What to Expect the Toddler Years (204 page)

Taking your child’s temperature can not only clue you in to an illness in the first place, but taking it during the course of an illness can help to answer questions about your child’s progress and response to treatment. In most cases, you can get all the information you need by taking the temperature once in the morning and once in the evening. Take it in-between only if your toddler suddenly seems worse. If he or she seems better, and your lips tell you that the fever is down, you don’t really need a second opinion from the thermometer. And both you and your toddler can avoid going through the ordeal of temperature-taking.

The four parts of the body that can most accurately reflect core body temperature are the mouth, the rectum, the axilla (armpit), and the ear canal. Since putting a thermometer in the mouth of a toddler is ineffective (most doctors don’t recommend taking temperatures orally until a child is at least four or five and can be counted on to keep the thermometer under the tongue long enough for the temperature to be measured), oral temperature-taking won’t be an option for quite a while, which leaves you with the rectal or axillary route for now. Or you can invest in a tympanic (or infrared auditory canal) thermometer, which reads body temperature in an instant through the ear.

The American Academy of Pediatrics recommends that parents no longer use glass mercury thermometers (to avoid accidental mercury exposure), so be sure to properly dispose of any glass mercury thermometers you may still have lying around. Instead use a digital, tympanic, or temporal artery thermometer. (There are also pacifier thermometers, but they are used with babies who are too young to use an oral thermometer and they are not always the most reliable.)

Digital thermometers are safe, easy to use, readily available, and relatively inexpensive. They can be used to take rectal, oral, or axillary reading (but don’t use the same thermometer for oral and rectal). Digital thermometers register more quickly than the glass mercury ones did—about 20 to 60 seconds—which is an advantage when dealing with a squirmy toddler. Plus, they are easier to read. Look for one that has a flexible tip for extra comfort. You can buy disposable covers in drugstores, but they aren’t really necessary.

Tympanic thermometers are fairly expensive and though they provide a reading in just seconds, they can be difficult to position. In general, a reading in the ear is less reliable than an axillary one, and neither is as accurate as a rectal reading—still considered the gold standard. Wax in the ear can also interfere with the temperature reading. You may want to ask the doctor for a demonstration on proper use.

Temporal artery thermometers measure temperature with a transducer that rolls across the forehead, and have been shown in studies to be very accurate (though still not as accurate as a rectal). They are easy to use and are becoming more widely available, though they are expensive.

Preparing your toddler.
Since vigorous activity or crying can raise a child’s temperature, try to take your toddler’s temperature after a period of about 30 minutes of rest or quiet play (coax a worked-up child to listen to a story or watch a video for a while, if necessary). If there’s been crying or screaming, wait until your child has calmed down before pulling out the thermometer. Though an oral temperature (appropriate only for older children) shouldn’t be taken within
half an hour of consuming hot or cold drinks or foods (since they could affect the readings), this precaution isn’t necessary when taking rectal or axillary temperatures. But these readings can be affected by such factors as room or air temperature. So wait, too, if your child has been playing in an overheated apartment (open a window), just came in from the cold, or recently climbed out of a warm bath.

Taking a rectal temperature.
Clean the end of the thermometer with rubbing alcohol or soap and water and rinse with cool (not hot) water. Turn it on and make sure you’ve erased any old readings from its memory. (Since every digital thermometer is different, be sure to read the instructions
before
you have a half-naked toddler in your lap). Prepare the thermometer by lubricating the sensor tip and the toddler’s bottom with Vaseline Sitting on a bed or sofa, place your bare-bottomed toddler tummy down on your lap (see the illustration below). A pillow to support your child’s head may increase comfort. Alternately, place your child’s tummy down on a couch, bed, or changing table with a small pillow or rolled-up towel under the hips to help raise the buttocks for easier insertion. The advantage of this position is that the child feels less controlled, and many toddlers will be less likely to fight if they aren’t restrained. The disadvantage: You have less control—and for some children, this means they won’t lie still.

The rectal thermometer is most often used with toddlers.

The axillary thermometer is useful when a child has diarrhea or refuses to allow a rectal thermometer to be inserted.

