Taking a child’s temperature is pretty straightforward, right?

You put the thermometer in their mouth, or ear, or on their forehead, keep it there for as long as needed, then read what it says. Simple!

Unfortunately our testing has found that finding out your child’s temperature is more tricky than you’d expect, due to a number of factors.

“We found that it can be confusing to know what temperature constitutes an actual fever,” says ÌÇÐÄVlog baby and kids expert Kim Gilmour.

It does depend on things like age, what part of the body you’re measuring, and the environment.

“Also, some thermometers convert the reading to what might be either a core temperature or an oral equivalent, adding to the confusion, and they don’t always make this clear in the instructions.”

What temperature is a fever?

Normal body temperature is generally 36–37°C, though this varies from person to person and can also be dependent on the time of day.

A fever is often defined as an oral temperature over 37.5°C for mild cases, or over 38.2°C in more severe cases.

Fever passes as the body fights off the disease, but babies with fever – especially those under three months of age – must be checked by a doctor in case the illness is serious. 

Always seek medical advice if you’re concerned about your child’s temperature or health.

Where are you taking the temperature from?

If you use a digital probe thermometer to take an oral temperature, you’ll get a different reading than if you take an axillary (armpit) temperature. That’s because different parts of the body are slightly different temperatures.

Let’s take oral temperature as a baseline. 

Here are the differences in temperature you’re likely to find if you take a temperature from a different part of the body:

• Ear: 0.3°C to 0.6°C higher than oral
• Armpit: 0.3°C to 0.6°C lower than oral
• Forehead: 0.3°C to 0.6°C lower than oral

Calculating oral equivalent temperature

To figure out the equivalent oral temperature when you’re taking a forehead reading, you’ll need to add 0.3°C to 0.6°C. 

To calculate the oral temperature from an ear reading, you’ll need to subtract 0.3°C to 0.6°C.

Is it a fever or not?

Imagine that you’ve taken your child’s temperature using an ear thermometer, and it comes back with a reading of 38.2°C – they have a fever, right? Well, maybe not. The equivalent oral temperature could be anywhere from 37.6°C to 37.9°C – warm, but maybe not a fever. 

BUT is the temperature readout the actual ear temperature, or the oral equivalent temperature? If the thermometer is displaying the oral equivalent temperature, then your child does have a fever. 

Confusing, right?

Which temperature is which?

When we tested baby thermometers, it was sometimes difficult to find out what kind of temperature reading the thermometer was giving: was it giving the core temperature, the oral temperature, the oral equivalent temperature, or the temporal artery temperature?

Even the instruction manuals often weren’t clear, and in some instances we had to contact the manufacturers directly to clarify which temperature their thermometers display. 

“Parents buying a thermometer off the shelf expect to know what type of temperature the thermometer is displaying, but many of the manuals don’t make it clear,” says Kim. 

Accuracy

Knowing whether your child has a fever can be even trickier if the thermometer you’re using is inaccurate. 

We found that good digital probe thermometers can meet their claimed accuracy to within 0.1°C. 

Ear and forehead thermometers are less accurate, but they don’t generally claim to be as accurate as digital probe thermometers. Our testing has found that they’re generally accurate to within 0.2°C.

Correct usage is the key to getting an accurate reading, so read the instructions or get a medical expert’s advice.

How to take your child’s temperature more accurately 

Dos:

• Find out what your child’s ‘baseline’ temperature is when they’re healthy. 
• Always take your child’s temperature in the same way and in the same location: oral, rectal, armpit, ear, forehead, etc.
• Read the thermometer instructions so you know how to use it and what kind of body temperature the thermometer is displaying – is it the tympanic (ear) temperature, or the oral equivalent?
• Make sure your child stays still while you’re taking their temperature. (Easier said than done, we know!)
• Make sure the ear thermometer is placed correctly in the ear, otherwise you may get an inaccurate reading. A build-up of earwax can also interfere with accuracy.
• Any baby under three months of age who has a fever should be taken straight to the nearest emergency department. 

Don’ts:

• Don’t take your child’s temperature straight after they’ve bathed or showered, or after they’ve been active. It can raise their core temperature, so you may not get an accurate reading. If they’re sweating, it can also affect the reading of a forehead thermometer. 
• Don’t take your child’s temperature straight after they’ve had food or drinks, if you’re using an oral thermometer. Hot or cold foods could influence the reading. Wait 15 to 30 minutes before taking their temperature.
• Don’t use ear thermometers on infants under six months – they’re generally not recommended due to the size of babies’ ear canals.
• Don’t use forehead thermometers on infants under three months; they’re generally not considered accurate for babies this young.
• Don’t bother using strip-type thermometers. Our testing has found that they’re very easy to use, but not very accurate. 
• Don’t use mercury or alcohol thermometers. If they break, they can cause injury or poisoning. 

The post When is a fever really a fever? appeared first on ÌÇÐÄVlog.

