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.

[Gompers, BSN, RN]

In the NICU, we do axillary temps for the most part, even on admission. We only do rectal temps on babies whose temperatures are extreme - hot or cold - to verify the temp. Once in a great while, we'll have a baby stay with us for 6-12 months (usually a vent dependent baby with a trach) and with those kids, we might do rectals since axillary isn't very accurate when you've got a 20 pound kid. We'll only do those three times a day, though, to limit trauma to the tissue.

[lpn1217]

I work in a birthing center and we always do axillary from birth to d/c usually 6 hours later.We tell the parents to take the temp under the arm unless the md asks for a rectal.

[peds4now, RN]

I can only speak as a parent of 6, as I'm still a nursing student. I understand the initial rectal temp for a newborn, but I see no reason to do a rectal temp on a healthy newborn after that. Axillary should be able to give you a heads up if there is a problem developing. That said, for a sick infant/toddler, I take a rectal temp at home. It is most accurate (I understand the tympanic is theoretically very accurate, but the logistics of getting a good reading with one are much more complicated that an old fashioned rectal temp), and when a baby is first coming down with something, I want an accurate #. After that, I use AX. By the way, for me it is sometimes harder to get an AX temp from a child older than an absolute newborn than a rectal temp-cooperation wise! If I lay a baby tummy down over my lap with the legs hanging down and just open the diaper enough to expose the rectum, there usually isn't much fighting. But try to get a fussy baby to let me hold the arm down securely over a thermometer???? Forget it. So I'm not sure skipping the rectal is really so kind.

Oh, I am rambling!

[Mimi2RN, ASN, RN]

The first temp on our newborns is always rectal, after that we do axillary, unless the baby is below 97.6. We recheck those with a rectal.

We found a baby with imperforate orifice not long ago. He had a dimple, but when the nurse tried to do the rectal, it was blind! He did well with surgery, too. Didn't have to have a colostomy.

[MissJoRN, RN]

By the way, for me it is sometimes harder to get an AX temp from a child older than an absolute newborn than a rectal temp-cooperation wise! If I lay a baby tummy down over my lap with the legs hanging down and just open the diaper enough to expose the rectum, there usually isn't much fighting. But try to get a fussy baby to let me hold the arm down securely over a thermometer???? Forget it. So I'm not sure skipping the rectal is really so kind.

Oh, I am rambling!

I worked peds night shifts long enough that 9 times out of ten I can take the rectal temp without waking up the kid... if only I can get the crib rail back up with out a big metal clang! :chuckle

[lovetoshop]

At the pediatrian's office that I work at, based on protocol we do rectal temps for 1 year and under. Tympanic or oral for children older. Based on the age of the child >1 and what they can handle (tymp vs oral). My opinion would be to do what you are advised for school, but once you are working do what is based on the protocol for the facility that you are working at.

[walkingrock, ADN]

I have been in NICU for 26+ yrs. We don't do rectal temps period, anymore. We also don't do tympanic, or add a degree! Axillary & skin temps only. Our nsy (normal newborn where they do the initial assessments on kids that don't come to us before staying in mom's room) doesn't do rectal temps either. PICU does axillary temps, OR they use a rectal probe and leave in place (much less invasive than a big ol' thermometer). I don't know about the Peds & ER depts where I currently work, but my previous work, where we frequently went to the ER & Peds we did NOT do rectal temps or tympanic temps on peds, just axillary; although the ER did rectal temps on them...I still see the pediatricians out there preferring rectal temps to be done by the parents, but I do believe they should be using axillary temps; however, they are usually doing axillary temps in their office on their young patients...just my $0.02 I think rectal temps are barbaric and should only be done in extreme circumstances (an extremely cold or hot infant or child, etc).

[daisybaby, LPN]

We only do rectal temps on our newborns. I think it's archaic and unnecessary. I work in a hospital where "because that's how we've always done it" rules.

Perhaps I'll do my next in-service on the risks of rectal temps and why axillary temps are quite sufficient....

[sarahpartain]

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.

I agree. An axillary temp in the ER is going to be really inaccurate! Axillary route only works when the child's arm has been next to his body such as when an infant is bundles. Typmanic is OK if done correctly (align the thermometer with the mandible). What about using the non-invasive thermometer that measures the arterai temp across the forehead and behid the ear? Has anyone experience with this method?

[NurseGizmo]

In our peds office we take oral usually 3-4 yrs and up, axill for the rest, rectal only by md order, and I have been testing the exergen temporal, and so far it matches with my ax or oral temps taken with the welch allyn sure temps. I once had a lady for 2 months subject her daughter to visits, lab tests. All because everytime she took her daughters temp it was always 100 or above. Come into the office no temp... One day she called again and I asked her to bring in her thermometer with her, because they were new to me, we lived in germany, and the military used tempa dots, or old rectal thermoms if needed. Guess what, she was using the ear thermom. on a rectal setting for a baby. Her daughter was 3 years old. So now i always ask what they are using.

[Gompers, BSN, RN]

Just wanted to add something...

Even though axillary temps are safer than rectal temps, which is why we use axillary in the NICU...in my experience the kids seem to tolerate the rectal temps better. The times I've had to do them (extreme temperatures, large chronic sweaty NICU baby, toddlers in pediatrics), the kids have been pretty calm. I just hold their legs together and gently insert the probe. Most don't even cry, maybe just squirm a bit. Axillary, on the other hand, makes them cry sometimes and it's so hard when you've got a 500 gram baby with no fat at all under the skin.

So I don't think rectal temps are painful or cruel, just more dangerous than axillary.

[luvnursing23]

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.

i work on a pediatric floor in a well known hospital and the only temps we do is a rectal temp. it is the most accurate and why take your chances with anything else when this is the most proven way? everyone i think though does it differently but i just wanted to reply and say i dont think someone is out dated if they say rectal is the best