. Body temperatures more than
40 °C are commonly seen during febrile outbreaks in 20 percent of the cases. (French
edition, 2012).

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 There are few studies in Egypt about temperature reduction by using warm
water therapy, instead of this measure, there are various measures that are implemented
in the health care setting to control fever in children, such as cold sponges, tepid
sponges, or external cooling. It also induces blood vasoconstriction and increases
terrifying as a result of swift cooling. On the other hand, warm water foot soaking
therapy has an effect on fever control in children with mild side-effects and pain for
children with fever. The research was then undertaken to pass this trial to healthcare
providers in healthcare facilities to decrease the amount of fever in children and to
teach mothers their knowledge to practice at home. Hopefully, the results of the current
study will add new evidence in the pediatric nursing practice.

Aim of the study

The current study aimed to:

evaluate effect of warm water foot bath therapy on body temperature among children
with fever.
Research hypothesis:

H 0: Warm water foot bath therapy will not reduce body temperature among children
with fever.
H1: Warm water foot bath therapy will reduce body temperature among children
with fever.
Subjects and Method

Research design

A quasi-experimental research design (study and control groups) were used in

the current study.

Subjects

A purposeful sample of 100 children having fever participated in the

current study at the age of 2-10 years who randomly divided into two equal groups
by using a simple random sampling technique. Study group: Consisted of 50
children who received warm water foot bath therapy and control group: Consisted

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 of 50 children who received routine care. According to the statistical equation in
which the sample size was 10 %from the total population size, the entire pediatric
population admitted to the outpatient clinic in Misr El-Hora general hospital was
1000 children with fever in 2018.
Inclusion criteria.
1. Children admitted to the hospital with body temperature more than 37.5oc
2. A child with a fever who is willing to participate in this research.
Exclusion criteria
1. Children with an ulcer, burn, or lesion in the legs or any skin conditions prohibit
the use of a warm foot bath
2.A child who has paralysis and paresthesia
3.Unconscious child
Setting: The study was conducted in an outpatient clinic at Misr El-Hora general
hospital which is affiliated with the Ministry of Health

Data collection tool

1- Interview Questionnaire Sheet: It was developed by the researchers after an

extensive review of related recent literature. It included two parts:

Part 1: It concerned with the Bio -demographic data about the child, it consisted of 4
items such as child’s age, sex, child’s diagnosis, and use of antipyretic.

Part Ⅱ: Mercury thermometer to check the axillary temperature of the children and
bath thermometer to check the temperature of the water.

Body temperature categories (https://www.healthhub.sg/a-z/diseases-and-

conditions/693/common-childhood-conditions-fever)

Low fever - 37.5-38 o C

Moderate fever - 38.1-38.9 o C

High fever - ≥ 39 o C

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 Validity

The content validity of the tools was performed by a jury of 3 experts in

Pediatric Nursing. The tool was examined for content coverage, clarity, relevance,
applicability, wording, length, format, and overall appearance.

Pilot Study
In order to provide viability, objectivity, applicability, clarification, adequacy
of the research tool, and to define potential tool issues, a pilot test was performed on
10% (5 children from the study group and five children from the control group) who
fulfilled inclusion requirements. The tool was easily completed and the validity of the
tool was added. The main research sample included children enrolled in the pilot study.
Ethical Considerations:
Written approval was obtained from the Research Ethics Committee of the
Faculty of Nursing, Minia University; there was no risk for study subject during
application of the current study, written consent was taken from all mothers of children
to participate in the study. The researchers explained the study's purpose and nature
through direct personal communication before participating in the study. These data
were confidential and were used for the research only. The study followed the common
ethical consideration to participate in clinical research, and privacy was assured during
data collection. Anonymity and privacy were assured through coding the data, and a
caregiver has the right to refuse to participate in the study without any rationale.
Children and their caregivers were informed that participation in the study was
voluntary; the researchers also informed the caregivers about their rights to withdraw
from the study without giving any reason and without any effect on their children's
care or treatment.
Data collection procedure:

The official permissions obtained from the Director of the Misr El-Hora
general hospital and the Head of outpatient clinics, up on letters issued from the
Faculty of Nursing, Minia University, and explaining the nature of the study
performed. Formal written consent was obtained from the mothers who have visited
the clinics and fulfilling the inclusion criteria.

