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A Cross-sectional Study Characterizing Pediatric Temperature Percentiles in Children at Well-Child Visits
Rebecca Dang1, Alan R Schroeder1, Yingjie Weng2
1Department of Pediatrics (R Dang, AR Schroeder, ME Wang, AI Patel), Stanford University School of Medicine, Palo Alto, Calif.
Insights
Updated pediatric temperature norms reveal median rectal temperatures of 37.2°C for infants and 36.7°C axillary for older children. These findings provide crucial reference values for clinical practice.
Area of Science:
- Pediatrics
- Clinical Thermometry
- Public Health
Background:
- Accurate temperature measurement is vital for pediatric disease risk assessment and management.
- Existing pediatric temperature thresholds may be outdated and lack applicability to current pediatric populations.
Purpose of the Study:
- To establish current pediatric temperature norms and analyze variations.
- To investigate temperature differences based on patient characteristics, measurement timing, and thermometer route.
Main Methods:
- A cross-sectional study analyzed 134,641 well-child visits from 2014-2019.
- Quantile regressions were used to determine temperature percentiles and variations.
- Sensitivity analyses were conducted, excluding infectious diagnoses and including clinic fixed effects.
Main Results:
- Median rectal temperature for infants (≤12 months) was 37.2°C; median axillary for children (1-18 years) was 36.7°C.
- The 99th percentile for infant rectal temperature was 37.8°C; 99.9th percentile for child axillary was 38.5°C.
- No clinically significant temperature variations were found based on sex, age, or time of measurement.
Conclusions:
- Updated pediatric temperature norms offer essential reference values for clinical practice.
- Consideration of thermometer route and clinical context is crucial when interpreting temperature values.
- Observed variations by sex, age, and time of measurement were not clinically significant.
Background:
Temperature measurement plays a central role in determining pediatric patients' disease risk and management. However, current pediatric temperature thresholds may be outdated and not applicable to children.
Objective:
To characterize pediatric temperature norms and variation by patient characteristics, time of measurement, and thermometer route.
Methods:
In this cross-sectional study, we analyzed 134,641 well-child visits occurring between 2014-2019 at primary care clinics that routinely measured temperature. We performed bivariate and multivariable quantile regressions with clustered standard errors to determine temperature percentiles and variation by age, sex, time of measurement, and thermometer route. We performed sensitivity analyses: 1) using a cohort that excluded visits with infectious diagnoses that could explain temperature aberrations and 2) including clinic as a fixed effect.
Results:
The median rectal temperature for visits of infants ≤12 months old was 37.2˚C, which was 0.4˚C higher than the median axillary temperature. The median axillary temperature for children 1-18 years old was 36.7˚C, which was 0.1˚C lower than the median values of all other routes. The 99th percentile for rectal temperatures in infants was 37.8˚C and the 99.9th percentile for axillary temperatures in children was 38.5˚C. Adjusted analyses did not demonstrate clinically significant variation in temperature by sex, age, or time of measurement.
Conclusions:
These updated temperature norms can serve as reference values in clinical practice and should be considered in the context of thermometer route used and the clinical condition being evaluated. Variations in temperature values by sex, age, and time of measurement were not clinically significant.
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