Taking an infant's temp.

rnmomruning · Mar 4, 2006

In our pediatric practice we take rectal temps up to six months of age. Rectal temps, when done correctly, are not uncomfortable or unsafe for infants. They are the most accurate. We have both tympanic and temporal thermometers for our older children. Both take practice and are easily missused. Any tympanic temp takes two hands, one to extend the ear canal while the secoond holds the probe. We use the temporal only when a child is very stressed out because we have found it not to be as accurate as the others yet much less intimidating.

Bayareamom · Jun 5, 2009

While I understand the need to check a newborn's vitals and I certainly understand concern when a newborn is running a fever, but why all the hype over what 'number' you may find when doing an exam of an infant/child/adult? Most fevers are caused by viral and/or bacterial infections -- the body's own defense mechanisms will overcome these, generally, without medical help. Viruses and/or bacterial infections can generate fevers that range all the way up to 105 degrees, but even at that level, they are not legitimate cause for concern. Fact: There is no consistent relationship between the height of a child's temperature and the severity of a disease. Knowing the precise level of your child's fever will tell you NOTHING about how sick he is if the fever is produced by either a virus or bacterial infection.

So -- why all the fever phobia? I can remember when I was young and was constantly coughing. I had this dry cough that just wouldn't go away. I had NO FEVER -- but I was very sick indeed. If you went by my symptoms, I was very sick. A number on a thermometer would have told you NOTHING about my illness. Unfortunately, I was treated for 'walking' pneumonia, but years later, discovered that I actually had asthma. So -- question for you folks in the medical field: WHAT do they train you to look for with a NUMBER? If you drew up a chart and listed temp. measurements, starting with 97.5, all the way thru to say...106 degrees. What would you do different medically for each corresponding number than you would do otherwise, if you DIDN'T have a temp measurement? Dr. Robert Mendelsohn, Pediatrician, now deceased, said to throw away the thermometer. Numbers tell you nothing. He did state that fevers in newborns was of concern and gave a few other instances where you would perhaps need to know temp. measurement -- otherwise, he stated taking temps of infants, especially rectal temps, was totally useless.

I tend to agree. (Legal Assistant here...just asking some questions.)

rn/writer, RN · Jun 5, 2009

I'm glad you mentioned the exception for newborns. Neonates with elevated temps may need abx for infection. Some of our GBS+ moms do not get the recommended 2 or more doses of abx at least 4 hours prior to the birth, so those kids have cbc with diff and cultures drawn. In the 48 hours it takes for the cultures to process, we take the temps q 4 hours to catch problems as soon as possible. Kids can have infections for other reasons, and we hope to head those off as well.

The more frequent problem is cold kids. Babies of diabetic moms, late preterm kiddos, low-birthweight babies, and babies suffering from substance withdrawal can all be prime candidates for low temps. The low temps ramp up metabolism to compensate, and this can lead to low blood sugar.

Neonates need good temperature monitoring for the first 48 hours at least. This is one reason why we are reluctant to send higher risk kids home after a short stay (12-24 hours). If the baby needs blood cultures, the docs won't write d/c orders sooner than 48 hours.

As for older kids, most docs are not recommending rectal temps for normal kids under normal circumstances. Unless there is some extenuating circumstance, taking a rectal temp just isn't worth the risk, especially on a very young wiggle child.

The parameters for "worrying" about a temp have become much looser over the years, the exception being kids who are known to be susceptible to febrile seizures. For the average crowd, the newer thinking is that the fever is there for a reason and bringing it down too far too fast may well interfere with that process. The old days of alcohol baths and plunging a kid into icy water have passed, thank goodness. Kids were absorbing the ETOH through the skin and the ones being submerged in artic bathwater were not faring all that well either.

There isn't the old rush to give antipyretics for the same reasons mentioned above. Similarly, when kids are throwing up, the current school of thought is, "Let 'em." Their bodies are trying to expel something unfriendly and with good reason. The trend seems to be to let the body take care of itself and intervene in a reasonable fashion (as opposed to a panic) when the situation warrants.

