Measuring fever in children

Children are said to have a fever from 38.5 °C, babies under three months already from 38 °C. The most reliable way to determine body temperature is with a clinical thermometer.

Especially for small children, it is important that taking a temperature is quick and requires as little effort as possible, such as dressing and undressing or holding still. How long the measurement takes depends on where the fever is taken and which thermometer is used.

How can I tell that my child has a fever?? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Children can usually be seen to have a fever: A hot, reddened face, tired or glazed eyes and otherwise pale skin are typical signs. The first thing many mothers and fathers do when they suspect their child has a fever is to put their hand on the child’s forehead. If the forehead or neck feels hot, this may indicate a fever. Many children have no appetite or are tearful. Some children are also very thirsty.

Which thermometers are available and how accurate are the measurements?? Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Battery-operated digital thermometers (contact thermometers) can measure body temperature in the buttocks (anus), in the mouth (under the tongue ), or in the armpit. Infrared and chemical thermometers can be used to take the temperature in the ear or on the forehead. They are more expensive than digital thermometers. To avoid measuring errors, it is important to follow the operating instructions for all models.

The most accurate results are obtained by measuring the temperature in the buttocks or – for children over four years of age – in the mouth. However, taking a temperature in the armpit, ear or forehead is more comfortable for a child. When taking measurements in the mouth or under the armpit, a child must already be able to follow along well.

It is also possible to combine two measuring methods: If the ear or forehead thermometer shows an elevated body temperature, you can check it again with a measurement in the buttocks.

Taking a temperature in the buttocks information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Taking a temperature in the buttocks provides reliable results, but can be uncomfortable for the child. Before inserting the thermometer into the anus, it is best to apply a thin layer of a greasy cream so that it slides better and does not hurt the child.

For reliable measurement results, it is sufficient to insert only the tip of the thermometer, i.e., 1 to 2 centimeters. Babies are best placed on their backs and their legs held up for this purpose. Older children usually prefer to lie on their stomach.

It is important to clean hands and clinical thermometer thoroughly after taking a temperature, because pathogens can be found in the buttocks.

Taking a temperature in the mouth Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

To measure fever in the mouth, the clinical thermometer is first freshly cleaned. Then it is placed under the tongue at the back. Taking a fever in the mouth is quite accurate. However, the child must cooperate: That is, he or she must keep the mouth closed and the tongue still during the measurement, which can be difficult for younger children.

The measurement is falsified if the child has drunk hot or cold beverages shortly beforehand.

Taking a temperature under the armpit Information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

When taking a temperature under the arms, the thermometer is placed in the armpit and the arm is held close to the body. This is simple, but can be inaccurate if the child moves too much during the measurement: then the measured values can deviate up to 2 degrees from the real body temperature. On average, taking a fever in the armpit underestimates body temperature by about 0.5 degrees.

Ear thermometer information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Special infrared thermometers for measuring fever in the ear determine the heat emitted by the eardrum. Such ear thermometers work very fast, but are significantly more expensive than digital thermometers.

For ear thermometers, it is important that the probe of the thermometer points towards the eardrum. This is more easily achieved by pulling the child’s ear slightly backwards-upwards. The measurement results obtained in this way are on average about 0.3 degrees below the actual body temperature.

It is not easy for the inexperienced to find the right place in the ear, especially with babies. The correct use of an ear thermometer is described in the user manual. If a few measurements have been taken in the ear and, for comparison, in the buttocks, and the results are similar (with a difference of 0.3 to 0.5 degrees), it can be assumed that the measurement in the ear is equally reliable.

Forehead thermometer information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Forehead or temple thermometers are easy to use, comfortable for the child, and work even when the child is asleep. They are available, for example, as infrared, liquid crystal, or chemical thermometers.

However, they are less accurate than other measurement methods because, for example, sweat on the skin affects the measured values. Therefore, they are not currently recommended for use when an accurate measurement is needed.

Canadian Agency for Drugs and Technologies in Health (CADTH). Non-Contact Thermometers for Detecting Fever: A Review of Clinical Effectiveness . 20.11.2014. (CADTH Rapid Response Reports).

National Institute for Health and Care Excellence (NICE). Fever in under 5s: assessment and initial management . 22.05.2013. (NICE Clinical Guidelines; Volume 160).

Niven DJ, Gaudet JE, Laupland KB, Mrklas KJ, Roberts DJ, Stelfox HT. Accuracy of peripheral thermometers for estimating temperature: a systematic review and meta-analysis . Ann Intern Med 2015; 163(10): 768-777.

IQWiG health information should help to understand the advantages and disadvantages of important treatment options and health care offers.

Whether one of the options we have described is actually useful in an individual case can be clarified in consultation with a physician. Health can support, but not replace, discussions with doctors and other professionals. We do not provide individual advice.

Our information is based on the results of high-quality studies. Prepared by a team of authors from medicine, academia, and editorial staff and peer-reviewed by experts outside IQWiG. We describe in detail how we develop our texts and keep them up to date in our methods .

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