Taking Temperatures

Is there a fever? There is no need to take the baby’s temperature on a regular basis unless you think the baby seems ill (unexplained and sustained irritability; significantly decreased feeding; repetitive vomiting; frequent diarrheal stools; feeling distinctly warm to the touch). It is important to realize the newborns tend to take on the temperature of their surroundings so that they might have a falsely lowered temperature from being in too cool an environment and being under dressed or have a falsely elevated temperature from being excessively wrapped up The best strategy is to keep your home comfortable for you ~ 72-75 degrees F and add or subtract clothing to keep the baby comfortable. If you are in a very cold environment that you cannot control, remember that a great deal of body heat is lost via the head; therefore a soft knit hat will help to keep the baby warm. Conversely, we live in a very warm environment where heat stress is a real issue for young infants. Be very careful of hot cars; take strolls in the early morning hours when temperatures are most moderate. Offer extra water on very hot days.

How to take an axillary (under arm) temperature: Make sure that the armpit area is dry. Shake the thermometer until the mercury reads below 97’F. Place the bulb high in the armpit and hold there with the child’s arm firmly against the chest. Read the temperature after five minutes.

How to take a rectal temperature: Shake the thermometer so the mercury registers less than 97°F. Lubricate the silver bulb with Vaseline, A&D Ointment or KY Jelly. Position your baby on his back and hold his ankles in one hand, the thermometer in the other. Gently insert the silver bulb of the thermometer into the rectum about one-half inch, or until the bulb can no longer be seen. Always hold both your baby and the thermometer. Hold the thermometer carefully in place, approximately three minutes or until the mercury stops moving. Remove the thermometer and read the degree of temperature, then shake the mercury down again and wipe the thermometer off with an alcohol wipe or cool, soapy water so that it will be ready for the next time.

There is very little practical difference between the axillary and rectal temperature in infants under 6 months of age. Beyond this age there may be as much as a degree or more lower temperature in the axillary area as compared with a rectal reading. Therefore, in infants < 6 months of age you can take the temperature in either location and interpret the result without adding or subtracting any value. Infants beyond 6 months of age, you can begin with an axillary reading. If you find that it is <101°F, in a child who seems significantly ill, it should be repeated rectally as it is possible the core temperature will be higher than the surface temperature in the older (larger) child.

The normal temperature range is 97°-100° F; 100°-101° is an intermediate zone and > 101°F is considered a fever. In infants under 3 months of age, we want you to contact our office promptly if this temperature (> 101° F.) is sustained over a few hours, cannot be explained by environmental factors and/or is associated with symptoms of illness as noted above. The management of fever in older infants and children will be discussed in a subsequent section.