Accuracy of Pacifier Thermometers in Young Children

Carie A. Braun, PhD, RN

Disclosures

Pediatr Nurs. 2006;32(5):413-418. 

In This Article

Abstract and Introduction

Abstract

Nurses and families are continually searching for less invasive yet accurate methods of measuring temperature in children. Although pacifier thermometers are readily accessible to consumers, few studies report the accuracy of such instruments. This study aimed to determine the validity/reliability of one type of pacifier thermometer in approximating core body temperature using a prospective, within-subjects design, comparing pacifier and rectal temperatures in children (n=25), ages 7 days to 24 months, in one pediatric hospital-based setting. The mean ±SD difference between rectal and supralingual temperatures adjusted upward by 0.5°F was 0.012°F ± 0.777°F, which was not statistically significant. The 95% confidence interval (-0.309-0.333) fit within the manufacturer specifications. The correlations between the rectal and adjusted pacifier temperature was 0.772 and between 3-and 6-minute pacifier temperatures was 0.913. These data provide support to previous assertions that pacifier thermometry is an acceptable method of temperature approximation in young children.

Introduction

Nurses are continually searching for less invasive yet accurate methods of measuring temperature in children. Multiple studies have indicated that the goal is to measure or, at best, approximate core body temperature (Callanan, 2003; Erickson & Kirklin, 1993; Erickson & Woo, 1994; Guiffre, Heidenreich, Carney-Gers ten, Dorsch, & Heidenreich, 1990). Core temperature measurements can be obtained through direct contact with the rectum, esophagus, pulmonary artery, urinary bladder, and tympanic membrane (Erickson & Woo, 1994). Of these, rectal temperature measurement has been regarded as the most accurate and accessible method of measuring core body temperature (Beckstrand, Wilshaw, Moran, & Schaalje, 1996; Brennan, Falk, Rothrock, & Kerr, 1995; Dollberg, Lahav, & Mimouni, 2001; Greenes & Fleischer, 2001; Morley, Hewson, Thornton, & Cole, 1992; Press & Quinn, 1997; Shann & Mackenzie, 1996). The major drawback with rectal temperature measurement is that it is considered invasive and uncomfortable and can result in rectal perforation if not performed correctly. This risk was estimated at one in two million (Morley et al., 1992). Although the actual risk may be small, the perceived invasiveness and discomfort may deter parents from accurately assessing the child's temperature rectally in the home.

Given the drawbacks of rectal temperature measurement, re search ers have attempted to determine the accuracy of various instruments that approximate core temperature. Alter native methods and sites suitable for children have included axillary, forehead/temporal artery, infrared tympanic, and supralingual temperatures. Recommendations from axillary temperature studies in infants and young children were mixed. Some have advocated for this procedure as a reasonable alternative to rectal temperature measurement (Shann & Mackenzie, 1996) and others have determined little relationship between rectal and axillary measurements (Jensen, Jensen, Madsen, & Lossl, 2000; Wilshaw, Beckstrand, Waid, & Schaalje, 1999). Greenes and Fleisher (2001) found noninvasive temporal artery thermometry provided a limited sensitivity for fever detection in young children but this method was determined to be more accurate than infrared tympanic thermometry in infants. Similarly, others have found infrared tympanic thermometry to be largely inaccurate in children under three years of age (Brennan et al., 1995; Morley et al., 1992; Peterson-Smith, Barber, Coody, West, & Yetman, 1994; Selfridge & Shea, 1993; Sganga, Wallace, Kiehl, Irving, & Witter, 2000).

Although the devices are readily available, few studies have been performed on the use of pacifier thermometers, which use the supralingual site, to measure temperature in children (Banco, Jayashekara mur thy, & Graffam, 1988; Beck strand et al., 1996; Hensley et al., 1999; Press & Quinn, 1997). In 1988, Banco, Jayashekaramurthy, and Graffam warned against the use of pacifier thermometers as this tool was determined to lack sensitivity in detecting fever in children younger than 2 years of age. The pacifier thermometer used in that study had a temperature sensitive dot that turned from green to black when exposed to a temperature above 100 degrees Fahrenheit (°F). Despite improvements in the technology, Beckstrand et al. (1996) similarly noted inaccuracy of pacifier thermometry when compared to rectal temperatures in children less than 2 years of age. More recently, Press and Quinn (1997) indicated that when 0.5°F was added to the final pacifier temperature, the pacifier thermometer was an accurate method of approximating core body temperature in children ages 7 days to 24 months with high levels of sensitivity and specificity for detecting fever. Similarly, Hensley et al. (1999) reported reasonable accuracy with another brand of pacifier thermometer when adjusted upward 1.3°F.

Given the paucity of research in this area, the purpose of this study was to elicit further data regarding the accuracy of supralingual temperature measurement using the pacifier thermometer.

Therefore, the following research question guided this study: What is the accuracy of pacifier thermometers in approximating core body temperature in children between 7 days and 24 months of age? Reliability of the pacifier temperature measurement was determined by the agreement between the rectal thermometer and pacifier thermometer measurement. The null hypothesis implies a significant difference and therefore no relationship between rectal and supralingual-acquired temperature measurements after adjusting the pacifier temperature by 0.5°F to correspond with manufacturer recommendations and as supported by Press and Quinn (1997).

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