Chapter 3: Health Promotion and Protection
3.6 Management of Illness
3.6.1 Inclusion/Exclusion Due to Illness
220.127.116.11: Guidelines for Taking Children’s Temperatures
After reading the CFOC standard, see COVID-19 modification below (Also consult applicable state licensure and public health requirements).
A normal body temperature is considered 98.6°F (37°C). A fever is a higher than normal body temperature. Body temperature increases in response to infection or other causes. In infants and children, a temperature of 100.4°F (38°C) or more from any area of the body is considered above normal.1,2 A child with a fever may feel warm, look flushed, sweat more than usual, be less active. Getting a correct temperature can help guide staff to make decisions about inclusion, temporary exclusion, or dismissal of children with a fever.
When early care and education program staff suspect that a child has a fever, they should take a temperature with a digital thermometer. A digital thermometer does not have mercury and is not made of glass. Different types of digital thermometers measure temperature at different areas of the body.3 It is important to use the correct method based on the child’s age and to document the temperature, time the temperature was taken, and type of thermometer used. Do not adjust the temperature reading for the location in which the temperature was taken. Whatever method you use, it is also important to follow the manufacturer’s cleaning instructions for the thermometer before and after each use. Thermometers may include:
- Tympanic (ear) thermometers. These may be used with children 6 months and older. Infants younger than 6 months have narrow ear canals, and tympanic thermometers can give inaccurate results. Tympanic thermometers need to be placed correctly in the child’s ear to be accurate. An accurate temperature depends on gently pulling the ear back before inserting the thermometer. A buildup of ear wax can make the temperature reading incorrect. Wait 15 minutes to take a temperature after being outside on a cold day, as that can cause an inaccurate low reading.
- Oral (under the tongue) thermometers. These can be used for children 4 years old and older. Use individual plastic covers each time, or clean and sanitize these thermometers each time according to the manufacturer’s instructions. Once the thermometer is turned on, place the tip under the tongue. Make sure the child’s lips are sealed until the thermometer beeps. Do not use teeth to keep the thermometer in place. If the child has had a hot or cold drink, wait 30 minutes after the drink to use an oral thermometer.
- Temporal artery (forehead) thermometers can be used for children of any age. This is the safest and most accurate way to get the temperature for a child under 6 months old in early care and education settings. Follow the manufacturer’s directions to know how and where to slide the thermometer across the forehead to make sure you get accurate results.
- Axillary (armpit) thermometers. These can be used for a child of any age. Temperatures are only accurate when the thermometer stays in the child’s closed armpit for the time recommended by the manufacturer. This method can be fast, but armpit temperatures are the least accurate.
- Rectal (in the bottom) thermometers. These are not recommended in early care and education programs due to health and safety concerns. A rectal thermometer could perforate (poke a hole) in the child’s rectum if not used properly. It could also pass germs from the stool, and if not properly cleaned, could spread illness among children and staff.
Armpit thermometers, pacifier thermometers, or fever strips are not accurate and not recommended. Glass or mercury thermometers should not be used in early care and education programs due to safety concerns.
COVID-19 modification as of May 21, 2021
In response to the Centers for Disease Control and Prevention’s COVID-19 Guidance for Operating Early Care and Education/Child Care Programs, if early childhood programs conduct daily health screenings with temperature checks on multiple children, it is recommended that programs use a:
King County (Washington) Public Health Department. Types of Thermometers for Child Care
American Academy of Pediatrics:
Taking an accurate temperature can guide staff as they make decisions about caring for children with a fever. If a child has a fever, early care and education program staff should prepare to manage the illness while keeping the child comfortable and safe. For more information, see 18.104.22.168 Inclusion/Exclusion/Dismissal of Children.
Safety and child abuse concerns may come up when using rectal thermometers. Early care and education program staff should be aware of these concerns. If rectal temperatures are taken, steps must be taken to make sure that all staff members are trained properly in this procedure and the opportunity for abuse is small (e.g., make sure that more than one adult is present while taking the child’s temperature). Rectal temperatures should be taken only by staff with specific health training in performing this procedure, and parents/guardians must give permission.
Thermometers with mercury can easily break and release toxic levels of mercury fumes. To prevent mercury toxicity, the American Academy of Pediatrics (AAP) does not recommend using mercury or glass thermometers in early care and education programs.1 Many state or local agencies operate facilities that collect used mercury thermometers. For more information on hazardous waste collections in your area, contact your state environmental protection agency or your local public health department.
TYPE OF FACILITYCenter, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS22.214.171.124 Conduct of Daily Health Check
126.96.36.199 Inclusion/Exclusion/Dismissal of Children
188.8.131.52 Inclusion and Exclusion of Children from Facilities That Serve Children Who Are Ill
- American Academy of Pediatrics. Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide. Aronson SS, Shope TR, eds. 6th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2022.
American Academy of Pediatrics. How to take a child’s temperature. Healthychildren.org Web site. Last reviewed October 12, 2020. Accessed April 27, 2022. https://www.healthychildren.org/English/health-issues/conditions/fever/pages/How-to-Take-a-Childs-Temperature.aspx
American Academy of Pediatrics. Signs and symptoms of fever. Healthychildren.org Web site. Last reviewed November 21, 2015. Accessed April 27, 2022. https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/Signs-and-Symptoms-of-Fever.aspx
COVID-19 modification as of May 21, 2021
Standard was last updated on September 13, 2022.