Do you take vitals on babies who are sleeping?

Jory, MSN, APRN, CNM · Oct 5, 2012

This...depends on which department you work in.

I used to work in a facility where every baby was on a monitor, unless it was well-baby nursery.

When the babies were on a monitor, we DID NOT wake them up for vitals...they were already on a monitor, so we just wrote them down off the monitor. We did our listening and temperatures during times when the baby was awake. It always translated to "roughly" Q4 vitals. So the baby was assessed very often. You cannot get obsessive about, "Oh, it's 2:00 a.m., time for vitals!!!" No, we did it around the baby's schedule.

Now, with well-baby nursery, where they are not on vitals...they are also, being fed every 2 to 3 hours. We had the parents to call us when the baby was awake around the time that vitals were to be taken.

This is called "consolidation of care". It is to NO BENEFIT to keep waking a sick or sleeping infant just because you didn't get there when the baby is awake. Most units have smaller assignments in peds, well-baby and the NICU, so it is VERY possible to work around the baby's schedule.

imaginations · Oct 17, 2012

Absolutely you take vital signs on a sleeping patient.

Sometimes a sleeping patient can be a sign of deterioration. My last six months have been spent in paediatric neurology/neurosurgery and it's absolutely critical to wake these children for the hourly, second hourly or fourth hourly vital signs and neuro obs.

~PedsRN~, BSN, RN · Oct 17, 2012

We take vitals as they are ordered - Q2 (Gah, hope not), Q4, or Q8. I will say that I think we over monitor sometimes, however. A kid that is in the hospital as a feeder/grower... do we really need to be shoving a thermometer up their bum every 4 hours? :)

But to answer the question, they are done as they are ordered. A parent can (and they do!) refuse anything - and they often do. We are based around "family centered care", which sometimes I also think we take too far (but that's a different thread, perhaps. LOL). If a patient refuses, we chart it. :)

rn/writer, RN · Oct 18, 2012

We take vitals as they are ordered - Q2 (Gah, hope not), Q4, or Q8. I will say that I think we over monitor sometimes, however. A kid that is in the hospital as a feeder/grower... do we really need to be shoving a thermometer up their bum every 4 hours? :)
But to answer the question, they are done as they are ordered. A parent can (and they do!) refuse anything - and they often do. We are based around "family centered care", which sometimes I also think we take too far (but that's a different thread, perhaps. LOL). If a patient refuses, we chart it. :)

We take axillary temps on newborns. We might take a rectal temp if the axillary temp is really low after several tries, but this happens so rarely that I can't remember the last time I took one.

Rectal temps carry a only a small risk when done by a professional, but many docs do not want parents attempting this at home. To that end (pun intended), they'd rather not have parents even see a rectal temp being taken.

Of course, this could be different with a critically ill child in a PICU. But even it our NICU, I have never seen a rectal temp being taken.

Pediatric Critical Care Columnist · Oct 18, 2012

Of course, this could be different with a critically ill child in a PICU. But even it our NICU, I have never seen a rectal temp being taken.

In our PICU if we're that concerned about a kid's temp that we're doing rectal temps, we'll put in either a rectal or esophageal probe to monitor it continuously. The probes are not much different from an NG - soft and flexible - so they're an obvious choice for us. Obvious contraindications for rectal temps in any child would be things like lower GI and ano-rectal (for imperforate orifice, for example) surgery, perineal burns and thrombocytopenia. Axillary temps can be difficult to obtain accurately if the kiddie is very scrawny (no flesh to press together!) but I've sometimes used the inguinal fold instead on those ones. I don't recommend tympanic temps on any child because the thermometer must be positioned JUST SO to accurately bounce off the eardrum and that's usually impossible in a conscious child.

rn/writer, RN · Oct 19, 2012

Thanks for the explanation, Jan. I thought as much. A continuous soft probe would be much less hazardous and traumatic than a rigid thermometer. Sad to think of little ones so scrawny you can't do axillary temps, although I do see this sometimes in 36-weekers. I'll keep that inguinal option in mind.

