Skill List > Body Temperature Measurement: Tympanic (Child)
Clinical Alert
Falsely high or low temperature readings could result in unnecessary diagnostic procedures and treatment. Ear temperature measurements should be avoided in infants less than 4 weeks old (National Institute for Health and Clinical Excellence (NICE) 2013).

Elsevier Clinical Skills covers the principles of this procedure. You must follow local policies and procedures regarding technique, equipment used and documentation.
Authors:
Based on Mosby Nursing Skills    
Adapted by: Matthew Carey RN Child BSc Dip HE
Updated by: Janet Kelsey BSc(Hons) MSc PGCEA AdvDipEd RSCN RN RNT
Last updated: September 2017
Learning Objective
After reading the skill overview, watching the animation, following up some of the references/web sites and completing the self-test quiz you should be ready to be assessed in practice in the skill of tympanic temperature recording in children and infants.

Introduction

Body temperature is the measurement of the presence or absence of heat. Normal body temperature results when heat production and heat loss are balanced. Body temperature is influenced by factors such as age, environment, and illness. Core body temperature is maintained constantly, with only minor deviations from the normal range, which is 36.6–37.8ºC (Aylott 2008).

Heat-producing processes of the body such as metabolism, disease processes, prolonged heavy exercise, shivering, unconscious tensing of muscles, and increased thyroid activity can sometimes produce more heat than necessary. To offset excessive heat production and restore normothermia, the body uses these four processes:

  • Convection: heat transfer by air movement or liquid carrying heat away from an object. This transfer is dependent on air velocity, temperature, and exposed surface area. Convection losses increase with shivering and wind conditions.
  • Radiation: an energy transfer via electromagnetic waves to surrounding cooler surfaces without direct contact. The degree of heat loss by radiation is directly related to core and ambient temperature and the exposed body surface area. The large head size in proportion to body size of infants and children also predisposes them to hypothermia. Most losses emanate from the unprotected head, which accounts for the majority of heat loss in the operating room.
  • Conduction: the transfer of heat to surrounding objects through direct physical contact. Conduction heat loss increases five times if the child is wet and up to thirty times with cold water immersion (Lange Varga 2008).
  • Evaporation: occurs primarily through perspiration, which is removed from the skin as transdermal water loss by changing from a liquid into a vapour. These losses can also occur from the respiratory tract and open body cavities.

Neonates and infants are different in that they maintain body temperature through a chemical non-shivering thermogenesis, the process through which norepinephrine is secreted to break down brown fat in order to create heat (Altimier 2012).

Another important consideration is that the body surface area in children and infants is proportionally greater compared with that of adults (James et al. 2014); thus, more heat is lost to the environment through evaporation, conduction, and convection. The mechanisms for temperature regulation are so efficient that any deviation from normal body temperature can indicate potential illness. A vigilant and accurate assessment of thermal balance is vital in the recognition of the seriously ill infant, child or young person (Department of Health 2004). Critically ill infants and children are at risk for ineffective thermoregulation from environmental and maturational factors (Jones et al. 2003).

Assessment of body temperature is an evaluation tool that provides information about the severity and nature of the illness.

The selection of site and device to be used in measuring temperature needs to be considered depending on the age of the child. Infants under the age of 4 weeks should have their temperature measured with an electronic thermometer in the axilla (Macqueen et al. 2012). In children aged 4 weeks to 5 years, body temperature should be measured by one of the following methods:

  • Electronic thermometer in the axilla.
  • Chemical dot thermometer in the axilla.
  • Infrared tympanic thermometer (NICE 2013, RCN 2017).

Rectal thermometers should not be routinely used with children aged 0–5 years (NICE 2013); however, their use may be indicated within the intensive or high dependency care setting, where clear guidance for health professionals should be available (RCN 2017).

Specific information about temperature monitoring devices is available from each manufacturer and must be understood by the nurse before any piece of equipment is used.

Patient and family education

  • Provide individualised, developmentally appropriate education to the family and to the child based on desire for knowledge, readiness to learn, and overall neurological and psychosocial state (RCN 2017).
  • Explain the reason for monitoring temperature, the site selected, the device to be used, and the frequency of monitoring.
  • Determine the child’s and family’s understanding and gain consent for the procedure.
  • Explain normal body temperature ranges, indications for obtaining a measurement, and what deviations from baseline may be relevant to the individual child.
  • Explain what interventions may be required to assist with the child’s body temperature regulation.

Note: Tympanic thermometer measurements can be unreliable due to a number of variables that can influence the reading (Batra et al. 2012). Healthcare professionals should not use this route in patients with otitis media, sinusitis, or any recent surgery to the ear. This procedure may also be difficult to perform in children with very small external ear canals.

Preparation and safety

  • Select the correct method for taking the child’s temperature, taking into account their age and condition.
  • Assess any potential risk factors, including past medical history, and any known causes relating to underlying conditions.
  • Review any current medication.
  • Review laboratory results that might indicate coagulopathy, platelet dysfunction, or pre-existing neutropenia.
  • Consider the child’s level of development, interaction, and their ability to understand the procedure.
  • Ensure that the child and family understand and are aware of the reasons for completing the procedure highlighting any potential risks and benefits.
  • The equipment should be cleaned before and after use according to local policy.

