Rectal temps in peds

*PICURN* · Mar 7, 2005

Our policy is AXILLARY for all kids, however most of the time we have the skin temp probes that are connected to the monitor and give us a continuous temp for the kid. I have also seen rectal being done, but not often

prmenrs, RN · Mar 7, 2005

I believe most NICUs and NB services do axillary--it can be very dangerous to do rectals (there was a whole series of perforated bowels in one study). You might do one to see if the orifice is patent, but if there is meconium all over the place, it's patent, and I've still seen nurses get a rectal "because that's what the routine is".

I never took rectals on my son, and told the pediatrician I wasn't going to either. I think it's rude!!

Vicki_RN · Mar 10, 2005

In our ER our docs insist on us taking rectal temps on babies. I don't mind doing this if they aren't squirming all over the place, (makes me nervous) but I'm just curious how anyone else takes temps on peds.
I have called up to my peds floor to give report and asked about rectal temps and told that they don't do them up there. Anyone have any thoughts on the advantages, disadvantages of rectal temps?
Thanks, Pam :)

Interesting, that we have the same situation in our institution... the Peds unit does not do rectal and the ED does. However, the whole facility is currently looking to purchase the new temporal artery scanners. We just completed a trial and they appeared very accurate. As many have said, there are issues with the tympanics if they are not used correctly. However, the temporal artery scanners need to be used correctly as well, for instance, you can't scan an area of the forehead that has been bundled or facing down in bed. But I do think that there is less room for error with the temporal artery scanner than tympanic, due to it's ease of use and method of operation. Hope this helps!

ERNurse678 · Mar 10, 2005

We do rectal temps on all pt's under the age of 3. This is the most accurate way. And it does matter whether their temp is 101 or 106. As for our ER we have different protocols for tylenol and motrin depending on the fever.

Also, if a child has a temp of 106 and I am the triage nurse, they are going to the critical care area versus the intermediate area

nurse_wannabe · Mar 10, 2005

I'm glad this post came back up again...

I am due to have a baby boy in a few months. I do NOT want a rectal temp taken on him in the newborn nursery. The risks of a perforated bowel may not be very high, but if there is any risk at all, I don't want it to be performed on my baby when it is completely unneccessary.

Does anyone have any ideas on how to handle this request with the nurses? Do I have the right to request axillary or tympanic temp instead?

needsmore$ · Mar 10, 2005

Dear nursewannabe-

You have the right as the parent to refuse any care that is being given to your child ( unless it borders on abuse/neglect, etc due to it's omission). If you feel this strongly, then you need to make this own as part of your birth plan when you go to the hospital.

We also do rectal temps on peds that are sick but not immuno suppressed( not lacerations or minor injuries). I know some ped patients come in for a chief complaint of "crying". A well-lubricated thermometer can cause little ones to pass gas or stool-and sometimes relieve the problem!!

We did a study comparing tympanic vs rectal temps on peds-and found that there were ALOT of inconsistencies- whether due to nurse procedure, or child's ear anatomy I don't know; but tympanics seem to be less accurate. They are still used in peds' offices. I can't tell you how many times I felt like the ped nurse at the doc's office has taken my child's temp w/ tympanic-told me "she doesn't have a fever"- and not use any other assessment tools-like feeling her HOT FLUSHED skin, bright red cheeks, glassy-eye look.

Just a second note-

I get so annoyed at parents who bring their child to the ED w/ a complaint of fever and have not administered any tylenol/motrin. It seems that the parents need to "show me" that a fever is present. I feel that we as nurses need to change a few things-

When the child comes to you-and parents report a "fever" and you take an accurate temp and find it to be WNL- don't make the parents feel like they shouldn't have brought their child. Congratulate them on good care if they have been giving meds for fever. The child shouldn't have to suffer because the parent feels they need to "prove" that a fever exists. I find that this is happening mainly because of nurse attitudes that parents may encounter when they bring their child. I know I have felt this way--defensive- when I utilize my pediatrician office and am told "she doesn't have a fever-it's normal".

