Introduction to Pediatric Temperature Assessment

Temperature assessment is a crucial component of pediatric clinical evaluation. Accurate measurement and interpretation of body temperature can provide valuable insights into a child's health status and guide diagnostic and therapeutic decisions.

• Temperature assessment is essential for:
  • Detecting fever
  • Monitoring disease progression
  • Evaluating treatment efficacy
  • Identifying potential infections or inflammatory conditions
• Pediatric temperature assessment requires special considerations due to:
  • Age-specific normal ranges
  • Varied measurement methods
  • Physiological differences in children

Normal Temperature Ranges in Children

Understanding normal temperature ranges is crucial for accurate interpretation of pediatric temperature measurements.

Note: These ranges may vary slightly depending on the measurement method and individual factors.

Temperature Measurement Methods in Pediatrics

Various methods are available for measuring temperature in children, each with its own advantages and considerations:

1. Rectal Temperature:
   • Gold standard for infants and young children
   • Most accurate method
   • Recommended for children under 3 years
   • Contraindicated in neutropenic or immunocompromised patients
2. Axillary (Armpit) Temperature:
   • Less invasive, but less accurate
   • Typically 0.5°C (0.9°F) lower than rectal temperature
   • Suitable for screening in older children
3. Oral Temperature:
   • Accurate in cooperative children over 4 years
   • May be affected by recent food/drink consumption
   • Typically 0.3°C (0.5°F) lower than rectal temperature
4. Tympanic (Ear) Temperature:
   • Quick and comfortable
   • Accuracy can be affected by ear wax or improper technique
   • Not recommended for infants under 6 months
5. Temporal Artery Temperature:
   • Non-invasive and quick
   • Becoming more widely used
   • Accuracy comparable to rectal temperature in some studies

Definition of Fever in Pediatrics

Fever is generally defined as an elevation in body temperature above the normal range. However, the specific temperature threshold may vary depending on the measurement method and the child's age.

Note: In neonates (0-28 days), a rectal temperature of ≥38.0°C (100.4°F) is considered fever and requires immediate evaluation.

Factors Affecting Body Temperature in Children

Several factors can influence a child's body temperature, potentially affecting the interpretation of temperature measurements:

• Diurnal Variation: Body temperature typically fluctuates throughout the day, with lowest temperatures in the early morning and highest in the late afternoon/evening.
• Physical Activity: Vigorous exercise can temporarily elevate body temperature.
• Environmental Factors: Ambient temperature, humidity, and clothing can affect body temperature.
• Metabolic Rate: Increased metabolic rate (e.g., after eating) can slightly raise body temperature.
• Hormonal Changes: In adolescent females, menstrual cycles can influence body temperature.
• Medications: Certain medications (e.g., antipyretics, steroids) can affect body temperature.
• Hydration Status: Dehydration can lead to an elevated body temperature.
• Emotional State: Stress or excitement can cause a slight increase in body temperature.

Clinical Implications of Temperature Assessment

Accurate temperature assessment has significant clinical implications in pediatric practice:

1. Diagnosis:
   • Fever is a key symptom in many infectious and inflammatory conditions
   • Pattern and degree of temperature elevation can guide differential diagnosis
2. Treatment Decisions:
   • Guides the use of antipyretic medications
   • Influences the decision to initiate empiric antibiotic therapy
3. Monitoring:
   • Helps assess response to treatment
   • Aids in identifying complications or disease progression
4. Prognostic Value:
   • Persistent fever may indicate treatment failure or complications
   • Hypothermia in neonates can be a sign of serious infection
5. Screening:
   • Used in fever screening protocols (e.g., during infectious disease outbreaks)

Note: While temperature assessment is crucial, it should always be interpreted in the context of the child's overall clinical presentation and other vital signs.

Documentation of Temperature Assessment

Proper documentation of temperature measurements is essential for accurate clinical assessment and continuity of care:

• Record the following information:
  1. Numerical temperature value
  2. Unit of measurement (°C or °F)
  3. Measurement method (rectal, oral, axillary, tympanic, temporal)
  4. Date and time of measurement
  5. Any factors that may affect the reading (e.g., recent physical activity, medications)
• Frequency of measurement:
  • Follow institutional protocols or physician orders
  • Typically every 4-6 hours for febrile patients, or more frequently if clinically indicated
• Trends:
  • Note any significant changes or patterns in temperature over time
• Associated symptoms:
  • Document any symptoms associated with temperature changes (e.g., chills, sweating, lethargy)
• Interventions:
  • Record any interventions performed in response to temperature readings (e.g., administration of antipyretics)

Example documentation: "Temp 38.5°C (101.3°F), rectal, 06/08/2024 at 14:30. Patient received acetaminophen 15mg/kg PO at 14:45. Will reassess in 1 hour."