Accuracy of Pacifier Thermometers in Young Children

Carie A. Braun, PhD, RN

Disclosures

Pediatr Nurs. 2006;32(5):413-418. 

In This Article

Methods

Informed consent from parents/ guardians was obtained. A script was designed to answer parent questions consistently among researchers. Rectal thermometers were calibrated at the start of each data collection day according to manufacturer specifications. End-of-day calibration also assured accuracy of measurement throughout the data collection time period. Each child received a new pacifier thermometer; these were not formally calibrated prior to use.

The SunMarkAE Digital Pacifier Thermometer (McKessonHBOC, San Francisco, CA) was used to obtain supralingual temperatures. The pacifier thermometer provided a digital numerical temperature read-out. The manufacturer insert indicated the following specifications: measurement range 90.0 to 109.0°F, accuracy ±0.2 to 0.3°F for temperatures between 96.4-106.0°F. The pacifier thermometer was assessed for strength, cracks, and tears by inspecting the thermometer and tugging on the orthodontic nipple. If the pacifier was secure, this was placed in the child's mouth at least 10 minutes after eating or drinking to avoid the impact of heat or cold on oral temperature (Tendrup, Allegra, & Kealy, 1989). After the digital degree temperature sign display stopped flashing (3-5 minutes) the temperature measurement was complete. To assure consistency, however, the pacifier was left in place for a total of 6 minutes. The temperature was recorded at 3 minutes and 6 minutes in degrees Fahrenheit.

Rectal temperature measurement (SureTempAE, Welch Allyn) provided criterion-related validity with which to compare supralingual temperatures. A digital/electronic thermometer was selected to avoid the potential for breakage and toxic mercury exposure as may occur with mercury in-glass thermometers. Also, digital/ electric rectal thermometer measurements have been found to be highly correlated with mercury in-glass thermometer measurements in previous studies (Dollberg, Lahav, & Mimouni, 2001; Nuckton, Goldreich, Wendt, Nuckton, & Claman, 2001; Sganga et al., 2000). Rectal temperature measurements were completed using a consistent protocol regarding the child's position and depth of measurement (specified as 1.5cm). Digital rectal thermometers were placed in dwell (manual) mode and the result was read and recorded at 3 minutes. Temperatures were recorded in degrees Fahrenheit.

Trained research assistants collected temperature measurements. Three of the research assistants were senior-level baccalaureate nursing students and one was an experienced pediatric critical care nurse. Children consistently underwent pacifier thermometer measurements first, followed by rectal temperatures to decrease agitation and possible crying during the pacifier measurement. Data were entered into SPSS (10.0) and were analyzed using a paired samples t test and Pearson correlation to determine the strength of the relationship between rectal and pacifier thermometer readings after adjusting the pacifier temperature upward by 0.5 degrees, as recommended by the manufacturer. Statistical significance was determined at the p<0.05 level. Clinical reliability was determined if over 90% of the two measures (rectal and pacifier temperature) were within 1.0°F, given the cumulative variability (standard deviation) of measures: ±0.2 to 0.3 for rectal temperatures (Herzog & Coyne, 1993) and ±0.2 to 0.3 for pacifier temperatures. This was calculated averaging 0.25 degree variation in both directions for both measures (0.25 x 2 x 2). Clinical reliability was also based on detection of fever and was determined if 90% or more of subjects with a rectal fever were also determined to have a pacifier fever.

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