I guess I wouldn't throw out the thermometer just yet. As with newborns, some kids bottom out when they have certain kinds of infections and that's important to catch. Some kids do have a tendency to develop febrile seizures. And some kids peg the meter with temps of 104 and higher. What parents need to know is when to give meds, when to use mild cooling techniques, when to call the doc, and when to head for the ED. They should find this out from the doc before a crisis arises. They should ask what the doc recommends for taking the temp, and when calling in, they should tell what method they used so the staff person can factor in the reliability of that method.

I understand that new parents sometimes freak when their child is sick, but fevers are not usually an emergency. They can certainly become emergencies, but if parents are educated about what makes a fever cross that line and how to manage if it does, at least a little of their stress can be lessened.

Bayareamom · Jun 6, 2009

Thanking you for your prompt, thoughtful reply! In part, you stated:

"For the average crowd, the newer thinking is that the fever is there for a reason and bringing it down too far too fast may well interfere with that process. The old days of alcohol baths and plunging a kid into icy water have passed, thank goodness. Kids were absorbing the ETOH through the skin and the ones being submerged in artic bathwater were not faring all that well either."

Actually, this isn't 'newer thinking.' Some Pediatricians, such as Dr. Robert Mendelsohn, now deceased, were not advocating cold water/alcohol baths back when they were practicing...in the 1960's, 70's and 80's. Fevers are a sign your body is doing what it is meant to do. And yes, I am certainly glad to hear the days of plunging a kid into icy cold water have passed!

Here is what I have learned about fevers/temperature:

When fevers occur (from Dr. Mendelsohn's book): Iron, which many germs need in order to thrive is being removed from the blood and stored in the liver. This reduces the rate at which the bacteria multiply. The action of interferon, a disease fighting substance produced naturally in the body, also becomes more effective.

Artificially induced fevers have been used in lab experiments with animals to demonstrate this process. Elevated temperatures decrease the death rate among animals infected with disease, but if their body temperatures are lowered, more of them die. Artificially induced temperatures have actually been used for many years to treat diseases in humans that do not normally produce fevers themselves.

So -- where am I going with this --

I guess I'm just trying to figure out WHY a pediatrician's first question to any worried Mom out there with a sick child is, 'what is their temperature?' UNLESS the child's temperature has literally SPIKED (which obviously could be a serious sign), what difference does it MAKE what the kid's 'number' is? What is that actually going to TELL the physician? If my child, for instance, has a fever of 100 degrees or higher, what exactly does that tell you? Wouldn't you think that the child's SYMPTOMS/BEHAVIOR is more important?

Put it this way -- Dr. Mendelsohn stated he would feel more concerned with a child who was lethargic, with a fever of 100 degrees, than he would seeing a child running all over the place, with a fever of 104 degrees. If that's the case, I am quite certain he would have been very concerned with me when I was 10 years old, coughing this sort of dry cough constantly, and quite lethargic, with absolutely NO FEVER. I actually didn't even look sick. Yet, when my physician listened to my chest, he was absolutely stunned. My lungs were almost completely filled with fluid. In fact, he stated that my chest sounded like a kettle full of boiling oatmeal.

And speaking of numbers -- what difference does it make if you have a number that's a little higher than another number? To me, the risks of taking a rectal temp on ANYBODY are just too significant. Nurses make mistakes -- so do parents. Rectal perforation is a real hazard (I've read about the risks in JAMA). So what if a rectal temp is more accurate -- as I've said, what difference in the quality of medical care/procedures you are going to take whether a child has a fever of 99 degrees, or a fever of 102 degrees, with the same symptoms? What does the DIFFERENCE IN NUMBER mean, if anything?

