Temperature measurement in pediatrics

Temperature measurement in pediatrics

• • • • Ask the Question
        • PICOT Question: In infants and children, what is the most accurate method for measuring temperature in febrile children?
      • Search for the Evidence
        • Search Strategies
          • Clinical research studies related to this issue were identified by searching for English publications within the past 15 years for infant and child populations; comparisons with gold standard: rectal thermometry.
        • Databases Used
          • PubMed, Cochrane Collaboration, MD Consult, Joanna Briggs Institute, National Guideline Clearinghouse (AHRQ), TRIP Database Plus, PedsCCM, BestBETs
      • Critical Appraisal of the Evidence
        • Rectal temperature: 
          • Rectal measurement remains the clinical gold standard for the precise diagnosis of fever in infants and children compared with other methods.
          • However, this procedure is more invasive and is contraindicated for infants younger than 1 month of age due to risk for rectal perforation
          • Children with recent rectal surgery, diarrhea, or anorectal lesions, or who are receiving chemotherapy (cancer treatment usually affects the mucosa and causes neutropenia) should not undergo rectal thermometry.
        • Oral temperature (OT): 
          • OT indicates rapid changes in core body temperature, but accuracy may be an issue compared with the rectal site.
          • OTs are considered the standard for temperature measurement, but they are contraindicated in children who have an altered level of consciousness, are receiving oxygen, are mouth breathing, are experiencing mucositis, had recent oral surgery or trauma, or are younger than 5 years of age
          • Limitations of OTs include the effects of ambient room temperature and recent oral intake
        • Axillary temperature: 
          • This is inconsistent and insensitive in infants and children older than 1 month of age
          • A systematic review of 20 studies concluded that axillary thermometers showed variation in findings and are not a good method for accurate temperature assessment 
          • In neonates with fever, the axillary temperature should not be used interchangeably with rectal measurement. 
          • It can be used as a screening tool for fever in young infants
        • Ear (aural) temperature: 
          • This is not a precise measurement of body temperature. A meta-analysis of 101 studies comparing tympanic membrane temperatures with rectal temperatures in children concluded that the tympanic method demonstrated a wide range of variability, limiting its application in a pediatric setting
          • Other published reviews continue to find poor sensitivity using infrared ear thermometry.
          • Diagnosis of fever without a focus should not be made based on tympanic thermometry, because it is not an accurate measure of core temperature
        • Temporal artery temperature (TAT): 
          • TAT is not predictable for fever in young children but can be used as a screening tool for detecting fever less than 38° C (100.4° F) in children 3 months to 4 years of age