A fever is usually defined as an elevated body temperature of 38°C or higher (normal body temperature is generally 36–37°C).  Since there can be as little as 1°C difference between a healthy temperature and a fever, getting an accurate reading is important. 

But how do you know that your thermometer is giving you an accurate temperature reading?

Cold, flu and COVID-19: It’s very difficult to distinguish between the symptoms of COVID-19, influenza and a cold. If you have symptoms such as a sore throat, headache, fever, shortness of breath, muscle aches, cough or runny nose, you may need to self-isolate and to be assessed by a medical professional. You may also need testing for COVID-19. 

How accurate are personal thermometers? 

Our personal thermometer reviews test digital probe thermometers, infrared thermometers (forehead and ear) and the Nurofen Feversmart Temperature Monitor which sticks directly to the skin. 

Most thermometers claim to be accurate within 0.1–0.3°C. But our team of experts found that some personal thermometers can be off by as much as 0.83°C, meaning that a healthy temperature of say, 37.4°C could be misread as a fever of 38.2°C, causing unnecessary alarm and even unwarranted trips to the emergency room. 

While we mostly found thermometers which showed incorrectly elevated temperatures, there have also been consumer reports of thermometers showing readings lower than the actual temperature, leading to missed fevers.

Six of the 15 thermometers in our latest test did not meet their own accuracy claims. All the models that failed to meet their accuracy claims were forehead infrared thermometers (one was a forehead/ear thermometer), as well as the Nurofen Feversmart Temperature Monitor, which is a patch you place directly on your skin. 

We also tested repeatability, which measures the consistency of the thermometer’s readings. Six of the 15 thermometers did not achieve good repeatability, meaning they displayed variable temperatures when testing the same person over a short period of time. Those with poor repeatability were all either ear or forehead infrared thermometers.

Which thermometers can you trust?

We recommend thermometers that score at least 75% overall, and are accurate and easy to use, with no unsecured button batteries. Our top rated thermometers give accurate and consistent results and if used correctly you can be confident they are correctly diagnosing your child’s temperature. 

A good thermometer is generally considered to be accurate to within 0.3°C. Our top-rated digital probe thermometers can meet their claimed accuracy of within 0.1°C. 

Ear and forehead thermometers are generally less accurate, but our testing has found that the better models are still accurate to within 0.2°C.

Remember to check for other symptoms

Emergency paediatrician Dr Ruth Barker says that while noticing a fever is helpful, monitoring other symptoms is just as important.

“Parents need to remember that the degree of fever is not the sole indicator of illness,” says Barker. “It should form part of a broader assessment which involves the child’s level of alertness, their colouring – if they look flushed, or pale or grey, their food and water intake and the presence of other symptoms like vomiting.

“Regardless of what the thermometer says, if you think your child is sick, you should seek medical attention.”

Case study: A close call with a newborn

Katie* believes she missed a fever in her newborn son because of an inaccurate forehead thermometer.

“One day when my son was about two months old, I noticed he was really irritable and I suspected he might have a fever, but he had no other symptoms,” she says. 

Katie took her son’s temperature with a forehead thermometer and it came up as 36°C.

“I had a feeling something wasn’t right so I tried to book him into the doctor. The receptionist asked if he had a fever and I said no, so she said it wasn’t urgent and booked me an appointment the next day.

“The next day, before leaving for the doctor, I took my son’s temperature again and got the exact same reading as the day before. But when the doctor took his temperature, it showed a very high fever, so my son was immediately given Panadol and taken in the ambulance to the emergency department. 

“We were sent to another hospital where our son was admitted and treated with regular antibiotics and Panadol for his high temperatures. Luckily he recovered and we were able to take him home after two long nights in hospital. We never found out the cause of his illness – it was recorded as an infection of unknown cause.

“I kept thinking that if only we had identified his fever earlier he could have had Panadol and antibiotics before things escalated.”

*Not her real name

Case study: A false positive

Jaime says her newborn daughter was admitted to hospital unnecessarily after an inaccurate forehead thermometer reading.

“When my daughter was 11 days old we had the doctor come for a home visit because she was sneezy and snotty,” Jaime says. 

The doctor used a thermal forehead thermometer and got a temperature reading of 38.4. He told Jaime her young daughter likely had an infection and needed to head to children’s emergency just to be safe. 

“When we arrived, the medical staff said even though she didn’t have any symptoms, they needed to check for everything because of the high temperature reading she had had at home,” says Jaime. “So they used a cannula to draw bloods and they wanted to take spinal fluids too, but I refused. 

“We had to stay in hospital for 24 hours before they told us that she had no infection, no symptoms and no fever readings – there was nothing wrong with her at all. 

“I was so shaken and exhausted by this experience. As a first-time mum I trusted the thermometer and the doctor’s comments over my own instincts and I still beat myself up over it today.”

Case study: Problems in childcare centres

Childcare worker Sarah says she’s noticed the forehead scanning thermometers used in her centre are often inaccurate.

