Temperature Reading

Dear Lisa,

This time of year it seems our family and especially our kids come downwith colds and flu bugs along with fever frequently. My husband and I usually take their temperatures (Or Try) but so often they mouth breathe and cough, which cause slow readings. We just bought an ear thermometer and I hate it! We have three boys ages 6-14 and all of them seem unable most of the time for an oral reading, even with a digital type. Usually I do an underarm temp with my 10 and 14 yr. old, when they can't take it orally.

I have in the past taken their temps rectally when their Oral reading was low. Which they aren't thrilled about but do cooperate. My 6 yr old hasn't mastered the oral temp yet, and underarm temps with him are poor. My Question is when I can't take a good enough oral reading is rectal ok, if they agree and cooperate, or is underarm good enough? Thanks.

“Can’t get a temperature reading”

Dear “Can’t get a temperature reading”,

One of the most difficult things to do is get a temperature on a child, so I can understand your concern. Children do tend to move a lot and many of them have difficulty keeping a thermometer in their mouth. Children over three years of age are old enough to understand the importance of cooperating for a temperature reading. Fortunately an exact rectal temperature reading is not essential in order to make a diagnosis of an illness in older children. Older children can better describe their symptoms and show other signs, besides a temperature, showing that there is a problem. Therefore an exact rectal temperature reading is not necessary on an older child with a mild illness such as a cold or a virus. An oral or axillary temperature is sufficient in a child over three years old unless your doctor tells you differently.

The story is much different for children 3 years old and younger. Young children many times cannot describe their symptoms or localize their pain. Therefore an accurate temperature reading is many times necessary in order to diagnose a problem. An exact temperature reading is essential in young infants, because a temperature in this age group can represent a serious condition. In young infants, a temperature sometimes is their only symptom and may represent an infection such as a urinary tract infection, meningitis or bacteremia.

In my practice, it is very rare that I ever took or required a rectal temperature reading on a child over 3 years old. The common childhood illnesses that occur in this age group typically can be diagnosed with other information such as a history or physical examination. There are some circumstances where a developmentally delayed child or a child with a medical condition such as mental retardation, autism, cerebral palsy or severe ADHD needs a rectal temperature. In these scenarios it may be impossible to determine a temperature using any other route.

In addition, there are some children who have medical conditions that require an exact temperature reading because an increase in temperature could represent a complication. These conditions include HIV, cancer, neutropenia and sickle cell anemia. Even in these cases many times an oral or axillary temperature is a sufficient screening device.

When taking your child’s temperature it is important to let your doctor know what route you use. The expected reading is different for each route taken. A normal oral temperature is expected to be 98.6 degrees Fahrenheit ( 37 degrees Celcius). If a temperature is taken rectally, it is expected to be one degree higher; therefore a normal rectal temperature is 99.6 degrees Fahrenheit ( 37.5 degrees Celcius). If a temperature is taken using the axillary route, it is expected to be one degree lower than the oral route; therefore a normal axillary temperature is expected to be 97.6 degrees (36.5 degrees Celcius). (1)

So as a parent, when determining whether your child has a temperature or not, you need to add one degree Fahrenheit to your reading when doing an axillary temperature. You can then compare this number to the normal oral temperature, 98.6 degrees Fahrenheit. If you do an axillary temperature and the reading is 98 degrees Fahrenheit, then your child’s temperature is considered to be 99 degrees, which is considered a normal temperature.

The other important thing to know is that a child’s temperature normally changes throughout the course of the day. This change in temperature does not mean that there is a problem. During a normal day, a child’s temperature can vary 1 to 1.5 degrees Fahrenheit.

There are a few factors that may cause this change in a child’s temperature. A child’s temperature may vary depending upon the amount of clothes they are wearing or due to the temperature of the environment. Sometimes after exercising or eating the body temperature can elevate temporarily. The lowest reading usually occurs early in the morning before rising and the highest temperature occurs between 5 to 7 pm in the early evening. (1)

The temperature may also change depending upon the amount of time that a thermometer is in place and the type of thermometer used. Therefore many times the temperature is not correct because the thermometer was not in place for the appropriate amount of time. Rectal temperatures can also be incorrect due to improper technique because of a child’s movement. (1)

Since you have normal healthy children with no medical issues, there is no reason to continue to take rectal temperatures at their ages unless your doctor instructs you to use this route. A rectal temperature is invasive, uncomfortable and invades an older child’s privacy. Attempts to ascertain a temperature should be done via an oral or axillary route. Therefore, you do not have to be concerned about getting a rectal temperature on your children.

A child 6 years old should have the capability to hold a thermometer in their mouth or under their arm. Children without medical issues should be expected to keep their mouth closed or their arm still in order to take a temperature. It may help to use a timer or count while taking the temperature in order to keep a child focused and cooperative. You can also exercise the option of having their temperature taken by the nurse at your doctor’s office during the visit. In some cases, children are much more cooperative for other people, besides their mother.

If your children are having an issue with this, I suggest purchasing an electronic thermometer that reads in 10 seconds. Even children with a stuffy nose or a cough should be able to hold their mouth closed for 10 seconds. You can purchase this type of thermometer at your local pharmacy or CVS pharmacy for approximately $10.00. This investment will save you a lot of time and worry; and your children undue discomfort.


References:
(1)Bellack J, Bamford P. Nursing Assessment, A Multidimensional Approach. 1984. Belmont California:283-286.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice For Parents