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temperature taking: overcoming the fever fear factor

by Laura Jana, M.D., FAAP

A flushed, warm-to-the-touch child is likely to generate concern for any parent. Why? Because these symptoms may reveal your little one has a fever. Unlike older children who can verbally express pain from body aches or headaches paired with a noticeably poor appetite, infants can only make you aware of how they're feeling by showing irritability, changes in sleeping or eating habits and fussy crying. The only way to know is by taking your little one's temperature, making sure it is as accurate as possible. Dr. Laura Jana has shared her respected temperature-taking tips to guarantee you perform the task properly and understand when there's cause for concern.

What is considered fever? What is a "normal" body temperature? Parents should have an understanding of fever, safe and accurate temperature taking, as well as know the risk of fever in a newborn and that in older infants and children. Overcome the fever fear factor by learning how to take temperature correctly and know when it's important to call the pediatrician.

Common cold viruses may cause fevers during a baby's first few months of life, whereas newborns run the small risk of having a more serious underlying infection. The younger the infant, the less prepared the immune system is to fight infection and the more seriously an elevated temperature should be taken. Therefore, any young infant with a fever should be brought to the immediate attention of a doctor.

Old-fashioned mercury-in-glass thermometers have been replaced with new digital models that allow for safe and accurate temperature readings and offer features such as color-changing displays and faster response times. Reduce anxiety and increase confidence associated with taking temperatures by becoming familiar with the use of the thermometer on a ''normal'' day — a day when there is no reason to suspect your child has a fever.

Temperatures are taken most commonly in the mouth (orally), in the bottom (rectally), or under the arm (axillary). Ear, forehead and pacifier thermometers are also available but they do not provide as accurate of a reading as commonplace methods. Check with your pediatrician regarding the method that is best for your child.

rectal temperature taking is recommended for infants since the readings are the most accurate measure of core body temperature.

  • Lay baby on either his belly or back on a comfortable, but firm, flat surface such as across your lap, on a changing table, sofa or even on the floor.
  • If on his back, hold baby's legs up just as you would if changing a diaper. If on his belly, position so that his bottom sticks up a bit by tucking his knees under or letting his legs drape over your lap. Dab some lubricating jelly onto the short, round tip of the thermometer.
  • Carefully insert the thermometer tip into the rectal (anal) opening until the metal tip is no longer showing (approximately 1/2").
  • Consider purchasing more than one thermometer so that one is designated "For rectal use only."
  • A rectal measurement of 100.4�F or above is generally considered fever.

oral temperature taking is generally recommended for children who are at least 4 or 5 years of age because they are old enough to understand the concept of keeping a thermometer under their tongue.

  • Make sure that your child has not had a cold or hot drink within the last 30 minutes.
  • Gently place the tip of the thermometer under one side of the tongue and towards the back.
  • Teach your child to hold the thermometer securely in place using both his lips and his (or your) hands. Unlike glass thermometers, digital thermometers can easily withstand biting, which helps hold the thermometer in place.
  • An oral measurement of 100F or above is generally considered fever.

underarm temperature taking is recommended for babies 3 months and older because it is far less accurate than other methods. Even for toddlers, this method can only give you a general sense of whether your child has a fever.

  • Make sure the child's clothing doesn't come between the thermometer and the skin and that the underarm area is dry.
  • Tuck the thermometer tip high up in the armpit and hold it in place by lowering the child's arm and keeping it snugly up against the chest until long enough to secure the temperature reading.
  • An underarm measure of 99F or above is generally considered fever.

When reporting your child's temperature to your pediatrician, there is no need to add, subtract or otherwise mathematically manipulate the results based on where the temperature was taken. Instead, simply be sure to mention how, when and where you obtained your measurement.

Dr. Laura Jana is the co-author of "Heading Home with Your Newborn: From Birth to Reality" (published by American Academy of Pediatrics). A pediatrician, mother of three and Associate Director of the Boys Town Institute for Child Health Improvement, she co-founded the Dr. Spock Company in 1999.