Is it appropriate to measure a child's temperature at the temple (temporal artery)?

Temporal Artery Temperature Measurement in Children

No, temporal artery thermometry should not be used as the primary method for measuring temperature in young children, especially those under 3 years of age where accurate fever detection is critical for identifying serious bacterial infections. Rectal temperature remains the gold standard and most accurate method for neonates and young children 1.

Why Rectal Temperature is Preferred

The most recent guidelines explicitly state that rectal temperature is the most accurate method and closest to core temperature 1. This precision is essential because:

• Infants ≤90 days have significantly higher risk of serious bacterial infections (bacteremia, meningitis, urinary tract infections)
• Fever may be the only clinical sign of serious illness in young infants
• Delayed diagnosis of invasive bacterial infection increases morbidity and mortality 1
• Clinical decision algorithms for febrile infants rely on accurate temperature thresholds (≥38.0°C/100.4°F) 2

Evidence Against Temporal Artery Thermometry

Multiple research studies demonstrate significant limitations of temporal artery thermometry:

Poor Sensitivity for Fever Detection

• Only 53% sensitive at detecting rectal fever ≥38.0°C (100.4°F) 3
• Only 27% sensitive at detecting rectal fever ≥39.0°C (102.2°F) 3
• Sensitivity of 61.5% compared to rectal in children 0-36 months 4
• Sensitivity ranges from 64.6% to 83.5% depending on cutoff used 5

Clinically Significant Temperature Differences

• Mean difference of 1.99°F (1.11°C) lower than rectal temperature in febrile children 3
• Temporal readings averaged 0.2°C lower than rectal, with even greater differences (>0.5°C) in febrile patients 4
• Mean temporal temperature was 0.27°C lower than rectal overall 5

Environmental Factors Worsen Accuracy

Temporal artery thermometry becomes increasingly unreliable in different nursing environments 6:

• Room air: acceptable agreement (mean difference 0.10°C)
• Phototherapy: poor agreement (mean difference 0.50°C)
• Radiant warmers: very poor agreement (mean difference 0.97°C)
• Incubators: very poor agreement (mean difference 1.15°C)

When Temporal Thermometry Might Be Acceptable

Temporal artery thermometry may be used only for fever screening in specific low-risk situations 4, 5:

• Older, cooperative children (>4-5 years)
• Primary orthopedic or trauma presentations where fever detection is not the primary concern
• Very busy clinic settings for initial screening only, using a lower cutoff of 37.7°C 5
• Any positive temporal reading must be confirmed with rectal temperature in young children

Critical Pitfalls to Avoid

1. Never rely on temporal thermometry alone in children <36 months presenting with possible infection
2. Do not use temporal thermometry in neonates or infants where serious bacterial infection is a concern
3. Recognize that normal temporal readings can miss significant fever - nearly half of febrile children will be missed 3
4. Environmental factors (warmers, incubators, phototherapy) dramatically reduce accuracy 6

Recommended Approach by Age

• Neonates and infants <3 months: Rectal temperature mandatory 1
• Children 3-36 months with suspected infection: Rectal temperature strongly preferred 2, 4
• Older cooperative children (>4-5 years): Oral temperature preferred; temporal may be used for screening 1

The bottom line: In the emergency department or acute care setting where accurate fever detection impacts clinical decision-making and risk stratification for serious bacterial infection, rectal thermometry remains the required standard for young children 3.