Procedure

  1. Ensure the child and family understand and consent to the procedure and questions are answered.
    Rationale – Evaluates and reinforces understanding of previously taught information.
    Developmental level, cognitive ability, and anxiety influence the approach to and effectiveness of teaching.
  2. Verify the correct patient according to local policy.
  3. Gather needed equipment and supplies.
    Rationale – Facilitates completion of the procedure in a timely manner.
  4. Perform hand hygiene and put on an apron. Wear personal protective equipment where necessary.
    Rationale
    – Standard precaution; reduces the transmission of micro-organisms.
  5. Explain the procedure to the child in developmentally appropriate language.
    Rationale
    – The child knows what to expect.
  6. Obtain the measurement. Record and document the temperature including mode, time, and date on the child’s observation chart and if required in the child’s notes.
    Rationale
    – Establishes temperature measurement and completes the assessment.
    Some thermometers have a memory feature built in that can recall previous temperature measurements.
  7. Take the child’s temperature with the same method at intervals as designated in local policy. Temperature should be monitored regularly until it is stable.
    Rationale – Vital signs should be taken as often as necessary considering the child’s current condition and status. Temperature monitoring should not be delayed in infants, children, and young people with worrying symptoms.
  8. Check that the thermometer is in good working order. To decrease the possibility of inaccuracy, electronic and infrared devices should be regularly checked or calibrated and batteries replaced according to the manufacturer’s instructions.
    Rationale – Question the accuracy of any temperature reading that does not correlate with the child’s present state. The temperature should be double checked with an alternative device or site. Inaccurate temperature measurement can result in serious errors in diagnosis and treatment (see Alert).
  9. Always place a new disposable cap over the tympanic probe and apply it until it snaps into position.
    Rationale – Disposable caps or probe covers reduce the risk of cross-contamination.
    Ear temperature measurements should be avoided in infants less than 4 weeks old (NICE 2013).  Professional judgement should be used when assessing the size of the child’s ear canal and a different method used if the ear canal is considered too small to facilitate accurate measurement.
  10. Switch on the tympanic ear thermometer.
    Rationale – Ensures readiness of device.
  11. Ensure the child is sitting or lying down.
    Rationale – Ensures a comfortable, relaxed position for both the child and the healthcare professional completing the procedure.
  12. Perform an ear tug:
    1. for children under 1 year, pull the ear straight back
    2. for children aged 1 year to adult, pull the ear up and back (Macqueen et al. 2012).
      Rationale – Use of an ear tug straightens the curvature of the ear canal.
      Tympanic measurements can be affected by whether the child has been lying on that ear or has been exposed to extremes in temperature, and are limited by cerumen (wax), sizing of probe covers, and positioning of the thermometer. The presence of otitis media may result in local heat production (Craig et al. 2002).
  13. While tugging the ear, gently position the probe snugly into the ear canal, orienting the tip towards the tympanic membrane i.e. pointing towards the child’s opposite eye (Casey 2000).
    Rationale – The ear is easily accessible, and this method of measurement is highly accepted by children.
    The ear canal radiates energy in the form of electromagnetic waves. Infrared thermometers detect this thermal radiation (Davie & Amoore 2010). Narrow ear canals impede reading this energy, which causes inconsistent and falsely low readings (Batra et al. 2012).
  14. Press and hold the activation button until a reading appears or an audible sound indicates completion.
    Rationale – The device obtains the tympanic temperature.
    For safety and injury prevention, never leave the child alone when obtaining a temperature measurement.
  15. Remove the thermometer and read the temperature.
    Rationale – Procedure is complete.
    Tympanic membrane thermometer readings closely parallel core body temperatures because the hypothalamus and tympanic membrane both receive the blood supply from the internal carotid artery. Operator variability is common with the use of tympanic membrane thermometers when used in children.
  16. Discard the cap or probe cover.
    Rationale – Use of a new cap or probe cover for every reading is vital to prevent cross-contamination.
  17. Obtain the measured value from the device readout.
    Rationale – Make a mental note of the temperature or document it immediately. Some thermometers have a memory feature built in that can recall previous temperature measurements.
  18. Dispose of used supplies and equipment in the appropriate clinical waste bin. The equipment should be cleaned after use according to local policy.
    Rationale – Standard infection control procedure; reduces transmission of micro-organisms.
  19. Remove gloves, if worn, and perform hand hygiene.
    Rationale – Standard infection control procedure; reduces transmission of micro-organisms.
  20. Document the procedure on the child’s observation chart and/or notes.

Documentation and reporting

Record the following in the child's notes:
  • Child’s temperature, site used, and time and date of assessment.
  • Deviation from the child’s baseline temperature.
  • Comfort assessment.
  • Child and family education.
  • Unexpected outcomes and related treatment.
  • Education of family regarding monitoring temperature and keeping a temperature diary at home where appropriate.
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