SPN Position Statement:
Temperature Measurement
INTRODUCTION/PROBLEM STATEMENT
Temperature measurement in ill infants and children is a vital assessment parameter. Generally, the
measurement of body temperature is used to determine the presence or absence of fever. Fever can be
used to gauge the severity of illness by both parents and healthcare providers. However, many factors
such as age, activity level, time of day, disease/illness, ambient temperature, and clothing can influence
body temperature.
DEFINITION(S)
A normal temperature is not a specific number but instead can range from 97 to 100.4 degrees Fahrenheit.
According to the American Academy of Pediatrics (AAP) many fevers do not need treatment and are
simply an indicator that the immune system has been activated as the result of a bacterial or viral illness.
Fevers can actually help shorten a child’s illness (AAP, 2006). The need for immediate assessment, septic
workup, and treatment for infants less than 90 days old with fever must be recognized as the infant’s
condition can deteriorate quickly (Graneto, 2016).
One widely-accepted and expert resource for parents and nurses on pediatric fever is the American
Academy of Pediatrics website (www.aap.org), which offers public access to information and policy
statements on common pediatric problems, including fever. When searching for the term “fever” in the
HealthyChildren.org section of the AAP website (AAP, n.d.), one can find what could be considered an
expert definition of pediatric fever, signs and symptoms associated with fever, an overview of details
regarding when and how to assess pediatric temperature using oral, rectal, tympanic, and axillary methods,
as well as medications used to manage fever.
RATIONALE AND SUPPORTING INFORMATION
The most accurate and appropriate method of measuring fever in children has been a topic of concern for
many years. The use of the mercury thermometer has been phased out because of potential health
problems associated with mercury. In addition
to oral, rectal, and axillary methods, there are newer
modes of measuring temperature such as tympanic and temporal artery methods, and the addition of these
has increased the confusion. It is important that the nurse caring for infants and children, regardless of the
setting, be aware of best practice implications for measuring temperature, or fever, in pediatric clients.
For years, the measurement of temperature via the rectal route was the “gold standard.” This was
accomplished using a glass thermometer with mercury. The development of electronic and non-electronic
methods that are faster and inexpensive has created much discussion related to the best method for
measuring temperature in children. The pediatric nurse (regardless of setting) is commonly approached
requesting advice on temperature measurement in children. The nurse must be able to articulate and
discuss common safe practices for use in home and healthcare settings.
Over the past decade, the newer and more convenient modes of measurement of temperature have
spawned many studies regarding the most accurate and reliable method for measuring temperature in
children. While there have been no conclusive standardized results, the various studies each contribute to
a better understanding of temperature measurement in children. Although there are several methods
available for measuring temperature, the goal is to use the most accurate method with the least degree of
variance while still recognizing the comfort of the patient and ease of use for the healthcare provider.
Because of a greater degree of variance accuracy, the temporal artery method should not be used with
infants 90 days or younger who are ill, have a fever, or an ill diagnosis. The rectal method should be used
for these infants unless contraindicated by diagnosis (e.g., GI/rectal bleeding, prematurity, oncology
diagnosis). When the use of a rectal temperature method is contraindicated by diagnosis, the axillary
method should be used. The temporal artery method can reliably be used in infants less than 90 days old
without fever as well as for all patients greater than 3 months of age with or without fever, ill or well. In
children 6 months of age or older, the tympanic or temporal artery methods may be used with correct
positioning of the ear (tympanic) (Leduc & Woods, 2000).
Some of the studies that have been conducted include fever measurement in various settings (Jean-Mary,
Dicanzio, Shaw, & Bernstein, 2002; Martin & Kline, 2004; Maxton, Justin, & Gillies, 2004). Other
studies approached fever management using various modes/methods (Barton, Gaffney, Chase, Rayens, &
Piyabanditkul, 2003; Devrim et al., 2007; El-Radhi & Barry, 2006; Lefrant et al., 2003; Molton, Blacktop,
& Hall, 2001; Schuh, Komar, Stephens, Chu, Read, & Allen, 2004). Still other researchers approached the
issue in terms of various ages of the children (Greenes & Fleisher, 2001; Leick-Rude & Bloom, 1998;
Siberry, Diener-West, Schappell, & Karron, 2002). Limited studies have been conducted to analyze other
studies (Craig, Lancaster, Taylor, Williamson, & Smyth, 2002; Houlder, 2000).
POSITION and/or RECOMMENDATIONS
The mission of the Society of Pediatric Nurses is to advance the specialty of pediatric nursing through
excellence in education, research and practice. To address the issue of the measurement of
temperature/fever in children, SPN recommends the following best practice implications for measuring
temperature, or fever, in pediatric clients:
1. The nurse is aware that temperature measurement is a common concern for healthcare providers
and parents and is knowledgeable as to the various modes/methods available for measuring
temperature in children.
2. Documentation accurately reflects mode/method of temperature measurement.
3. Temporal artery thermometry is accurate with infants younger than 90 days without fever as well
as for all patients greater than 3 months of age with or without fever, ill or well.
4. The rectal method should be used for infants younger than 90 days unless contraindicated by
diagnosis.
5. The tympanic or oral methods may be used in children 6 months of age or older, with correct positioning of the ear (tympanic) and if the patient can cooperate (oral).