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 The baseline temperature axillary was measured before the implementation of
the study (pretest) by using a mercury thermometer for both the study and control
group.
The children in the study group were placed in a sitting position and his feet
including ankles was immersed in a basin with warm water, the warm water
temperature was adjusted to be 38-40 oc by using a bath thermometer and the child
was completely wrapped with a sheet or blanket except their head and neck exposed.
Warm water was periodically added to the footbath to maintain adjusted temperature,
researchers’ hand was placed between the warm water being poured and the children's
feet (to avoid burning the feet). The duration of the warm water feet bath was15
minutes, after that time, body temperature was measured by using the same
thermometer and recorded (post-test). The children were not administered antipyretic
medication.
The children in the control group received the routine general measures to reduce
fever in the hospital as plain water compresses on the forehead, axilla or armpits, and
the groin area for 15 minutes after that time, body temperature was measured by using
the same thermometer and recorded (post-test). The data collection procedure was
done at the period of six months from the beginning of September 2019 to the end of
February 2020

Statistical Analysis

Data entry was done using a compatible personal computer and the content of
the tool was analyzed, categorized, and then coded. After data were collected it was
revised, coded, and fed to statistical software (SPSS) IBM 25. The given graphs were
constructed using Microsoft Excel software. All statistical analysis was done using
two-tailed tests and an alpha error of 0.05. P-value less than or equal to 0.05 is
considered to be significant. The following statistical tests were used:

Descriptive statistics: included the means with standard deviation and percent
to describe the scale, categorical data, chi-square test, and a comparison of means was
performed using "t-test"

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 Correlation analysis: correlation is used to test the nature and strength of the
relation between two quantitative/ordinal variables. The sign of the coefficient
indicates the nature of relation (positive/negative) while the value indicates the
strength of relation as follows: weak correlation when r- value less than 0.25, a fair
correlation when r-value between 0.25-0.499, a moderate correlation when r-value
between 0.5-0.739, and strong correlation when r-value between 0.740-0.99.

Results:

Table (1): Comparison between Study and Control Groups Regarding their Bio-
demographic Data (n = 100).

Study Control
Biodemographic data group group (n= X2 P-value
(n= 50) 50)
No. % No. %
Age / years
2- 4 14 28.0 11 22.0
5- 7 28 56.0 32 64.0 .693 .707
8- 10 8 16.0 7 14.0 NS
Mean ± SD 5.6 ± 1.9 5.7 ± 1.8
Gender
Boy 13 26.0 19 38.0 1.654 .198
Girls 37 74.0 31 62.0 NS
Child’s diagnosis
Upper Respiratory 34 68.0 27 54.0
disorder 2.060 .151
Gastroenteritis 16 32.0 23 46.0 NS
NS means no statistical significance
Table (1): shows that 56.0% & 64.0% of the study and control groups aged
between 5- 7 years with mean age 5.6 ± 1.9 vs 5.7 ± 1.8 respectively, 74.0% versus
62.0% of them was female and 68.0% vs 54.0% of them their diagnosis was upper
respiratory disorders respectively with no statistically significant differences in which
P – value < .707, .198, .151 respectively

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 Table (2): Comparison Between Study and Control Groups Regarding their Use of
Anti-pyretic (n = 100).

Study Control group

Anti-pyritic group (n= 50) X2 P-value
(n= 50)
No. % No. %
Anti-pyretic
Yes 42 84.0 36 72.0 2.098 .148
No 8 16.0 14 28.0 NS
If yes, from / hours
6 12 28.6 14 38.9 1.144 .565
8 20 47.6 16 44.4 NS
10 10 23.8 6 16.7
NS means no statistical significance
Table (2): presents that 84.0% vs 72.0% of the study and control groups
administered antipyretic drugs when their children with elevation in the body
temperature and 47.6% vs 44.4% of them the last duration of antipyretic were 8 hours.