“Recently I noticed that one of the babies seemed to have a fever, so I checked and got a reading of 38.0,” says Sarah. “It was quite a young baby so I immediately alerted my boss to the high temperature. She came over to check herself and got a reading of 36.7, so said there was no need to alert the parents.”

Sarah was certain the baby was unwell and the centre continued to check her temperature throughout the day. 

“We kept getting such different readings that we never ended up alerting the parents,” she says. 

“There have been lots of times I’m sure a child has a fever but the inconsistent readings mean that the parents aren’t alerted.

On the flip side, Sarah says there have also been times when the centre has sent kids home with a fever, only for their parents to later report they didn’t have a fever at all when they got home. 

“One parent actually brought their own digital probe thermometer from home so that we could get accurate readings for their child.

“It’s hard because we’re asking parents to trust us with their kids, but we don’t trust the thermometers we’re using and the results we are getting.”

How to get an accurate reading

Even if you have a highly accurate thermometer, you can still get an inaccurate reading if you don’t perform the test properly. Temperature readings are affected by a number of different factors, including:

Measurement location

Different parts of the body are slightly different temperatures, so you’ll get different readings depending on where you test. Ear readings will generally be 0.3 to 0.6°C higher than oral readings, while armpit and forehead readings can be 0.3 to 0.6°C lower than oral readings.

Tip: Make sure you always test at the same location so you can accurately track changes over time. 

Baseline temperature

Different people will have a different healthy baseline temperature, so it’s helpful to refer to a known baseline temperature to accurately diagnose a fever.

But body temperature can vary by as much as 0.5°C throughout the day, with lower temperatures in the morning and higher temperatures in the evening. A woman’s temperature can also fluctuate with their menstrual cycle – generally it’s 0.5°C higher after ovulation, then goes back down when you get your period.

Tip: Take a reading in the morning and the evening when you’re feeling well to establish your average healthy body temperature.

Food/drinks and activity

Consuming hot or cold food or drinks can affect oral temperature readings, while exercise or a hot shower can elevate forehead temperature.

Tip: Stay as still as possible during the reading and don’t take a forehead reading directly after a bath, shower or exercise. Wait 15 to 30 minutes after eating or drinking to take an oral temperature.

Incorrect use

You need to read the thermometer’s instructions and follow them carefully to get an accurate reading. 

Tip: For oral readings, place the probe under the tongue and close the mouth. For armpit readings, keep the arm tightly pressed against the body. For ear readings, make sure the probe is positioned correctly.

Paediatrician’s tip: Dr Barker says that many parents simply feel their child’s forehead. “I often ask parents if their child feels warm, hot or burning,” says Barker. “It’s subjective, but the more parents practice it, the easier it gets. It can also be a helpful second check if what the thermometer is telling you doesn’t seem right.”

Advice for choosing a thermometer 

While choosing a thermometer with accurate readings is important, there are other factors to consider when deciding which model to buy.

Decide which type you want

There are three main types of personal thermometer on the market and each has their advantages and disadvantages.

Digital probe thermometers

These are usually fairly accurate and affordable but some take quite a long time to deliver a reading so may be tricky to use on kids. Dr Barker recommends buying a digital probe thermometer as the most accurate and convenient option that will suit the whole family.

Ear thermometers

These deliver fast readings but can be difficult to position correctly and readings can be affected by ear-wax build up. Dr Barker says parents of babies under 12 months should steer clear of ear thermometers, saying they are tricky to use with small ear canals and therefore can often be out by as much as 2°C.

Forehead thermometers

These are quick and non-invasive, but results can vary depending on skin type, skin colour, sweat, or whether the subject is wearing make-up. They are also not recommended for use on infants under three months.

Features to look for

• a large, backlit display 
• an audible beep that tells you when the reading is ready
• a colour change or tone when a fever is detected
• a memory function that displays the last temperature reading (or multiple previous readings) recorded so you can track changes
• a model that doesn’t use button batteries or has a safe battery compartment which does not allow children to access dangerous button batteries.

How are thermometers regulated?

A digital thermometer which is intended to be used for diagnosing fevers or monitoring human body temperature is considered a medical device and must be included on the Australian Register of Therapeutic Goods (ARTG). 

This means personal thermometers are required by law to comply with set out by the Therapeutic Goods Administration (TGA). 

The regulations state that medical devices like thermometers that have a measuring function must provide “accurate, precise and stable measurements” appropriate for that device.  

There is a standard (ISO 80601-2-56:2009) which specifies the general and technical requirements for thermometers, including a requirement that the thermometer is accurate within 0.3°C. 

However this standard is not mandatory to meet TGA requirements, meaning thermometers aren’t strictly required to achieve this accuracy in order to be listed on the ARTG.

And while manufacturers are required to undergo auditing by an independent third party and to provide evidence that their product complies with the regulatory requirements, products are not usually tested by the TGA before being sold. 

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