6. The patient assessment includes etiologies that influence temperature/fever in children.
7. Evidence-based practice determines the best method for evaluating temperature/fever in any given
setting, based on the age and condition of the client.
8. Evidence-based practice is utilized to determine best practice in policy development.
REFERENCES
American Academy of Pediatrics. (2006). A minute for kids. Fever: A symptom, not a sickness. Retrieved
December 11, 2007, from http://www.aap.org/sections/media/fever.htm
American Academy of Pediatrics (n.d.). Healthychildren.org. Retrieved December 22, 2016 from:
https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/Fever-and-Your-Baby.aspx
Barton, S.J., Gaffney, R., Chase, T., Rayens, M.K., & Piyabanditkul, L. (2003). Pediatric temperature
measurement and child/parent/nurse preference using three temperature measurement instruments.
Journal of Pediatric Nursing, 18(5), 314-320.
Craig, J.V., Lancaster, G.A., Taylor, S., Williamson, P.R., & Smyth, R.L. (2002). Infrared ear
thermometry compared with rectal thermometry in children: A systemic review. Lancet, 360(9333), 603609.
Devrim, I., Kara, A., Ceyhan, M., Tezer, H., Uludag, A.K., Cengiz, A.B., Yigitkanl, I., & Secmeer, G.
(2007). Measurement accuracy of fever by tympanic and axillary thermometry. Pediatric Emergency
Care, 23(1), 16-19.
El Radhi, A.S., & Barry, W. (2006). Thermometry in paediatric practice. Archives of Disease in
Childhood, 91(4), 351-356. Greenes, D.S., & Fleisher, G.R. (2001). Accuracy of a noninvasive temporal
artery thermometer for use in infants. Archives of Pediatrics & Adolescent Medicine, 155(3), 376-381.
Houlder, L.C. (2000). The accuracy and reliability of tympanic thermometry compared to rectal and
axillary sites in youngchildren. Pediatric Nursing, 26(3), 311-314.
Graneto, J. W. (2016). Emergent management of pediatric patients with fever.
http://emedicine.medscape.com/article/801598-overview#a2.
Jean Mary, M.B., Dicanzio, J., Shaw, J., Bernstein, H.H. (2002). Limited accuracy and reliability of
infrared axillary and aural thermometers in a pediatric outpatient population. Journal of Pediatrics, 141,
671-676.
Kelly, M., McCarthy, S., O’Sullivan, R., Shiely, F., Larkin, P., Brenner, M., & Sahm, L. (2016). Drivers
for inappropriate fever management in children: A systematic review. International Journal of Clinical
Pharmacy 38: 761-770.
Leduc, D. & Woods, S. (2000). Temperature measurement in paediatrics. Candian Paediatric Society
Position Statement. http://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/indepth/thermometer/art-20047410).
Lefrant, J.Y., Muller, L., de La Coussaye, J.E., Benbabaali, M., Lebris, C., Zeitoun, N., et al. (2003).
Temperature measurement in intensive care patients: A comparison of urinary bladder, oesophageal,
rectal, axillary, and inguinal methods versus pulmonary artery core method. Intensive Care Medicine, 29,
414-418.
Leick-Rude, M.K., & Bloom, L.F. (1998). A comparison of temperature taking methods in neonates.
Neonatal Network, 17(5), 21-37.
Martin, S., & Kline, A. (2004). Can there be a standard for temperature measurement in the pediatric
intensive care unit? AACN Clinical Issues, 15(2), 254-266.
Maxton, F.J.C., Justin, L., & Gillies, D. (2004). Estimating core temperature in infants and children after
cardiac surgery: A comparison of six methods. Journal of Advanced Nursing, 45(2), 214–222.
Molton, A., Blacktop, J., & Hall, C.M. (2001). Temperature taking in children. Journal of Child Health
Care, 5(1), 5-10. Schuh, S., Komar, L., Stephens, D., Chu, L., Read, S., & Allen, U. (2004). Comparison
of the temporal artery and rectal 20(11), 736-741.
Siberry, G.K., Diener-West, M., Schappell, E., & Karron, R.A. (2002). Comparison of temple
temperatures with rectal temperatures in children less than 2 years of age. Clinical Pediatrics, 41, 405414.
Sullivan, J., Farrar, H., (2011). Fever and antipyretic use in children. Pediatrics, 127, 580-587.
Wang, D., Bukutu, C., Thompson, A., & Vohra, S. (2009). Complementary, holistic, and integrative
medicine: Fever. Pediatrics in Review, 30(2), 75 – 78.
Ward, A., Edwards, M., & Torchia, M. (2016). Patient education; Fever in children (Beyond the basics).
http://www.uptodate.com/contents/fever-in-children-beyond-thebasics?source=search_result&search=patient+education%3A+fever&selectedTitle=1%7E150
Original
Date/Revisions:
Next Review:
REVIEWED AND APPROVED BY:
Original Authors:
Cindy Asher, RN, CNS and LaDonna K. Northington, DNS, RN
Committee:
SPN 2007-2008 Clinical Practice Committee
Date: December 2007
SPN Board of Directors:
Date: February 2008
Revised:
Subject Matter Expert:
LaDonna K. Northington, DNS, RN,C
Date: December 2016
02/08; 12/16
12/18