Fact: I have never checked my kids’ temperature

It is true.  Never.  Once I tried.  My son was 18 months old and had Hand Foot and Mouth Virus.  He had been out of school (and I had been home from work) for a solid 2.5 days due to fever.  I was trying to convince myself that he really did not have a fever and I could go back to work.  I tried to use an ear thermometer.  For the record, I own a digital rectal thermometer but I could not find it at the time.  I do not know what I was thinking.  Everyone knows that 18 month olds hate having medical instruments in their ears and ear thermometers are notoriously inaccurate.   It was a fruitless endeavor.  My usually joyful toddler squirmed to the floor in tears before the required five seconds were up and I realized that, fever or no fever, a kid this miserable did not belong at school.

When I was a medical student, I used to document "tactile temperature" with a sense of serious doubt.  Then one of my attendings drew my attention to an article published in Pediatric Emergency Care in 1996.  The article showed that moms are pretty great at telling if their kids were febrile or not with about 80% accuracy.  When you compare that with ear thermometers, forehead strips and other devices, 80% is pretty respectable.  Now that I am a parent, I do not need a study to tell me that moms know what they are talking about.  It is painfully obvious when my son has a fever.  My house turns into Meltdown City as he loses all abilities to cope with frustration.  He feels incredibly hot.  This is usually topped off with a running nose or some other lovely sign that his body has been turned into a virus breeding ground.  (I use my son as the example because he has had many, many fevers.  Thankfully, my daughter has only felt warm once and this was accompanied by a runny nose and happy baby smiles.)

I see a lot of kids whose parents have kept a detailed record of the ups and downs of the thermometer readings.  Some of these parents are checking temperatures every two hours.  To begin with, I am super impressed by their dedication and ability to get the readings.  You see how well my one and only attempt went.  How do you get a kid who feels terrible to hold still that long?  That many times in a day?  It cannot not be easy.  To be completely honest, though, as a pediatrician, I do not care about fevers in that detail.  For the most part, I do not care about the numbers at all.  If you are his primary caregiver and you tell me he had a fever, I believe you.   I actually kind of prefer the tactile temperature.  Anecdotally, actual numbers can make things more confusing.  I spend quite a bit of time sorting out and discussing home readings of 108, 99.7, 19 and Lo.  The findings of a study done at Stanford University indicate that most people (as in, every person surveyed) have a hard time remembering what temperature readings dictate a true fever.   Hands, on the other hand, seem to have a pretty great memory for the difference between warm and hot.

I have never checked my kids’ temperature because the actual number does not make much of a difference to me.  I know he (or she) is sick.  I know he has a fever.  And on day one, two and three of illness, I know that it is most likely a virus.  So if he does the other things he is supposed to do - breathe, drink, pee and throw impressive fits when I approach him with the blue nasal suction bulb - the height of his fever is not going to change much of what his pediatrician or I will do for him. 

Now, a caveat - there is always a caveat - neither of my kids has ever been lethargic.  Neither of them has ever had a fever under the age of 3 months.  If I was ever faced with either of these situations, I do not know that I would waste time rummaging through the linen closet looking for my digital thermometer.  I think I would be bee-lining it to the nearest medical center.  The only situation that I can imagine myself wanting to know a real number at home would be if I really thought my child had a fever but could not figure out why.  As in, no runny nose, cough, upset tummy, etc.  But even in that case, I would probably be seeking out an objective medical opinion fairly soon afterwards.  A temperature reading greater than 100.4 F would only speed my decision along.

References:

Dodd, SR, et al.  “In a systematic review, infrared ear thermometry for fever diagnosis in children finds poor sensitivity.”  Journal of Clinical Epidemiology. 2006 Apr;59(4):354-7. Epub 2006 Feb 20.

Graneto JW and Soglin DF.  “Maternal screening of childhood fever by palpation.”  Pediatric Emergency Care. 1996 Jun;12(3):183-4.

Wallenstein MB, et al.  “Fever Literacy and Fever Phobia.”  Clinical Pediatrics. 2013 Mar;52(3):254-9. Epub 2013 Jan 24.