Table (3): Comparison Between Study and Control Groups Regarding their Axillary
Body temperature (Baseline – After warm water foot bath therapy ) (n = 100).

Study group Control group

Body temperature No. % No. % X2 P-value
Baseline temperature
Lower fever 6 12.0 10 20.0 4.899 .086
Moderate fever 29 58.0 18 36.0 NS
High fever 15 30.0 22 44.0
After warm water foot bath therapy application
Normal body 37 74.0 20 40.0
temperature 12.576 .006**
Lower fever 9 18.0 20 40.0
Moderate fever 4 8.0 8 16.0
High fever 0 .0 2 4.0
NS means no statistical significance **Highly statistically significant
differences
Table (3): More than half (58%) of the study group versus more than one third (36%)
of the control group had a moderate fever in baseline while near to three quarters (74%)
of the study group versus more than one-third of the control group their body
temperature return to normal levels after warm water bath therapy with high statistical
significance difference in which P-value 0.006.

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 Table (4): Mean Body Temperature of the Study and Control Group (In the baseline
body Temperature and After warm water Foot Bath Therapy Application) (n = 100)

Items Study Control t P-value

group group
Baseline 38.7 ± .417 38.6 ± .587 .530 .597 NS
temperature
After warm water 37.4 ± .496 37.8 ± .554 4.105 .0001**
application
NS means no statistical significance **Highly statistically significant
differences

39.0
38.7 Study group

38.6 Control group

38.5

38.0 37.8

37.5 37.4

37.0

36.5
Baseline After Application

Figure (1): Mean scores of the body temperature in the study and control groups (in
the baseline and after warm water foot bath therapy application) (n = 100).

Table (4) & Figure (1): illustrates that, mean body temperature among the study
group in the baseline was 38.7 ± .417 versus 38.6 ± .587 among the control group
decreased to 37.4 ± .496 versus 37.8 ± .554 after application respectively, with
statistical significance at P-value < .0001**

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 Table (5): Correlation Between Children Age and their Body Temperature at Baseline
and after Warm Water Foot Bath Therapy Application among Study and Control
Groups.

Children age
Items Study Control
Antipyretic r -.164- -.084-
P- value .255 .562
Baseline temperature r -.097- .019
P- value .502 -.329-*
Temperature after warm R -.077- -.094-
application P- value .597 .516
*correlation significance at < .05

Table (5): shows that there was no association between children's age and their
baseline and after warm water foot bath therapy application among study and control
groups.
Table (6): Correlation between Children Diagnosis and Their Body Temperature at
Baseline and After Warm Water Foot Bath Therapy Application among Study and
Control Groups.
Study group Control group
Items Respiratory Gastroenteritis Respiratory Gastroenteritis
disease disease
No. % No. % No. % No. %
Baseline temperature
Lower fever 3 8.8 3 18.8 4 14.8 6 26.1
Moderate fever 20 58.8 9 56.3 8 29.6 10 43.5
High fever 11 32.4 4 25.0 15 55.6 7 30.4
2
X (P- value) 1.102 (.576) NS 3.232 (.199) NS
After warm water foot bath therapy application
Normal body 24 70.6 13 81.3 6 22.2 14 60.9
temperature
Lower fever 7 20.6 2 12.5 17 63.0 3 13.0
Moderate fever 3 8.8 1 6.3 4 14.8 4 17.4
High fever 0 .0 0 .0 0 .0 2 8.7
2
X (P- value) .653 (.722) NS 14.775 (.002)**
NS means no statistical significance **Highly statistically significant
differences

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 Table (6): presents that 22.2% of children had respiratory disease compared to 60.9%
of children who had gastroenteritis their body temperature decreased to normal level
after application of plain water compresses on the forehead, the axilla, and the groin
area for 15 minutes in the control group with statistically significant differences which
P-value < .002.

