A5V4d

Thermometers and the detection of fever
route was used in infants and young children. Alternatives methods include using the axilla or using a
tympanic thermometer. These methods are generally considered to not be as accurate as traditional
measurement 29,30 but they are often quicker and easier to use in young children. 31 Axillary and
tympanic measurements may also be better accepted by children and their carers. 31,32
Oral and rectal temperature measurements
Review question
How accurate are the different types of thermometer in the measurement of body temperature in
young children, and how do they compare in their ability to detect fever?
How accurate are the readings of temperature from different sites of the body in young children, and
how do these sites compare in the ability to detect fever?
Narrative evidence
An attempt was made to find evidence of the comparative accuracy of oral and rectal temperature
measurements using mercury-in-glass or electronic thermometers. Two EL II studies were found that
looked at the diagnostic accuracy of an electronic thermometer embedded in an infant pacifier. 33,34
The studies recruited children of different ages (e.g. 10 days to 24 months 33 to < 2 years 34 ). The
reported sensitivity was 10% and 63.3%, respectively.
The GDG did not consider these studies to be applicable to UK practice because these thermometers
are not available and the evidence for their usefulness is weak.
Evidence summary
The GDG was aware that temperature measurements by the oral and rectal routes were rarely used
in young children by healthcare professionals in the UK. These sites are probably the most accurate
for temperature measurement but there are concerns about their safety and acceptability. The GDG
could not reach a consensus among themselves as to whether these routes should be used and it
was therefore decided to use the Delphi technique in an attempt to achieve formal consensus.
Regarding oral thermometers, the following background information and statement was put to the
Delphi panel.
Background
In older children and adults, the inside of the mouth is considered to be one of the most accurate sites
for the measurement of body temperature. When temperature is measured via the mouth, it is
necessary for the thermometer to be held in place under the tongue while the measurement is taken.
Most children’s nurses are taught that children under the age of 5 years cannot cooperate with this
procedure and that inaccurate measurements will be obtained. There are also concerns that some
young children will bite the thermometer, and others find the technique uncomfortable or even painful.
Delphi statement 7.2
Healthcare professionals should not routinely use the oral route (mouth) to measure body temperature
in children under the age of 5 years. The following responses were obtained from the first
round of the Delphi process (see section 3.2):
1 to 3 4 to 6 7 to 9 Don’t know Missing Total Median
2 (4%) 4 (8%) 44 (85%) 2 (4%) 1 52 9
The statement therefore achieved consensus at the first round of the Delphi technique.
Regarding rectal thermometers, the following background information and statements were put to the
Delphi panel. The results from the first round of the Delphi process are also shown.
Background
In this technique, the probe of an electronic thermometer is placed in the rectum (back passage). The
rectum is often considered the most accurate site of measurement of body temperature; the rectal
route is therefore a reliable way of detecting fever in babies and young children.
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