Babyquant

Frequently asked questions about measuring temperature in children

[mme_highlight] The cut-off value to be considered a fever depends on how and where the temperature is measured (rectal, oral, armpit, ear or forehead temperature). Rectal temperature is the most accurate. In 4 year old and older children mouth temperatures are also reliable. [/mme_highlight]

Fever is a raise in body’s temperature above a certain temperature that translates a normal response of the body to numerous situations – an infection is the most frequent. The cut-off value to be considered a fever depends on how and where the temperature is measured (rectal, oral, armpit, ear or forehead temperature). Fever is still a matter of concern for most parents as there are many misconceptions, including on the correct way to measure fever in children and on how should measurements be interpreted.

Do parents know how to measure fever?

Regarding fever, as with other health matters, sociodemographic data counts. A study conducted in Harvard with a multiethnic and socially diverse sample of parents, concluded that parents who had not graduated from high school had 5 times the odds of not using a thermometer to check for fever and 3 times the odds of not asking a health care provider for advice.

A study was conducted to compare the accuracy parents’ and nurses’ measurement of fever in children, either using the same home thermometer, either when parents used a home thermometer and nurses used one from the hospital. Results are presents below.

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Accuracy of parents in measuring body temperature with a tympanic thermometer(Study Design: Parents and then nurses measured the temperature of 60 children with a tympanic thermometer) Mean difference when both parents and nurses used a tympanic thermometer designed for home use: –        0.44 ± 0.61 °C –        33% of the readings differed by ≥ 0.5 °C   Mean difference when parents use a home thermometer and nurses use a hospital one: –        0.51 ± 0.63 °C –        72 % of the readings differed by ≥ 0.5 °C. Using the home thermometer

OR – Odds Ratio; CI – Confidence Interval
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A glass or a digital thermometer…which one to choose?

Nowadays, digital thermometers are an inexpensive widely available device and, in addition, they are recognized as the most accurate way to evaluate the body’s temperature. Glass thermometers continue to be used among many families, but parents should be aware that they’re not recommended because they contain mercury and, if broken, there can be a dangerous exposition to this toxic metal. If a digital thermometer is not at your disposal and you have to use a mercury one, shake it down carefully before using it.

What is the most accurate way to take my child’s fever?

Rectal temperature is the most accurate. In 4 year old and older children mouth temperatures are also reliable. Remember that armpit, ear temperatures are not as accurate as rectal or mouth temperatures. In addition, the forehead temperature is not accurate to evaluate a child’s temperature, because it depends on the temperature of the person who is touching the child’s skin. A survey was conducted to understand how parents recognize their children fever and where they measure it.

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Parent’s methods to evaluate their child’ fever(Study Design: survey among 402 parents whose children were enrolled and presented for health care at a primary health care clinics) Fever recognition: –        Touching child: 65.4% –        Measure Temperature: 31.6% –        Touching child and measuring temperature: 3%   Site used to take temperature: –        Mouth: 50.2% –        Anus: 25.9% –        Armpit: 21.1% –        Other: 2.7%

OR – Odds Ratio; CI – Confidence Interval
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Correct way of taking a rectal temperature

Prepare the thermometer putting a little bit of petroleum jelly (Vaseline) in its silver end. Then put your child lying down across your lap and introduce carefully the silver end of the thermometer inside your child’s anus. Wait holding it in place – note that a glass thermometer will take about two minutes and digital one less than a minute.

Correct way of taking an ear temperature

To measure ear temperature, often referred to as tympanic temperature, you have to use a thermometer specially designed for the ear pavilion – non-contact tympanic thermometer. Gently pull back your child’s ear and then insert the thermometer, holding the probe for about two seconds.

Correct way of taking a mouth temperature

If your child has drunk or eaten something hot or cold, you should wait 30 minutes or more before taking a mouth temperature, otherwise, results would not be reliable. In addition, do not forget to wash the thermometer with cool water and soap.

To take your child’s mouth temperature, put the thermometer under the child’s tongue and ask her/him to hold it with her/his lips, and not use the teeth. Wait about 3 minutes with a glass thermometer and less than a minute in the case of a digital one.

Correct way of taking an armpit temperature

To take an armpit temperature, place the extremity of the thermometer in the children’s armpit after checking first if it’s dry. Tell your child or hold yourself her/his arm against the chest for about 5 minutes.

What are the values considered fever?

• Rectal temperature: > 38ºC (100.4ºF)
• Mouth temperature: > 37.8ºC (100ºF)
• Armpit temperature: > 2ºC (99ºF)
• Ear temperature: >38ºC (100.4ºF)

Summary and Recommendations

• The cut-off for a temperature measurement to be considered fever depends on how it is done and where in the body it is taken.
• Knowing how to take your child’s temperature adequately is important to obtain an accurate measurement.
• Digital thermometers should be preferred over the glass ones, which have a risk for toxic exposure to mercury if they are broken.
• Rectal temperature is the most accurate measurement, although mouth temperature is also accurate in children older than 4 years of age. Touching the forehead is not reliable to assess fever.