If parents are not giving meds because of this concern-then at triage or wherever the child is initially seen-a great opportunity exists to educate parents that they don't have to "prove" that their child has a fever by withholding meds- We don't make chest pain people "prove" their having pain-

Thanks for listening to my little vent-

Anne RN CEN

mommatrauma, RN · Mar 11, 2005

Dear nursewannabe-
You have the right as the parent to refuse any care that is being given to your child ( unless it borders on abuse/neglect, etc due to it's omission). If you feel this strongly, then you need to make this own as part of your birth plan when you go to the hospital.
We also do rectal temps on peds that are sick but not immuno suppressed( not lacerations or minor injuries). I know some ped patients come in for a chief complaint of "crying". A well-lubricated thermometer can cause little ones to pass gas or stool-and sometimes relieve the problem!!
We did a study comparing tympanic vs rectal temps on peds-and found that there were ALOT of inconsistencies- whether due to nurse procedure, or child's ear anatomy I don't know; but tympanics seem to be less accurate. They are still used in peds' offices. I can't tell you how many times I felt like the ped nurse at the doc's office has taken my child's temp w/ tympanic-told me "she doesn't have a fever"- and not use any other assessment tools-like feeling her HOT FLUSHED skin, bright red cheeks, glassy-eye look.
Just a second note-
I get so annoyed at parents who bring their child to the ED w/ a complaint of fever and have not administered any tylenol/motrin. It seems that the parents need to "show me" that a fever is present. I feel that we as nurses need to change a few things-
When the child comes to you-and parents report a "fever" and you take an accurate temp and find it to be WNL- don't make the parents feel like they shouldn't have brought their child. Congratulate them on good care if they have been giving meds for fever. The child shouldn't have to suffer because the parent feels they need to "prove" that a fever exists. I find that this is happening mainly because of nurse attitudes that parents may encounter when they bring their child. I know I have felt this way--defensive- when I utilize my pediatrician office and am told "she doesn't have a fever-it's normal".
If parents are not giving meds because of this concern-then at triage or wherever the child is initially seen-a great opportunity exists to educate parents that they don't have to "prove" that their child has a fever by withholding meds- We don't make chest pain people "prove" their having pain-
Thanks for listening to my little vent-
Anne RN CEN

I absolutely agree with you Anne, and you are so right...we are not only there to take care of their children, we are there to educate them as well....and sometimes, all they need is a little education...when babies are born, they certainly don't come with instructions..and I know in my area our "motherhood" population is getting increasingly younger, 12 and 13 year old mothers....they are just babies themselves and need all the help they can get...especially since when you think about it...at 30 I could potentially be a grandmother...there is no life experience now like their used to be....

rjflyn, ASN, RN · Mar 12, 2005

Well my input is being primarly an ED nurse but just did a year in PICU we never did rectals in the unit. In the ER though we always did them. The major reason against them was that most of the patients in the unit were high risk for infection anyway and it was just to risky to do a rectal. That and when using a proper digital thermometer set to axillary mode its highly accurate at trending . That and it doenst matter if the temp is 101.5 or 104 the treatment is the same. Also we look at the pateint,if they are hot to the touch, flush and dry or sweaty and the theremometer read 98.6 or something totally unbelievable we got a different instrument and rechecked it. Besides that most the orders written re fever and tx or need to repeat labs were triggered at 101.5F. That and kiddos with a fever are getting fussy, whiney or grumpy anyway and get tylenol irregaurdless what the temp is.

rj

camay1221_RN · Mar 12, 2005

In my experience the axillary temp(esp on really little ones) is the most traumatic..they hate having any part of their body held in place for any amt of time. With the rectal, they usually just looked at me and by the time they thought to cry it was over. Of course, there is a rsik so nurses techs etc should really know how far to put that probe in.

The pediatricians I used to work for always wanted a rectal temp on infants under the age of six months. Many times they would have us, the RN's, show the parents the appropriate way to do a rectal temp and if they still weren't comfortable, they wanted the axillary. I don't like or trust the tympanic thermometers.

What I think is a hoot, is the parent of a ten year old who still takes her kids temp axillary! Good grief!

Rollins · Mar 12, 2005

we perform rectal temps on everyone 2 years and under.axillary and tympanics just are not accurate enough.

saltwaterstat · Mar 19, 2005

In our ER our docs insist on us taking rectal temps on babies. I don't mind doing this if they aren't squirming all over the place, (makes me nervous) but I'm just curious how anyone else takes temps on peds.
I have called up to my peds floor to give report and asked about rectal temps and told that they don't do them up there. Anyone have any thoughts on the advantages, disadvantages of rectal temps?
Thanks, Pam :)

I find the best way to do it.. is to have the baby/toddler on it's back, grasp the legs by the ankles, and put your palm on the butt w/ the thermometer extending thru your 2nd n 3rd fingers. of course, do do initially have to insert it..and then quickly palm it. this way, when they move, you do too...you are able to stay w/ them even while squirming. ...and kinda gettn right in the baby/toddlers face, and doing everything you can to distract them from whats actually goin on. hope this helps!

Rambob · Mar 19, 2005

Our Peds instructor, "Curmudgeon of the year" took off 20 point from one of my papers. :angryfire

She said "We NEVER take rectal temps because fecal material holds heat."