Which Thermometers Are Most Accurate in Children?

Winter is taking a tole on nurse practitioners that treat children.  The number of two-year-olds I have struggled with to do a proper otic exam is approaching infinity.  Although small, these kids can kick hard.  My nerves and gut are looking forward to Spring's warmer weather.  Given the resolve of small children to avoid all medical procedures, it is tempting to use devices like the tympanic thermometer or temporal artery (forehead) thermometer to avoid the dreaded rectal temperature taking.  But are these methods accurate?

Multiple research studies have evaluated the difference in accuracy between rectal, tympanic and temporal artery thermometers.  Unfortunately, they all arrive at the same conclusion- the standard rectal temperature route is most accurate in children.

The tympanic thermometer is repeatedly shown to be the most inaccurate choice for temperature-taking in children.  One study shows that tympanic thermometers fail to correctly diagnose fever in 3-4 out of 10 febrile children.  

The temporal artery thermometer which reads temperature from the forehead has proven more accurate than the tympanic route.  Temporal artery readings still did not prove as accurate as rectal thermometers.  The temporal artery thermometer overestimates temperature in afebrile children and underestimates temperature in febrile children.  Although environmental temperature does not effect the accuracy of this device, accuracy can be affected by perspiration and recent activity level. 

Sorry NP's (...and kids), based on the inaccuracy of tympanic and temporal artery thermometers, pediatric physician organizations continue to recommend rectal thermometers as the standard of care in children. 

 

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