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References

• Taveras EM,Durousseau S, Flores G. Parents’ beliefs and practices regarding childhood fever: a study of a multiethnic and socioeconomically diverse sample. Pediatr Emerg Care. 2004 Sep;20(9):579-87.
• Zyoud SH,Al-Jabi SW, Sweileh WM. Beliefs and practices regarding childhood fever among parents: a cross-sectional study from Palestine. BMC Pediatr. 2013 Apr 28; 13:66.
• Robinson JL,Jou H, Spady DW.Accuracy of parents in measuring body temperature with a tympanic thermometer. BMC Fam Pract. 2005 Jan 11;6(1):3.
• Schmitt BD. Feverphobia: misconceptions of parents about fevers. Am J Dis Child. 1980 Feb;134(2):176-81.

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Breastfeeding: myths and facts

[mme_highlight] There are a number of myths associated with breastfeeding which should be clarified, as these can significantly alter the quality of feeding  by decreaseasing the efficacy and compliance of mothers. A major mistake by which many mothers quit breastfeeding their child is lack of knowledge on this topic. [mme_highlight]

Healthcare providers recommend exclusive breastfeeding to all babies during the first 6 months of postnatal life and continuation of breastfeeding as part of the nutritional plan until the baby turns 2 years. Y. Vandenplas (1) suggest that exclusive breastfeeding with delayed introduction of weaning foods reduces morbidity and mortality by decreasing the risk of infections and allergies in babies.

However, there are a number of myths associated with breastfeeding which should be clarified, as these can significantly alter the quality of feeding  by decreaseasing the efficacy and compliance of mothers.

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Decision to breastfeed
(study conducted by Eugene Declercq (2))
– 70% of primiparous mothers (mothers who have their first child) decide to breastfeed their babies;
–  only 50% of others remain compliant with their decision after first post- delivery week.
– 49% of the mothers who introduce early formula supplementation do not breastfeed their babies ;

almost 45% of mothers who introduce pacifiers gave up breastfeeding before baby turn 6 months.
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What are the myths commonly associated with breastfeeding?

Myth # 1: If you work full time, you can’t breastfeed your baby:

Research conducted by AS Ryan (3) suggested that the decision to breastfeed is higher among mothers soon after delivery; however, the scenary is different among working mothers.

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Decision to breastfeed among working mothers
(study conducted by AS Ryan (3))

• Full-time working mothers: proportion of breastfeeding mothers decreases from 66% (stay at home mothers) to 26.1% (in full-time working mothers)
• Part-time working mothers: proportion decreases to 36.6%.

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Nevertheless, in the past few years, due to the increasing awareness and maternal education,  the breastfeeding rate has increased to over 204.5% in full- time working mothers, but overall results are still unsatisfactory.

If you are working a full-time job, you can still feed your baby. Here are a few tips:

• Get a good quality breast pump or extractor and pump milk frequently at work. In order to obtain greater results, carry with you bottles or clean sterilized bags to store milk in a refrigerator at work place to feed your baby with once you get home.
• You can also extract milk in the morning before going to work (the nanny or caregiver can feed the baby with your milk in your absence).
• Make sure to breastfeed the baby as much as you can when you are home.

Myth # 2: During breast feeding you do not need contraception

Lactation acts as a natural contraception period during which most women do not need any protection as high prolactin levels inhibit ovulation. However, contraception is not permanent and if you strictly want to avoid another pregnancy, it is better to consult a healthcare professional for a reliable contraceptive option that does not interfere with your lactation.

R.H. Gray (4) reported the results of his study on breast feeding moms of Baltimore and Manila and identified that ovarian cycles are not started until 27 to 38 weeks post partum. He further identified that:

• Luteal defects are seen in almost 41% of all early ovulatory cycles;
• Anovulatory cycles are reported in 46.1% women for 6 months after childbirth.

However, despite exclusive breastfeeding, 1 to 5% women become pregnant. If you are not breastfeeding regularly, there are 10% chances of becoming pregnant with unprotected intercourse. The risk of conception doubles after 6 months post-delivery.  Some helpful contraceptive options during breastfeeding are:

• Condoms
• Spermicidal jellies
• Diaphragm
• Intrauterine device (IUD)
• Permanent contraception options (if you are sure you have already completed your family; possibilities are vasectomy and tubal ligation).