Discussion

Warm water foot bath treatment allows the blood vessels to dilate and
increase the circulation of blood, releasing heat as sweat and supplying oxygen for
brain cells to help eliminate toxins. Immersion in a bath of water promotes circulation,
increases tissue nourishment, and loosens stress (Mandal, Datta, Ahmed, and De,
2014).

Regarding the biodemographic characteristics of the study and control group

Table (1), the current study showed that more than half of the study and control groups
aged between 5- 7 years, with mean ±SD 5.6 ± 1.9 and 5.7 ± 1.8 respectively, less than
three quarter versus less than two-thirds of them was girls and more than two-third vs
more than half of them their diagnosis was upper respiratory disorders respectively
with no statistically significant differences.

This comes in line with Mandal, Datta, Ahmed, and De, (2014) who studied
''effectiveness of warm water foot-bath therapy on physiological parameters of
children with a fever at a selected hospital, Kolkata, West Bengal'' and reported that
the majority of the studied children belong to 6–8 years of age, and less than half
children belong to 9– 11 years.

But this result comes inconsistent with Ezzat and Abdelhameed, (2020) who
studied ''Educational Protocol for Improving Mothers Practices on the Types of Fever
in Zagazig City'' and reported that more than half of the studied children their age less
than one year and more than three-quarter of them were male.

Regarding using antipyretic medications, the present study showed that most of
the study and control groups administered antipyretic drugs when their children had

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 an elevation of body temperature and the last duration of antipyretic use was 8 hours
in less than half of them.

This result comes in the line with Herman and Nurshal, (2017) in their study
about ''The effect of health education to parent’s behaviors on managing fever in
children'' in Pariaman’s General Hospital, West Sumatera, Indonesia reported that
most parents give paracetamol when the child's body temperature above 37.8 °C and
the majority of parents agree that antipyretic is the primary treatment of fever in
children.

Also, Nisha, (2018) carried out a study to evaluate the effectiveness of warm
water foot therapy on adults with fever admitted in Raghav Hospital, Appakudal, erode
district'' and reported that all of the experimental and control group take antipyretic
drugs.

Regarding the body temperature of the studied children, the current study
revealed that slightly less than three-quarters of the study group their body temperature
returned to normal level versus less than half of the control group and more than one-
quarter of the study group still their body temperature high versus less than two-thirds
of the control group with statically significance differences with P-value < .001. This
result supports the first hypothesis

This result was confirmed by Eldo, (2015) who studied ''a study to evaluate the
effectiveness of warm water foot bath therapy on reducing the level of temperature
among children with hyperthermia in masonic hospital at Coimbatore'' and reported
that the majority of the experimental group their body temperature had moderate
pyrexia versus less than three-quarters of the control group in baseline decreased to
less than two-thirds of the study group return to normal body temperature versus none
of the control group.

In addition (Selvakumari, 2011) who studied ''Hot water foot bath therapy for a
patient with fever'' and revealed that less than three-quarters of the studied sample
believed therapy was effective to a ‘great extent’, one-quarter of them believed it was

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 effective to ‘some extent’ and the minority of the study sample thought that the
treatment was ‘not at all’ effective.

Also, the current study illustrated that more than half of the study group versus
more than one-third of the control group had moderate hyperthermia in baseline and
less than three-quarter of the study group versus less than half of the control group
their temperature returned to normal level post-application of warm water foot bath
with statistically significant differences at P-value .006. This result rejects the null
hypothesis of the current study.

More than half of the study group versus more than one-third of the control
group had a moderate fever in baseline while near to three-quarters of the study group
versus more than one-third of the control group their body temperature return to
normal levels after warm water bath therapy with high statistical significance
difference in which P-value 0.006.

This result comes in accordance with Mandal et al., (2014) who stated that in
the experimental group, the majority of children having an axillary temperature
between 99.7–1000 F, 26.70% of children having an axillary temperature between 99.4
and 99.70 F, and one-fifth of children having an axillary temperature between 99 and
99.30 F. Similarly, in the control group, majority of children having an axillary
temperature between 99.7 and 1000 F, 20% of children having an axillary temperature
between 99.4 and 99.70 F and one-third of children having an axillary temperature
between 99 and 99.30 F.

