Taking a Child’s Temperature
POLICY: Temperatures will be taken per center’s policy. Digital thermometers will be used. Do NOT use mercury thermometers as it can break and release highly toxic mercury fumes.
PURPOSE: To detect illness early in order to minimize the spread of infection and ensure the child is safe to attend childcare.
To protect the health of the children and staff.
There are some regulation requirements that apply only to child care centers licensed with mildly ill children programs. Unless it is part of the incidental medical services (IMS)*, staff should NOT offer taking Rectal temperatures in child care centers or family child care homes. Regardless of parent’s consent, this should not be practiced in a child care setting unless it is part of IMS (CDSS, 2023). (See Title 22, Division 12, Chapter 1, Subchapter 4 for licensing information regarding IMS)
BACKGROUND:
When Does Your Child Have a Fever?
- Average body temperature is around 98.6° F (37.0° C)
- A fever is an elevated body temperature with these readings:
- Forehead or Ear temperature: 100.4° F (38.0° C) or higher
- Oral (mouth) temperature: 100° F (37.8° C) or higher
- Under the arm (armpit) temperature: 99° F (37.2° C) or higher
- Caution: Ear temperatures are not accurate before 6 months of age
Where to Take the Temperature
- Rectal* temps are the most accurate but are not recommended in the child care setting. Forehead temps (temporal) are the second most accurate. Oral and ear temps are also accurate if done properly. Temps done in the armpit are the least accurate. Armpit temps are useful for screening at any age.
- Age under 3 months old: An armpit temp is the safest and is good for screening if taken right. New research shows that forehead temps may also be accurate under 3 months of age. If the armpit temp is above 99° F (37.2° C), re-check it and notify the parents/guardians. If young babies under 3 months old have a fever, they should get medical advice right away (not the next day) at either their doctor’s office, an urgent care, or possibly an emergency room.
- Age 3 months to 4 years old: Forehead temps are the best. An ear thermometer can be used after 6 months old. An armpit temp is good for screening if it is taken right.
- Age 4 years and older: Safe to take the temp orally (by mouth). Ear and forehead thermometers are also good.
- Digital (electronic) thermometers are easily found in stores. Most of them give an accurate temp in 10 seconds or less. The AAP suggests you replace any glass thermometer with one of these products.
- Refer to the Inclusion/Exclusion Guidelines.
PROCEDURE:
Armpit Temperature: How to Take
- Age: Any age for screening
- Put the tip of the thermometer in the armpit. Make sure the armpit is dry.
- Close the armpit by holding the elbow against the chest. Do this until it beeps (about 10 seconds). The tip of the thermometer must stay covered by skin.
- The child has a fever if the armpit temp is above 99.0° F (37.2° C). If you have any doubt, take the child's temp by forehead.
Oral Temperature: How to Take
- Age: 4 years and older
- If the child had a cold or hot drink, wait 30 minutes.
- Put the thermometer under one side of the tongue towards the back. It's important to put the tip in the right place.
- Have your child hold the thermometer with his lips and fingers. Don't use the teeth to keep in place. Keep the lips sealed until it beeps (about 10 seconds).
- The child has a fever if the temp is above 100° F (37.8° C).
Ear Temperature (Tympanic): How to Take
- Age: 6 months and older (not accurate before 6 months)
- This thermometer reads the heat waves coming off the eardrum.
- A correct temp depends on pulling the ear backward. Pull back and up for children over 1 year old.
- Aim the tip of the ear probe between the opposite eye and ear.
- Caregivers like this thermometer because it takes less than 2 seconds. It also does not need the child to cooperate. It does not cause any discomfort.
- Caution. Being outdoors on a cold day will cause a low reading. Your child needs to be inside for 15 minutes before taking the temp.
- Earwax, ear infections and ear tubes do not keep from getting correct readings.
Forehead Touch Temperature: How to Take
- Age: Any age
- This thermometer reads the heat waves coming off the temporal artery. This blood vessel runs across the forehead just below the skin.
- Place the sensor head at the center of the forehead touching the skin.
- Slowly slide the thermometer across the forehead toward the top of the ear. Keep it in contact with the skin.
- Stop when you reach the hairline.
- Read your temp on the display screen.
- Note: some newer forehead thermometers don't need to slide across the forehead. Follow the box directions on how to take the temp.
- Used in more doctor's offices than any other thermometer.
- Caregivers like this thermometer because it takes less than 2 seconds. It also does not need the child to cooperate. It does not cause any discomfort.
- Caution: forehead temperatures must be digital. Forehead strips are not accurate.
Forehead No-Touch Temperature: How to Take
- Age: any age
- Aim the thermometer at the center of the forehead.
- Stay less than 1 inch (2.5 cm) away. Do not touch the forehead.
- Do not move the thermometer.
- Press the measurement button.
- How to use of non-contact infrared thermometers (NCITs) (FDA, 2020)
Remember: Fever is just one sign of illness, but an important one. Parent/guardians should consult child's healthcare provider for any questions about fever.
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