Baby with low core body temp

[grace202004]

As an RN primarily dealing with adult patients I feel like I am a little out of my league here and any advice from you pedi nurses would be much appreciated..

my daughter (7 months) was running high temps up to 105.1 for several days, within this time we had been to ER twice, told once it was a virus (go home, push fluids, tylenol,motrin etc) On the second visit they found the kidney infection and gave rocephin 400mg IM, to follow up in clinic the next day and started Oral keflex) That night temps dropped to 93.0 rectal. It is NOT cold in my home, she was dressed appropriately etc. Used several warm blankets to warm her up while on the phone with ER doc, who stated just to warm her up "I think shes just cold" WELL DUH! Stated I could bring her out for eval but as long as she was acting okay (which she was, woke up fine and was smiling, being herself) just warm her with blankets and watch her. Several warm blankets, two sleepers, a hat, in bed under down comforter with husband and I and her temp rose to 96.9 where it hovered for much of the night until morning came on and she actually began to spike from the sheer amount of blankets this time. Temps normal t/o day. Seen in the clinic that day, dr states low temp is probably a fluke thing, as blood cultures from 2nd ER visit the day before had been negative, and gave another dose of IM rocephin. Call if fevers spike again. That night same thing happens, Rectal temp drops to 95.4 as i felt i caught it sooner this time, immediately began warming her as before and again only got it up to 97.0 or so, called clinic immediately next morning and was finally admitted to hospital by a different doc. stayed for three days for IV rocephin and was d/c home today. Temps at hospital dropped to lows of around 96's ® during night or naps only. Dr felt that the temp fluctuations were getting better and not quite as low as before, and has her on oral keflex with a slightly higher dose. She is acting pretty normal except for excessive sleepyness, she is taking several naps t/o the day which i suppose could still be r/t the kidney infection, but tonight she is still dropping to around 96.7 during sleeep. My question is have any of you seen this before, and if it could possibly indicate something more serious, what tests should I ask for. Her thyroid was checked at birth and found to be normal, no cardiac abnormalities that we know of, she isnt losing weight and is developing appropriately according to her age.

[grace202004]

Also I am not asking for medical advice, just wondering if you have seen this and what the root cause was in that situation. There is very little information available for a LOW core temp, and I am really worried, racking my brain to figure this out.

Thanks in advance

[NotReady4PrimeTime, RN]

It's very common for babies to drop their temps when they sleep, even to 36C or about 96.8F. Their immature nervous systems have difficulty with temperature regulation and they tend not to have a lot of insulation (> convective heat loss). They have faster heart rates (> radiation) and faster resps (> evaporative heat loss) than older kids and adults. That's why oftentimes, exposing their skin to the environment is often enough to bring down a mild fever.

It's also very common for babies to drop their temps when they have infections. It's a mechanism to improve cardiac output: the heart rate drops slightly as the surface blood vessels constrict and the blood pressure rises. We use therapeutic hypothermia in our cardiac babies, dropping their temps to 34C (93.2F) to decrease the workload on their hearts. We rarely want them to be cooler than that (post-cardiac arrest we aim for 32C or 89.6F to decrease brain metabolic demand) because of the risk of bradycardia.

Does this help?

[grace202004]

Thank you so much Jan, Yes that does help a lot!!

[janebmm2]

Hi there! I came upon this page while searching for reasons of body temperature drop in babies and I am thankful to know I'm not the only mother puzzled by such temperature variation.

I have a 9months old baby whose body temperature started dropping as low as 34.6degC since last night. My hubby just took her to the hospital now after I checked on our babysitter who took my girl's temp with a reading of 34.7degC and has merely increased to 35.2 after she wrapped her with thick blanket. Last night, we kept her warm by dressing her up and putting on blankets with the heater turned on in our room. She had heaten up to 36degC but was mostly down at 35.5~35.7degC. This morning though, before having her breakfast, her body temp measured 37.2degC. We are using a thermoscan. Last night, the lady in the pharmacy told my husband to take her temp rectally which we did and we got a temp reading of 35.7degC. She also had rashes in her forehead, back and stomach area. It appears like the usual heat rash but was alarming since it wasn't that hot yesterday and she didn't sweat that much. She is currently taking meds for AGE and Tonsilitis treatment. On Friday night, she had a high fever up to 39.5degC and with the doctor's consent, I administered a supository (Voren) to bring her temp down. It was the first time I used Voren on her (1/2 tab). For the rest of the night (Fri-Sat morning), her body cooled down to below 35degC but eventually normalized until yesterday afternoon. Reading from the internet, it appears that low body temperature, just like fever, entails some kind of infection. It bothered me to see that it can also be caused by heart murmur or thyroid abnormality so we decided to bring her to the doctor.

I will update you later about how the check up was. This should help moms like us know how to deal when things like this happen to our kids.

Cheers and more power to all moms out there :)

[janebmm2]

Here's an update:

My baby has a "ROSEOLA INFANTUM" - see link for more information http://emedicine.medscape.com/article/803804-overview

Eventually, the supository I gave her triggered her body temp to decrease, though defervescence follows fever in roseola. The doctor adviced us not to use supository (VOREN) in fevers for our kids anymore not until all other options don't work.

Roseola is infectious through fluids from the nose and mouth thus we have to watch and keep our 3 year old daughter farther than usual from her baby sister.

BTW, the tonsilitis and AGE diagnosed are somewhat misdiagnosed though I can't blame the clinic doctor for that as they are the obvious signs. Roseola comes with throat inflammation (lymph nodes) and diarrhea, cough as well (which my baby starts to manifest this morning).

I hope this information helps.

[NotReady4PrimeTime, RN]

I would agree that using diclofenac for a viral fever isn't a wise choice. That's a big gun when a peashooter should work. Fever by itself in any child can be an effective treatment for viral illness (in the absence of febrile seizure) because viruses don't like their host to be too warm. I tend not to be overly aggressive in treating fever unless the child is in obvious discomfort, and then I choose acetaminophen (paracetamol) or ibuprofen. Diclofenac is only available by prescription in Canada and I've never used it for a child. (Used it for ME post-op and thought it was the absolute BEST...)

Roseola used to be far more common than it is now. All of my children had it when they were small; they recovered with comfort care.

[Redhead28]

I have seen low core body temps in children that are on the verge of sepsis. These have been children already in hospital with dx of infection.

[traumaRUs, MSN, APRN]

Since this thread is quite a few months old and we can't provide medical advice,will close.

[MishaCase]

My infant has a normal temp of 97.6° f with the armpit reading. I was told that the inside is a degree higher. I also know that a reading like that in that spot is a degree lower than most babies. Should i be worried that my infant spikes to 100.1°-100.4° with in minutes hours after getting his vaccines? The temperature comes down after i administer baby Tylenol, but only to about 99.1°-99.6°.

[Esme12, ASN, BSN, RN]

Call you pediatrician. We cannot give medical advice.