KelRN215, BSN, RN · Oct 20, 2012

I agree about the rectal temps... I've only done rectal temps a handful of times in 5 years as a pediatric nurse. In the oncology population, it was against policy to do rectal temps on them. Occasionally, if you got a temp of 34 degrees Celcius axillary on a patient who wasn't known to be baseline low (I saw many patients with severe brain injuries from birth whose baseline temps were in the 34-35 degree range), then you'd do a rectal temp. I vaguely remember one patient who was going to need to have an LP if he spiked again and had a temp of 39.2 axillary using the disposable thermometer when the CNA checked him. When I rechecked it, he was 38 something but lower than 38.5. 38.5 was the cutoff to take action and it was a significant discrepancy between the 2 thermometers so we did a rectal temp. He ended up getting the LP.

I also agree about the tympanics. When I worked in neurosurgery, I spent years trying to get people to stop taking tympanic temps on post-op cranis. You could seriously get a tympanic temp of 39.2 reported by the CNA and go recheck the kid and find that his oral temp is a perfect 37. You could also have a temp of 39 in one ear and a temp of 34 in the other. I just don't trust those thermometers.

~PedsRN~, BSN, RN · Oct 23, 2012

It is our policy that all children under the age of one have rectal temps. We are a large children's hospital, and our floor is one of high acuity. I often use "nursing judgement".

allnurses Guide · Oct 23, 2012

This is really interesting to me because I haven't worked inpatient in a long time, but I worked at a large children's hospital, too. We took axillary temps on just about everyone, which took for-ev-er. Soft rectal probes as Jan mentioned are probably more accurate, and certainly safer. I feel sort of like an old codger, "what'll they think of next, paw?" :)

yuzzamatuzz · Nov 6, 2012

This is called "consolidation of care". It is to NO BENEFIT to keep waking a sick or sleeping infant just because you didn't get there when the baby is awake. Most units have smaller assignments in peds, well-baby and the NICU, so it is VERY possible to work around the baby's schedule.

I agree that ideally we wouldn't wake sleeping babies, but I disagree that it is very possible to work around the baby's schedule. I work with mostly patients who are less than 1 year old. I have 5 patients on most nights and the nursing assistants usually have around 12-15 patients each. Because I work with mostly babies, vital signs also includes a diaper change and sometimes a daily weight. We also always have some parents who do not stay overnight so there are babies who need to be fed. It would be impossible for the nursing assistants on my floor to accommodate 10-15 infants and their sleeping/eating schedules. Also, babies can look great one minute and go down hill really quickly the next. For this reason, vital signs are very important. Some parents will refuse a set of vitals or a blood pressure in the middle of the night. However, depending on how stable the child is, we may not allow them to refuse. Usually parents understand the importance of vital signs and will agree to middle-of-the-night vitals when explained the rationale.

PedRN86, BSN · Nov 10, 2012

I work on a neurosurgery floor so I do have to take their VS and neuro vitals if they're asleep. No, it's not nice to wake a sleeping baby, and I do try to work around their schedule (especially if they only have q6-8 vitals), but if they're hourly or even every 4 hours I only have so much time to play with.

I let the family know the med and VS schedule at the beginning of the shift and encourage the family to let me know if the baby wakes up so I can cluster their care whenever possible.

RacheLeah · May 13, 2013

I'm sure you figured out a solution by now, however I wanted to tell you what I have always done for 5-6 years while all children are sleeping. If they don't already have their bp cuff, etc attached, I very quietly and slowly place it on their calf, lay the leg down, place the pulse ox on a toe very gently. If they start to stir, I immediately quit touching and drop to the floor so they don't see me! :) Then in a few minutes when they are still again I press start on nibp. It becomes like second nature to operate in stealth mode when you are a pediatric night nurse...it will come to you, I'm sure it has already!