Taking an infant's temp.

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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.

I work in maternal child and we do all of our temps axillary. Once upon a time we did rectal to check patency, no more.

The pediatricians I used to work for always want a rectal temp on infants under twelve weeks of age.

I started doing oral temps on my kids at about two. If I got resistance with that, I was a bad mom and threatened the rectal. Most of the time I got compliance.

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Axillary on infants, temporal (not tympanic) on kids. Temporal is great because you barely touch the kid, great for us night nurses that don't want to wake them up!

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On my postpartum unit (approx 5,000 babies/year), we do axillaries, including the admission temp.

If a baby has a temp below 97.5, we'll try another axillary under the other arm. If that, too, is low, we'll take a rectal to decide whether the kiddo needs to be placed under the warmer and have a dexi drawn. If we get a decent axillary after the baby has been warmed, we'll assume the rectal is okay as well.

No one likes rectals, least of all, the babies, but they can be downright dangerous for anxious parents to attempt. In fact, we don't recommend parents do rectals on newborns at all. If they are truly concerned something is wrong with their baby, an axillary with a repeat on the other side is enough of a screening tool to send them to the ped's office or ER. They can also look for other s/s, such as dehydration, lethargy, regurgitation, loss of appetite, etc.

Rectal temps are just not warranted under most circumstances.

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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.

Sorry, a little OT... I see them a lot in homecare and schools. I'm not entirely sure about them but I definitely find them more accurate on older kids than axillary or tympanic. Nice and easy to do a temp on an autistic kid, too!! This may be silly but since peds homecare can be laid back you find out some things you would never even think about otherwise... you can't take a temporal reading outside on the patio in summer... that's the only time I've found an inaccuracy :rolleyes: I usually try for at least two readings on the autistic little one since he's always in motion when I try but even then they're never farther than 3-4 tenths apart. Now if only there was a gadget for instant auscultation while running!! :chuckle

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1st newborn temp is rectal.

We have young docs - in their 30's - who want rectals on infants in the ER.

After the first rectal temp, we do axillary.

I do not like or trust tympanic temps on just about anybody - even though I know they've been tested pretty accurate. Just a personal problem I have. :rolleyes:

Since the thermometer barely goes in the rectum, I'm not sure how you can perforate anything - ours is barely the tip.

When my oldest was a baby we had glass mercury thermometers and I always did a rectal temp at home. :chair:

I do agree that parents should be taught the axillary method.

steph

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Specializes in NICU, Infection Control.

Steph--there have been "sentinal events", or @ least one where several newborns in one facility had perforations--a nurse was inserting the thermometer about 5 cms!!! :eek: Lubricated of course. So, it can happen.

I dunno, I think if the kid has a imperforate orifice, he's got other problems, too. And, in fact, we had a baby recently that had the weirdest oomphalocele I've ever seen--- just a little loop about 1 cm above the cutaneous junction. Looked an extra blood vessel or something. The ob almost got it w/the cord clamp, but missed, Thank God. So we [very gently] looked for an imperforate orifice, and sure enough--the sphincter was there, but met resistance

I hadn't heard of a temporal thermometer, but it sounds good to me!

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Steph--there have been "sentinal events", or @ least one where several newborns in one facility had perforations--a nurse was inserting the thermometer about 5 cms!!! :eek: Lubricated of course. So, it can happen.

I dunno, I think if the kid has a imperforate orifice, he's got other problems, too. And, in fact, we had a baby recently that had the weirdest oomphalocele I've ever seen--- just a little loop about 1 cm above the cutaneous junction. Looked an extra blood vessel or something. The ob almost got it w/the cord clamp, but missed, Thank God. So we [very gently] looked for an imperforate orifice, and sure enough--the sphincter was there, but met resistance

I hadn't heard of a temporal thermometer, but it sounds good to me!

5 cms!!!? She needs an inservice on taking rectal temps.

Our local drug store sells temporal therms.

What an interesting oomphalocele story . . ... we do the cord clamps (nurses) . . .I'll have to remember to watch for that.

steph

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Rectal temp first time, to assure patency and accuracy.

Then, Axillary from that point on, on all well babies.

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Specializes in Emergency/Trauma/Education.

prmenrs...Go to www.exergen.com and look at their Medical division. They make a hospital-grade and home-grade temporal artery thermometer.

There is a nifty rectal thermometer on the market that has a flange that prevents the user from inserting it too far. I don't know the brand name, but saw it while going through prenatal classes last fall. It may be a safer option for those parents/others who insist on doing rectal temps.

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Specializes in Med/Surg, Urg Care, LTC, Rehab.

I work at an Urgent Care clinic. The docs want a rectal temp on kids under one year of age. They don't feel our axillary temps are very accurate...

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I work at an Urgent Care clinic. The docs want a rectal temp on kids under one year of age. They don't feel our axillary temps are very accurate...

Which is why we do rectals on newborns and all kids who come in the ER under one.

steph

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Specializes in NICU, Infection Control.

You know, I'm pretty sure we trialed a previous model of this thermometer in our unit once--they wound up giving us several and I remember talking to Mary Ann Pompeii when we were doing it. Eventually, they all quit working, and for a while we were trading them back and forth, then I think we just gave up. And Welch-Allen came out w/a faster, cheaper model, so we switched to that. Easily 10 years ago. Wow! Nice people, I'm glad they're still going.

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