I guess that's what I'm trying to get at, here. Personally, I think rectal temp taking belongs in the stone age -- I agree with Dr. Mendelsohn -- throw out the thermometer -- numbers mean nothing.

Bayareamom · Jun 7, 2009

...any comments on the above questions I have posed? While I understand, to a degree, the initial response to my first post, I would be keenly interested in hearing responses from others in the medical field re: my questions posted with reference to 'numbers.' You take temps of infants rectally to get a 'correct' number because...WHY. What does that number actually TELL you -- this is what I would like to know. Isn't it more prudent to ask what 'symptoms/behaviors' a child exhibits, rather than focusing on a number? Recall, in my case when I was young, I did not run a fever at all, yet I was extremely ill.

It seems to me that physicians/nurses 'may' be perhaps more fever phobic than parents. Or is it perhaps parents are fever phobic, so to reduce anxiety amongst parents in general, an infant's temperature reading is taken.

I am speaking of, in general, the average child/infant, who may be ill with either a bacterial and/or viral infection -- those who are in generally good health overall otherwise.

Thanks.

rn/writer, RN · Jun 7, 2009

A single temperature doesn't tell you a whole lot unless it's an extreme. The specific number itself means less than the big picture of what the temp is doing. What you should be looking for is a trend over time. Is the temp going up? Coming down? Staying elevated for two days? Does it peak at certain times? Does it remain elevated even after medication. The answers can offer valuable information that, taken in context, could provide clues about what is going on with a young patient.

Do physicians and parents focus overmuch on temp? Sometimes. But most do look at the bigger picture that includes additional symptoms, behavior, appetite, disposition, exposure, and other factors. Lack of an abnormal temp should not be used to rule out disease when other symptoms exist and persist. Any doc or parent who turns away from a child with problems based solely on the presence of a normal temp is misinformed and will perhaps end up being negligent.

The fact that your illness wasn't properly diagnosed or taken seriously because a fever wasn't present is truly unfortunate. But in my mind, throwing out the thermometer entirely is just as extreme and potentially harmful as looking at the numbers to the exclusion of other data.

In a well-equipped medical orificenal, there ought to be an accurate thermometer--along with a lot of other tests and tools--to help diagnose and treat patients young and old.

CEG · Jun 7, 2009

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.

:yeahthat:

Bayareamom · Jun 7, 2009

CEG,

I agree with you -- temps taken rectally are simply not safe. Further, it was Dr. Mendelsohn, now deceased, but when living, a Board Certified Pediatrician who stated to 'throw the thermometer away,' numbers tell you NOTHING.

Frankly, I agree with him.

It's interesting -- I've been viewing a documentary entitled, "Shoot 'Em Up," regarding safety and efficacy issues behind vaccination. Dr. Lawrence B. Palevsky and Dr. Moskowitz are featured (two of my favorites). It would seem our culture is afraid of letting our kids GET SICK. Before you throw the ladle at me, I would urge all of you to view this documentary -- you can purchase it on Amazon.com. I have performed almost 20 years of research into healthcare issues. I used to be mainstream everything -- by nature, I am a pretty conservative gal. But in performing my medical research, I have had my eyes laid wide open. Everything from fever phobias, discussion about where that thermometer should go in taking temps (never in the rectum is where I stand), to what are we doing when we inject over 3 to 4 live viruses into a child's bloodstream, when that is NOT how we would normally acquire a live virus (not through the bloodstream, but through the nasal passages ). This makes a huge difference in how our body's immune system handles several viruses at once THROUGH OUR BLOODSTREAMS.

I have spoken to numerous nurses and physicians and other medical personnel who have ALL remained stumped when I have asked certain questions -- questions which need to be answered. Unfortunately, the one size fits all medical model does not work for approximately 30% of our population. We watched our beautiful four month old son experience high-pitched screaming after he had received the DPT vaccine (whole cell -- back in 1993). He is now learning disabled, but otherwise, he is doing well. When I asked our then pediatric nurse, who had proclaimed she'd never seen an infant in their practice suffer with a vaccine reaction, if she had been TAUGHT to look for a vaccine reaction while attending nursing school, this very lovely somewhat older lady looked back and me and said, "No, I was not." She gave me a blank stare of which I will never forget. It was very clear to me that she had never looked at it that way before.