Myth # 3: You cannot improve your milk supply

A lot of mothers complain that their babies do not suckle well or feed properly. Sometimes, mothers feel their baby is not getting enough milk or they are not producing enough milk. You should look for a doctor if you wish to improve your milk supply and in order to optimize breastfeeding.  There are a number of natural, herbal and holistic methods that can help in improving the production of milk but the most important is that you let your baby suckle frequently. Other helpful tips are:

• Gently massage your breasts 4 to 8 times a day (it enhances circulation, decreases the risk of developing obstructed ducts and also improves milk production).
• Use of certain herbs like Fenugreek, Red Raspberry, Blessed Thistle and Brewer’s Yeast has known efficacy in increasing milk production and flow (make sure to speak to your healthcare provider before starting any herbal or medical remedy).
• Medical drugs like Sulpiride and Metoclopramide are prescription drugs that increase milk supply.

Myth # 4: If you are not producing enough milk, your baby needs formula milk

Research conducted by Samir Arora (5) suggested that the second most common reason why mothers prefer to bottle-feed their baby is “insufficient milk production”.  This study identified that approximately 46.3% women bottle-feed their babies from day 1, but out of 44.3% who initiated breastfeeding after childbirth, more than 50% switched to bottle-feeding within the first month post-delivery due to low milk production.

It is normal for the milk supply to be low during the first few weeks after delivery, but depending on the suckling frequency of babies, the milk production and flow increase. Your body adapts itself to the nutritional demands of the child. Make sure:

• To allow your baby to suckle often;
• To allow your baby to suckle both breasts;
• The position of feeding is comfortable both for you and your child.

Myth # 5: You don’t need any additional help and resources other than your doctor’s recommendations:

This is another big mistake mothers can follow. It is highly recommended that a pregnant mother with her partner attends classes on breastfeeding during pregnancy. These classes provide first hand information on advantages of breastfeeding, how to take a start and explain some common problems face by a mother during nursing.
These sessions also play a good role in building relationships with other expectant parents and lactation professionals who can help in any problem. Nowadays some hospitals have breastfeeding classes. Make sure the classes you attend are conducted by authentic healthcare provider or a certified lactation educator.

In fact, a major mistake by which many mothers quit breastfeeding their child is lack of knowledge on this topic. During the end of pregnancy, a mother should build a circle of people, consisting of friend and family members, who have the knowledge on nursing and who have successfully breastfeed their babies.
Make sure to maintain a good relationship with any certified lactation educator or lactation consultant who can help you in any problem occur during your nursing period.

Research by Samir Arora suggested that 71% women who breastfeed their babies are influenced by the choices and preferences of their partners and maternal grandmother of the baby. The study further showed the main sources of information about breastfeeding used by lactating moms (table below).

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Main sources of information about breastfeeding used by lactating moms

• Family (33.9%)
• Books, magazines, social media (17.4%)
• Other (13.2%)
• Physicians (8.3%)
• Friends (9.9%)

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Myth # 6: Every baby feeds in one position

This is totally untrue. Feeding position determines a good latch. You have to try and test different positions in order to determine what position your baby is more comfortable in. Nature designed a mother’s body in a way that she can easily feed her baby.
Like parenting, breastfeeding is a natural thing every woman experiences after child’s birth. A mother needs a lot of practice to recognize her child’s hunger signs, and to help her baby sucking the milk correctly.
She should learn all the nursing position through which she can properly comfort her baby. A child also needs a lot of practice to suck the milk from mother’s breast correctly. Therefore both mother and child need proper practice and patience to optimally adjust to breastfeeding.

Summary and Recommendations

• There are some myths related with breastfeeding that, if not correctly clariied, can lead to an early breastfeeding stop or a suboptimal breastfeeding process.
• Working mothers tend to have a lower proportion of sustained breastfeeding; mother can pump milk and leave it to be given to the baby during her absence and she can try to make schedule adjustements to breastfeed as many times as possible.
• Mothers should talk with a health care provider if she thinks her milk production is impaired.
• Contraception issues should be discussed with a doctor.
• Parents should look for information on breastfeeding and attend sessions on this topic.

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References

• Vandenplas, Y. (1997). Myths and facts about breastfeeding: does it prevent later atopic disease?. Acta Paediatrica, 86(12), 1283-1287.
• Ryan, A. S., Pratt, W. F., Wysong, J. L., Lewandowski, G., McNally, J. W., & Krieger, F. W. (1991). A comparison of breast-feeding data from the National Surveys of Family Growth and the Ross Laboratories Mothers Surveys. American Journal of Public Health, 81(8), 1049-1052.
• Ryan, A. S., Zhou, W., & Arensberg, M. B. (2006). The effect of employment status on breastfeeding in the United States. Women’s health issues: official publication of the Jacobs Institute of Women’s Health, 16(5), 243.
• Gray, R. H., Campbell, O. M., Apelo, R., Eslami, S. S., Zacur, H., Ramos, R. M., … & Labbok, M. H. (1990). Risk of ovulation during lactation. The Lancet, 335(8680), 25-29.
• Arora, S., McJunkin, C., Wehrer, J., & Kuhn, P. (2000). Major factors influencing breastfeeding rates: Mother’s perception of father’s attitude and milk supply. Pediatrics, 106(5), e67-e67.

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