Frequently asked questions about measuring temperature in children
[mme_highlight] The cut-off value to be considered a fever depends on how and where the temperature is measured (rectal, oral, armpit, ear or forehead temperature). Rectal temperature is the most accurate. In 4 year old and older children mouth temperatures are also reliable. [/mme_highlight]
Fever is a raise in body’s temperature above a certain temperature that translates a normal response of the body to numerous situations – an infection is the most frequent. The cut-off value to be considered a fever depends on how and where the temperature is measured (rectal, oral, armpit, ear or forehead temperature). Fever is still a matter of concern for most parents as there are many misconceptions, including on the correct way to measure fever in children and on how should measurements be interpreted.
Do parents know how to measure fever?
Regarding fever, as with other health matters, sociodemographic data counts. A study conducted in Harvard with a multiethnic and socially diverse sample of parents, concluded that parents who had not graduated from high school had 5 times the odds of not using a thermometer to check for fever and 3 times the odds of not asking a health care provider for advice.
A study was conducted to compare the accuracy parents’ and nurses’ measurement of fever in children, either using the same home thermometer, either when parents used a home thermometer and nurses used one from the hospital. Results are presents below.
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| Accuracy of parents in measuring body temperature with a tympanic thermometer(Study Design: Parents and then nurses measured the temperature of 60 children with a tympanic thermometer)
Mean difference when both parents and nurses used a tympanic thermometer designed for home use: – 0.44 ± 0.61 °C – 33% of the readings differed by ≥ 0.5 °C
Mean difference when parents use a home thermometer and nurses use a hospital one: – 0.51 ± 0.63 °C – 72 % of the readings differed by ≥ 0.5 °C. Using the home thermometer |
OR – Odds Ratio; CI – Confidence Interval
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A glass or a digital thermometer…which one to choose?
Nowadays, digital thermometers are an inexpensive widely available device and, in addition, they are recognized as the most accurate way to evaluate the body’s temperature. Glass thermometers continue to be used among many families, but parents should be aware that they’re not recommended because they contain mercury and, if broken, there can be a dangerous exposition to this toxic metal. If a digital thermometer is not at your disposal and you have to use a mercury one, shake it down carefully before using it.
What is the most accurate way to take my child’s fever?
Rectal temperature is the most accurate. In 4 year old and older children mouth temperatures are also reliable. Remember that armpit, ear temperatures are not as accurate as rectal or mouth temperatures. In addition, the forehead temperature is not accurate to evaluate a child’s temperature, because it depends on the temperature of the person who is touching the child’s skin. A survey was conducted to understand how parents recognize their children fever and where they measure it.
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| Parent’s methods to evaluate their child’ fever(Study Design: survey among 402 parents whose children were enrolled and presented for health care at a primary health care clinics)
Fever recognition: – Touching child: 65.4% – Measure Temperature: 31.6% – Touching child and measuring temperature: 3%
Site used to take temperature: – Mouth: 50.2% – Anus: 25.9% – Armpit: 21.1% – Other: 2.7%
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OR – Odds Ratio; CI – Confidence Interval
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Correct way of taking a rectal temperature
Prepare the thermometer putting a little bit of petroleum jelly (Vaseline) in its silver end. Then put your child lying down across your lap and introduce carefully the silver end of the thermometer inside your child’s anus. Wait holding it in place – note that a glass thermometer will take about two minutes and digital one less than a minute.
Correct way of taking an ear temperature
To measure ear temperature, often referred to as tympanic temperature, you have to use a thermometer specially designed for the ear pavilion – non-contact tympanic thermometer. Gently pull back your child’s ear and then insert the thermometer, holding the probe for about two seconds.
Correct way of taking a mouth temperature
If your child has drunk or eaten something hot or cold, you should wait 30 minutes or more before taking a mouth temperature, otherwise, results would not be reliable. In addition, do not forget to wash the thermometer with cool water and soap.
To take your child’s mouth temperature, put the thermometer under the child’s tongue and ask her/him to hold it with her/his lips, and not use the teeth. Wait about 3 minutes with a glass thermometer and less than a minute in the case of a digital one.
Correct way of taking an armpit temperature
To take an armpit temperature, place the extremity of the thermometer in the children’s armpit after checking first if it’s dry. Tell your child or hold yourself her/his arm against the chest for about 5 minutes.
What are the values considered fever?
- Rectal temperature: > 38ºC (100.4ºF)
- Mouth temperature: > 37.8ºC (100ºF)
- Armpit temperature: > 2ºC (99ºF)
- Ear temperature: >38ºC (100.4ºF)
Summary and Recommendations
- The cut-off for a temperature measurement to be considered fever depends on how it is done and where in the body it is taken.
- Knowing how to take your child’s temperature adequately is important to obtain an accurate measurement.
- Digital thermometers should be preferred over the glass ones, which have a risk for toxic exposure to mercury if they are broken.
- Rectal temperature is the most accurate measurement, although mouth temperature is also accurate in children older than 4 years of age. Touching the forehead is not reliable to assess fever.
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References
- Taveras EM,Durousseau S, Flores G. Parents’ beliefs and practices regarding childhood fever: a study of a multiethnic and socioeconomically diverse sample. Pediatr Emerg Care. 2004 Sep;20(9):579-87.
- Zyoud SH,Al-Jabi SW, Sweileh WM. Beliefs and practices regarding childhood fever among parents: a cross-sectional study from Palestine. BMC Pediatr. 2013 Apr 28; 13:66.
- Robinson JL,Jou H, Spady DW.Accuracy of parents in measuring body temperature with a tympanic thermometer. BMC Fam Pract. 2005 Jan 11;6(1):3.
- Schmitt BD. Feverphobia: misconceptions of parents about fevers. Am J Dis Child. 1980 Feb;134(2):176-81.
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