If your child seems apprehensive, speak reassuringly and try distraction (with a couple of favorite songs, a book, a toy, or even a DVD). This is easiest to do if you have another person to assist—a spouse, an older child, a grandparent, or a friend. Spread the buttocks with one hand, exposing the rectal opening. With the other, slip about an inch to an inch and a half of the tip of the thermometer into the rectum. Stop sooner if you meet resistance; don’t force. Hold the thermometer in place between your index and middle fingers, with the other fingers of that hand pressing the buttocks together to keep the thermometer from sliding out. Keep the thermometer in place for 2 minutes, until it beeps (times vary). To avoid injury or discomfort, remove it immediately if you get very active resistance and no one is around to help you restrain your toddler. Even if the thermometer has been in for only half a minute or so, it will have
registered to within a degree of the actual temperature, giving you a rough figure to use in your assessments and/ or report to the doctor. Wipe the thermometer with a piece of tissue before reading. (You may want to put the thermometer down—the reading won’t change—to be read after you’ve rediapered your toddler.) It’s a smart idea to write down the temperature and the time of day it was taken before you forget it. Eventually, by age four or five, your child will most likely be able to sit still longer and will let you take his or her temperature orally.

The ear must be pulled upward (A) to straighten the ear canal (B) and permit a clear “view” for the tympanic thermometer. If the canal isn’t straightened (C), the angle may distort the reading.

Taking an axillary, or underarm, temperature.
Use this method of temperature taking when your toddler won’t lie still for a rectal or has diarrhea or when there is no rectal thermometer is available (do not use an oral rectally). Clean the thermometer with rubbing alcohol or soap and water and rinse with cool (not hot) water. Again, you can use disposable covers available in drugstores, but they are not necessary. Remove your toddler’s shirt so that no clothing will come between thermometer and skin, and be sure the armpit is dry. Place the tip of the thermometer well up into the armpit, holding the arm down snugly over it by pressing elbow against side. (A good tip: Hold your child sideways on your lap, with the arm with the thermometer against your chest, where you can keep your toddler close and still.) Hold the arm in place for at least 4 or 5 minutes (8 minutes is even better) for a glass thermometer and according to directions on a digital. (A digital reading may be more accurate if you keep your child’s arm at his or her side for 5 minutes before inserting the thermometer; axillary readings appear to be least accurate when a fever has just begun to rise.) Sing, read, or play a tape or video to keep your toddler still. (You shouldn’t leave a toddler unattended when taking his or her temperature anyway.)

Taking a tympanic temperature.
Carefully follow the directions that came with the thermometer. Ideally, ask your child’s doctor or nurse-practitioner to demonstrate the proper technique for taking a tympanic temperature. Basically, it’s just a matter of aiming the instrument correctly into the ear canal; in literally 1 second you get a reading. In general, a reading from the ear is less reliable than an axillary one, and neither is as accurate as a rectal reading—still considered the gold standard.

Taking an oral temperature.
You can begin taking oral temperatures when your child can hold the thermometer securely under the tongue with lips closed and can understand
and
follow directions not to bite down on it—usually at about age four or five, but occasionally earlier. For a good oral temperature reading, the thermometer should be tucked well into the pocket under the tongue and held there until it beeps. (If your child is mouth-breathing because of a stuffy nose, it may take longer for the thermometer to register.) A pacifier thermometer takes about 3.5 minutes and is somewhat less accurate, but is safe for toddlers. Wait 15 minutes after a child has had hot or cold food or drink before inserting
any
oral thermometer.

Arectal temperature is believed to be the most accurate since it registers core body temperature, but the oral temperature is presently considered the standard. Temperatures obtained rectally, as they are most frequently in toddlers, are usually one-half to a full degree higher than those obtained orally; axillary readings are generally about 1 degree lower, though they can be off even more at the onset of a fever. Generally, 98.6°F (37°C) is considered normal for an oral temperature, 99.6°F (37.6°C) for a rectal, and 97.6°F (36.5°C) for an axillary—although recent studies suggest that “normal” may vary considerably from person to person, and that the average may be a bit lower. A reading of 102.2°F (39°C) taken rectally is the equivalent of 101.2°F (38.4°C) taken orally and 100.2°F (37.9°C) by armpit. A tympanic thermometer can be adjusted to give a reading that is comparable to a rectal or an oral reading.

Digital thermometers are much easier to read than their old-fashioned mercury-glass counterparts. Write down your toddler’s temperature, along with the time it was taken. Jot down, too, how your child appears and what his or her behavior is like. When you report the temperature to your doctor, be sure to indicate how it was taken and how your child looks and acts.

After reading and recording the temperature, wash the thermometer with cold, soapy water, rinse and then swab the sensor tip with rubbing alcohol. Be careful not to wet the digital display, on/off button, or battery cover. And be sure to read the manufacturer’s instructions for proper storage as well. (As always, keep the device away from tiny hands—the thermometer is not a toy.)

In most cases, behavior is a better gauge of how sick a toddler is than body temperature. A young child can be seriously ill, with pneumonia or meningitis for example, and have no fever at all, or have a high fever with a mild cold. So it’s important to base your assessment of your child’s condition not just on body temperature, but on symptoms that go with it as well. See page 570 for tips on when to call the doctor for a toddler with fever.