Taking an infant's temp.

[kbclary4]

How do you all do it? Ear, rectal or underarm and add a degree? I am having a debate with a friend over the best way. She says the nurses in the hospital she delivered @ did it under the arm, but her pediatrician says that is not the most accurate way and to do it rectally.

[Jabramac]

The hospital I work in checks the first newborn temp rectally, then axillary from there on out. The pediatric department checks axillary. However, in the ER we check rectal or orally if the child can do oral, but in the ER we never check axillary.

[DorkyStudentNurse]

I don't start my first clinical placement until next week but when we learned temperatures, they told us it was normal to take the infant's temperature rectally initially and then any subsequent readings are either axillary or tympanic (although I'm not sure how often this is used).

[fergus51]

We only do rectal temps as a last resort. I would not be happy with someone sticking something up my baby's butt for no good reason. The rectal temps are considered the most accurate, but for a few tenths of a degree it isn't worth it to do all the time unless there are some real problems going on.

[prmenrs, RN]

The theory of the first rectal temp is to see if the orifice is patent, however, I've seen a nurse do a rectal when the baby's covered w/meconium! Go figure. You can also justify it that you want to check the core temp.

I just do auxillary, and that's what the parents should learn. We give a free (read: cheap) digital thermometer. It's hard enough to keep that in place, much less a rectal. And you don't need to add a degree. If everybody does the same thing, no problem. Otherwise, just note (and advise parents to tell their peds) how it was taken.

Tympanic thermometers aren't too accurate because for @ least the 1st 3-4 months, baby still has leftover stuff in his ears. For premies, the probe doesn't fit, no way!

If her peds tells her to do it rectally, he's pretty out of date (MY opinion!). I think it can be very dangerous! It is possible to go thru the bowel wall, and that is never good.

[TiffyRN, BSN, PhD]

We do initial temps rectally basically to check for patency. After that all axillary. But that is in NICU, not peds. Seems like I remember when I did my peds rotation we always did rectal temps. The rationale I was given for almost exclusive axillary temps is that the newborn/preemie rectal tissue is too delicate and prone to perforate to be doing frequent rectal temps. I could see a pediatrician having a preference for rectal temps as most of the infants he/she deals with are bigger and older.

[mandana]

Just finished my peds rotation and the rule there was axillary unless there was a reason to do rectal. Only saw one rectal and that was becasue the baby was very ill and they kept getting very cool axillary temps (which turned out to be accurate, but they needed to verify it rectally).

Amanda

[MirandaNICURN]

Same here that I have seen, all hospital policies seem to be take a rectal temp at birth to ensure patency (even if it is meconium) then no more rectal temps after that because it can tear the delicate rectal tissue. Axiallry is the way to go for neonates after that.

[MissJoRN, RN]

in nursery first temp rectal, the rest axillary, unless a NICU baby indicates mre aggressive monitoring

in peds rectal only in babies over 1 month, axillay in

FYI- some thermometers (such as our older Filacs) have a switch on the bottom that says direct and predictive, it should be switched to direct for axillary temps so it will take the most accurate temp... it takes longer and "reads"/monitors until it stops raising. The predictive mode takes just a few seconds to track the trend of a pt's tem and "guess" what the actaul temp is. It's pretty reliable in oral and rectal temps (and probably always the mode you use) but not as accurate in axillary temps. Just something I found out one day and became type-A about, LOL. I think the newer Filacs switch modes automatically if warrented, but haven't done an ax temp since we got them.

http://www.tycohealth-ece.com/index.php?folder=60

[Stitchie]

My pediatrician used a forehead heat-sensing probe to get temps on my twins when I had them in for ear infections. I thought that was really interesting -- no trauma to tissue possible, no holding the baby's head to get the tympanic temp, no wondering if the axillary temp is possible.

Very futuristic, like something from Star Trek!

[sjt9721, BSN, RN]

My pediatrician used a forehead heat-sensing probe to get temps on my twins when I had them in for ear infections. I thought that was really interesting -- no trauma to tissue possible, no holding the baby's head to get the tympanic temp, no wondering if the axillary temp is possible.

Very futuristic, like something from Star Trek!

That would be the temporal artery thermometer. I've seen positive and negative research about the method. They can be great for routine/screening temps but are extremely user-dependent.

Our ED & OP Surgery areas are using them.

[mandrews]

How do you all do it? Ear, rectal or underarm and add a degree? I am having a debate with a friend over the best way. She says the nurses in the hospital she delivered @ did it under the arm, but her pediatrician says that is not the most accurate way and to do it rectally.

We do all rectals on babys and oral temps on young children unless the dr orders rectal temps.

melissa