In this section
Note: This guideline is currently under review. Introduction
Definition of Terms
At Risk Patient Groups
Temperature management remains a significant component of hospital care for all neonatal and paediatric patients. Body temperatures outside normal ranges may be indicative of underlying disease processes or clinical deterioration, and should be identified within a timely manner. Maintaining a stable body temperature within normal ranges assists in optimising metabolic processes and bodily functions. Therefore, minimising environmental factors within the hospital setting which may result in unnecessary body temperature fluctuations is further important.
To assist healthcare professionals in undertaking the appropriate assessment and potential management of neonatal and paediatric body temperatures, at The Royal Children’s Hospital.
*Significant variation of suggested temperature values and ranges exists within current literature. The values presented in this table are derived from a collaboration of multiple sources and expert opinions, and should be utilized as a guideline only. Exact normal temperature ranges differ between individuals. It is important to ascertain an individual’s baseline in order to identify abnormal body temperature deviations, and to evaluate these in the context of other vital signs and overall patient presentation.
Please note, any febrile child who appears seriously unwell should have a thorough assessment and their treating medical team notified, irrespective of the degree of fever.
<3 months, hypothermia or temperature instability can be signs of serious illness.
Body temperature should be measured on admission and four hourly with other vital signs, unless clinically indicated for more frequent measurements.
Body temperatures falling outside normal ranges should be monitored and further managed where appropriate until normothermia is achieved.
When assessing body temperatures, it is important to consider patient-based and environmental-based factors, including prior administration of antipyretics and recent environmental exposures.
Body temperature should always be evaluated in the context of other vital signs and overall patient presentation.
Due to temperature variation between body sites, ideally the same route should be used for ongoing patient observations, as to allow for accurate temperature trend evaluation. Document the route used in EMR.
0-3 months: Axillary Route
Axillary digital thermometer is the preferred method for this age group, in most cases.
0-3 months: Rectal Route (if requested)
In special cases, a rectal temperature may be required for a more accurate assessment of body temperature.
This should be performed only if approved by medical staff, with ANUM involvement.
Rectal measurements should be avoided within the oncology population and in patients with low platelets, coagulopathy, or perineal trauma and pelvic area surgery, due to the increased risk of bowel perforation.
>3 months: Tympanic RouteTympanic thermometer is the preferred method for this age group.
Notes:If the patient has been exposed to cold conditions, allow for adequate time for patient to equilibrate to room temperature before measuring body temperature.
Both axillary and tympanic routes measure temperatures lower than true core body temperature.
Temperature measurement frequency may differ in sub-speciality areas, such as within the Emergency Department, critical care and peri-operative areas. Please refer to specific department guidelines for further information.
The following patient populations are at an increased risk of being unable to maintain normothermia:
A patient’s surrounding environment can greatly impact their ability to maintain an otherwise stable body temperature. Acknowledging and minimising environmental influences on thermoregulation is important for all paediatric patients, especially the neonatal and at risk patient populations.
The table below outlines approaches nurses, clinicians and families can utilise towards minimising preventable heat transfer from patients to their surroundings.
Wet or oozing dressings
Relocate patient away from cold surfaces
Close blinds on window
The following patient populations may require more specific interventions and/or differing management when body temperature falls outside traditionally normal values:
RCH Kids Health Info Fact Sheet on Fever in Children
Temperature Management Nursing Guideline Evidence Table 2019.
Please remember to read the
The development of this nursing guideline was coordinated by Elizabeth Cooke, RN, ED, and approved by the Nursing Clinical Effectiveness Committee. Updated August 2019.