Back to the temp taking - I guess my question with regards to whether or not one method of temperature taking is more accurate -- I don't really feel it is important to know the exact number -- only that the infant may be running a fever. To imply that one must take a rectal temp for 'accuracy,' sort of misses the point. Why risk perforating a bowel in the name of an ACCURATE number? Where is the logic...it completely baffles me.

I will never forget hearing what Dr. Mendelsohn told a graduating Harvard Medical School class at one point. He stated, and I am paraphrasing, "Congratulations! What I am about to tell you may surprise you, but nevertheless: One-half of what you have been taught is correct, the other half is not...it is up to you to find out which is which."

I hope all you nurses out there really take a hard look at some of this Nation's issues re: vaccines and the overall health status of our Nation's children (and adults for that matter). Dare to ask questions -- learn to follow your hearts and instincts when something you may have been taught just doesn't feel right. Dare to step out of the box and LISTEN to your patients when they give you so-called anecdotal evidence of a child's descent into abnormal behaviors after certain medications are given and/or after vaccinations. I have a number of family members who are in the medical profession -- they, too, are starting to ask some very hard questions vis-a-vis what they have been taught (vs. what they haven't been taught) while attending medical/nursing school.

Thanks for all your input.

Much appreciated.

--Kim

dawngloves, BSN, RN · Jun 8, 2009

-- I agree with Dr. Mendelsohn -- throw out the thermometer -- numbers mean nothing.

I disagree. Body temperature is an important diagnostic tool in differentiating between a viral or bacterial infection, amongst other things. When a doctor wants to know a pts. temp, it's only one of many things they want to know to help with their diagnosis. Especially in neonatology. Cold baby, acting fine, blood glucose 32. What's the baby's temp? 97f. Warm it up and re check. Bingo. Just saved that kid a septic work up and 48 hours of antibiotics with just a thermometer.

What parents need to understand is that an elevated temp is not a disease, it is a symptom. Nurses need to include that in their teaching.

Elvish, BSN, DNP, RN, NP · Jun 8, 2009

Temp can tell me a lot about a newborn. I don't base my entire decision-making around it, but it can give me a heads-up on a few very important issues.

Newborn that's slow-to-warm? I check a blood sugar. Found many a hypoglycemic baby that way.

Elevated temp? I look at mucus membranes, weight (loss), and output.....maybe the kid's dehydrated. Seen that elevated temp problem get solved with a bit of supplementation A LOT.

Found many a near-term kid with temp instability issues that aren't gaining weight; they're burning all their calories trying to keep warm and losing on both fronts. A little 22 or 24-cal formula and a little extra clothing, and bingo! Problem solved. Stable temps.

So yep....I use my thermometer at work. Is it the only thing? No, but it does give me a great heads-up that there might be other problems.

Bayareamom · Jun 8, 2009

How can you tell whether it's a viral or bacterial infection with a number on a thermometer?

Bayareamom · Jun 8, 2009

I totally agree with the second reply to my post. But please understand, I am NOT speaking of otherwise compromised patients. I am speaking of the normal, healthy child who is running a fever for whatever reason. I would love to hear what Dr. Mendelsohn would say re: some of the other posts. It would be interesting to hear...

I would still highly recommend his book, "How To Raise A Healthy Child In Spite Of Your Doctor," to those of you who may be wondering who he was. Great book... Also, the DVD, "Shoot 'Em Up," is a GREAT documentary regarding the healthcare issues in this country today. I would advise all of you who are now attending nursing school to research both sides to the story about vaccines most especially. There is a downside not often spoken about, which absolutely needs to be addressed.