Also, this result was supported by Pereira and Sebastian, (2018) who studied
''Effectiveness of hot water foot bath therapy in reduction of temperature among
children (6-12 years) with fever in selected hospitals at Mangaluru'' reported that the
median value of pre-test (100.20F) was found greater than the median of post-test
(98.90F) among children (6-12 years).

Warm foot application allows the blood congested to flow to distant areas of the
body and the leg and foot dilated arteries. In 15-20 minutes, as hot water foot bath
therapy is carried out, vessels on the feet tend to widen and to boost drainage, to

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 neutralize acid and kill bacteria, to relieve wear and tear and fever. The increased blood
supply returns the hypothalamic heat transfer points to a lower heat surface.

In regarding the mean body temperature of the study and control groups in
baseline and after application of warm water application, Figure (1), the current study
showed that the mean body temperature among the study group before the application
was 38.7 ± .417 versus 38.6 ± .587 among the control group decreased to 37.4 ± .496
versus 37.8 ± .554 after application respectively, with statistically significance which
P-value < .0001. This result reflects the effectiveness of the warm water foot therapy
in managing feverish children.

This result comes in the line with Pereira and Sebastian, (2018) who reported
that there was a very high statistically significant difference between the pretest and
posttest reduction in body temperature in the experimental and control groups, and also
this comes in congruence with Sunar, (2017) who studied ''An experimental study to
assess the effect of hot water foot bath in patients with fever'' in selected hospitals of
PCMC area, Pune and reported that the mean effect of hot water foot bath on fever at
pre-intervention was 101.04 ± 0.04 F whereas at post-intervention it was 99.37±0.58
F in the experimental group.

This result was confirmed by Eldo, (2015) who reported that the mean pre-test
score of temperature level was 101.81 F with a standard deviation of 1.112 was more
than the mean post-test score of 98.90 F with a standard deviation of 0.579. The
calculated mean difference was 2.91 and the obtained’ value of 17.9 was highly
significant at P < 0.05 level.

Also, Selvakumari, (2011) reported that the mean pretest score of temperature
is 101.06 ± 0.920 and the mean post-test score of temperature is 98.85 ± 0.615, and
the mean difference in the temperature is 2.21.

As related to the association between children's age and their body temperature
in the baseline of the study and control group, the present study showed that there was
no association between children's age and their body temperature before application
of warm water among the control group. This result comes in to agree with Eldo,

[SYLWAN., 165(2)]. ISI Indexed,Feb 2021 205

 (2015) who reported that there were no statistically significant differences between
child age among the experimental group with their levels of temperature.

Conclusion

Based on the findings of the current study the following conclusion can be
drawn: Applying warm water foot bath therapy in children with fever is effective in
reducing body temperature among children in the study group than those using plain
water compresses with statistically significant differences.

Recommendations
1. Provide the hospital with written protocol on methods of warm water foot bath
therapy to be applied in the hospitals.
2. On job training program should be provided for all nurses working in different
clinics regarding applying warm water foot bath therapy for hyperthermia
children
3. Developing health education program to teach the mothers to apply warm
water foot bath therapy in home to reduce fever.

4. Reapplication of the study on children with different age groups with fever

5. Further studies are recommended to examine the long-term effect of applying

warm water foot bath therapy on body temperature among children with fever.

Acknowledgment
Praise be to Allah, the Merciful, the Compassionate, for all the innumerable
gifts that we have got. One of these gifts is the accomplishment of this research work .
We want to thank the manager of the general hospital in Misr El-Hora, the outpatient
nurses, and all our children who have helped us to conduct this study, and thank you
to all, in particular, Professor Soheir Abd-Rabou Mohamed Professor of Pediatric
Nursing, Faculty of Nursing, University of Cairo, who assisted us directly or indirectly
in carrying out this work

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