Temperature and Fever

Willow suffered from Roseola recently. WebMD has a great Topic Overview on Roseola. It's basically a fever that lasts a few days and ends with a rosy-pink rash.

I got a call from daycare on Monday just after Noon that they had taken Willow's temperature (in her armpit) and it was 100.9 degrees Fahrenheit. Since Texas regulations say that if the armpit temperature is above 100.4 degrees the child must be sent home, I went and picked her up and took her home. This made me curious about temperature. Especially after I used our Temporal Artery Thermometer (which is designed for use on the forehead and behind the ear) and I got a different reading every time.

I was pretty sure that the rectal temperature was the most accurate and frankly I was pretty surprised that they could get Willow to stay still long enough to get a good armpit reading. Also I didn't know what kind of thermometer they used and I assumed they used a digital thermometer.

**As an aside, apparently Texas regulations add 1 degree to the armpit temperature from what the oral temperature would need to be to send a child home. This means supposing that her armpit temperature was 100.9, that assumes her oral temperature would be 99.9.**

The Mayo Clinic has a great article on Thermometer Basics (They also have a slide show on choosing a thermometer). They say that knowing your thermometer options is a must. "Years ago, a glass mercury thermometer was a staple in most medicine cabinets. Today, mercury thermometers have largely been replaced by digital thermometers.

"Regular digital thermometers use electronic heat sensors to record body temperature, often in 30 seconds or less. Regular digital thermometers can be used in the mouth, armpit or rectum. Digital ear thermometers, also called tympanic thermometers, use an infrared ray to measure the temperature inside the ear canal. They're even quicker than regular digital thermometers, often measuring body temperature in just a few seconds. A digital pacifier thermometer is another option for young kids.

"If you want to invest in a single thermometer for the entire family, a regular digital thermometer is probably best. If you'd like the option to use an ear thermometer or a pacifier thermometer, you might want to keep one of each on hand, too."

Baby 411, a book which I always recommend to new moms because it's so well written and easy to understand, says that ear thermometers are pretty sucky because they often overestimate temperature (on the high side worrying parents even more) and you really have to position it "just right" to get a good reading since it looks at the ear drum to get the temperature.

So, I ditched the temporal thermometer and went with my trusty digital thermometer. We don't have a mercury thermometer and Willow wouldn't sit still for as long as she would need to to get a reading with a mercury thermometer anyway.

According to WebMD, "The goal of taking a temperature is to assess how warm it is inside of the body. This means that the most accurate measurement will be one taken inside the body, which means rectally." (just like I thought) Additionally, according to Children's Hospital: "Most physicians recommend taking a baby's temperature rectally, by placing a thermometer in the baby's anus. This method is accurate and gives a quick reading of the baby's internal temperature. Axillary (underarm) temperature measurements must be held in place for 10 minutes. The tympanic (ear) type thermometers may not be accurate for newborns and require careful positioning to get an accurate reading. Skin strips that are pressed on the skin to measure temperature are not recommended for babies. Touching a baby's skin can let you know if he/she is warm or cool but you cannot measure body temperature simply by touch."

So, now we know about taking temperature and thermometers but, what constitutes a fever?

According to FamilyDoctor.org, "A normal temperature is about 98.6°F when taken orally (by mouth). Temperatures taken rectally (by rectum) usually run 1° higher than those taken orally. So a normal temperature is about 99.6°F when taken rectally. Many doctors define a fever as an oral temperature above 99.4°F or a rectal temperature above 100.4°F."

According to KidsHealth.org, "...how high a fever is doesn't tell you much about how sick your child is. A simple cold or other viral infection can sometimes cause a rather high fever (in the 102°–104° Fahrenheit / 38.9°–40° Celsius range), but this doesn't usually indicate a serious problem. And serious infections may cause no fever or even an abnormally low body temperature, especially in infants."

When I took Willow to the doctor, her Doctor told me that giving medicine for a low-grade fever was something that you should consider NOT doing unless your baby in uncomfortable because the fever is there to fight the infection (and the medicine treats the fever but not the infection). And FamilyDoctor.org agrees; "Fevers are a sign that the body is fighting an infection, so you may want to avoid giving medicine if your child is running a low-grade (up to 100.2°F) fever. The main reason to treat your child is to make him or her feel better. When your child is achy and fussy or his of her temperature is above 100.2°F, you may want to give him or her some medicine."

And when should you call the doctor?

If your child has any of the warning signs listed in the box below, call your family doctor.

Under 3 months old. Call your doctor right away if your baby's temperature goes over 100.4°F rectally, even if he or she doesn't seem sick. Babies this young can get very sick very quickly.

Three to 6 months old. Call your doctor if your baby has a temperature of 101°F or higher (even if your baby doesn't seem sick) or a temperature of 99.5°F that has lasted more than 24 hours.

Six months and older. If your child has a fever of 101.4°F, watch how he or she acts. Call your doctor if the fever rises or lasts for more than 3 days. In children 3 months to 2 years of age, if the temperature is 103°F, call your doctor even if your child seems to feel fine.

Yesterday Willow's fever broke and she broke out in a rash. She has been just fine ever since. She still has a slight rash but she is happy as a clam.