I've been waiting for a suitable topic to make my first posting on this listerv from across the Atlantic!
In the UK we have guidance from the National Institute for Health and Care Excellence (NICE) relating to fever in children, which our hospital follows.
Their recommendations are as follows:
Thermometers and the detection of fever
Oral and rectal temperature measurements
· Do not routinely use the oral and rectal routes to measure the body temperature of children aged 0–5 years.
Measurement of body temperature at other sites
· In infants under the age of 4 weeks, measure body temperature with an electronic thermometer in the axilla.
· In children aged 4 weeks to 5 years, measure body temperature by one of the following methods:
o electronic thermometer in the axilla
o chemical dot thermometer in the axilla
o infra-red tympanic thermometer
Healthcare professionals who routinely use disposable chemical dot thermometers should consider using an alternative type of thermometer when multiple temperature measurements are required.
· Forehead chemical thermometers are unreliable and should not be used by healthcare professionals
The full guidance and evidence base behind it is available, free to access, here:
By way of background:
NICE was originally set up in 1999 as the National Institute for Clinical Excellence, a special health authority, to reduce variation in the availability and quality of NHS treatments and care.
In 2005, after merging with the Health Development Agency, NICE began developing public health guidance to help prevent ill health and promote healthier lifestyles. Our name changed to the National Institute for Health and Clinical Excellence.
In April 2013 NICE was established in primary legislation, becoming a Non-Departmental Public Body (NDPB) and placing them on a solid statutory footing as set out in the Health and Social Care Act 2012. At this time NICE took on responsibility for developing guidance and quality standards in social care, and their name changed once more to reflect these new responsibilities.
As an NDPB, NICE is accountable to their sponsor department, the Department of Health, but operationally they are independent of government. Their guidance and other recommendations are made by independent committees. The NICE Board sets its strategic priorities and policies, but the day to day decision-making is the responsibility of NICE’s Senior Management Team (SMT).
The way NICE was established in legislation <http://www.nice.org.uk/About/Who-we-are> means that the guidance is officially England-only. However, NICE has agreements to provide certain NICE products and services to Wales, Scotland and Northern Ireland. Decisions on how NICE’s guidance applies in these countries are made by the devolved administrations, who are often involved and consulted with in the development of NICE guidance. Read more about NICE’s guidance <http://www.nice.org.uk/About/What-we-do/Our-programmes/NICE-guidance> .
I hope the above is helpful to the discussion.
Professor Andrew Rowland BMedSci (Hons) BMBS (Hons) MFMLM MAcadMEd FCEM FRCPCH FRSA
Consultant in Paediatric Emergency Medicine
Local Negotiating Committee Chairman
The Pennine Acute Hospitals NHS Trust
The University of Salford
Churchill Fellow 2014
The Winston Churchill Memorial Trust
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North Manchester General Hospital
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From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Rick Place
Sent: 28 August 2014 13:58
To: [log in to unmask]
Subject: Tympanic vs Temporal temperature measurements
Tastes great? Or less filling?
I cannot remember discussing this recently but we are considering changing our standard temperature measurement (and I fear we are laggards in this regard).
We are still using rectal temps for the young children where we need to be as accurate as possible (operative word: as possible).
In kids over 3 months we are using tympanic temps. We have noted events where the TM temp was significantly different than a rectal temp (e.g. febrile seizures).
On the whole, as Jim Chamberlain noted a number of years ago on a similar posting, you are generally ball-parking temps in the older kids, particularly as we have moved away from a rigid algorithmic approach to pediatric fever.
The ENA guidelines recommend temporal temps for kids older than 3 years and do NOT recommended tympanic temps in this age group.
In the 3 months - 3 year age range, they conclude there is "insufficient evidence" to prefer either.
So for this younger infant/toddler group: what are you doing and does anyone have strong feelings about this one way or the other? Has anyone made a switch between the two recently?
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