European Journal of Pediatrics

, Volume 178, Issue 10, pp 1501–1505 | Cite as

Performance of axillary and rectal temperature measurement in private pediatric practice

  • Jan Teller
  • Reto Bernasconi
  • Giacomo D. Simonetti
  • Sebastiano A. G. LavaEmail author
Original Article


To better understand the role and reliability of axillary temperature measurements in clinical real life, axillary and rectal measurements in infants presenting in a private pediatric practice because of fever were compared. Prospectively, 169 infants (81 girls), median 9 (interquartile range 6–13) months of age, were examined at room temperature (20–24 °C). Two left and two right axillary, as well as two rectal measurements were taken with a digital thermometer and subsequently averaged. The median and interquartile range for axillary and rectal measurements were 36.9 (36.3–37.6) °C and 38.2 (37.4–38.9) °C, respectively (p < 0.0001). The limits of agreement in the Bland-Altman plots were 0.32 to 1.98 °C, with a mean bias of 1.15 °C. Axillary thermometers showed a good sensitivity for detecting rectal temperature > 38 °C (95%) but limited specificity (75%), with an area-under-the-curve of 0.95.

Conclusions: Axillary readings are always lower than rectal ones, the limits of agreement are quite wide. Axillary readings can be used for screening but critical measurements should be confirmed by more reliable methods.

What is Known

• In infants and toddlers, temperature has been traditionally taken rectally.

• Axillary measurements are better accepted and are recommended in current guidelines.

What is New

• Axillary temperature was always lower than rectal temperature.

• The limits of agreement of axillary thermometers are wide.

• Axillary thermometers have a good sensitivity but limited specificity and are therefore adequate for fever screening.


Children Measurement Fever Infants Thermometer 



Confidence interval


Interquartile range


Jan Teller


Receiver operating characteristics


Standard deviation


Authors’ contributions

- Study concept and design: JT, SAGL

- Consent, Recruitment, Study execution: JT

- Statistical analysis: RB, SAGL

- Review of the literature, Preparation of the figures, Drafting of the manuscript: RB, SAGL

- Critical revision of the manuscript: GDS, SAGL

- Approval of the final manuscript: JT, RB, GDS, SAGL

Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This project was performed in the context of a routine quality assessment. All procedures performed were in accordance with ethical standards as laid down in the 1964 Helsinki declaration.

Informed consent

Caregivers received information on the study and (anonymous) study participation and had to give oral consent in order for their children to be enrolled in the study. Since only infants < 24 months of age were included, children assent was not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Private Pediatric PracticeLangnau I.E.Switzerland
  2. 2.Department of AnesthesiaBasel University HospitalBaselSwitzerland
  3. 3.Department of Pediatrics, Pediatric Nephrology UnitInselspital, and University of BernBernSwitzerland
  4. 4.Pediatric Institute of Southern SwitzerlandOspedale San Giovanni Bellinzona, and Università della Svizzera ItalianaLuganoSwitzerland
  5. 5.Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV)Lausanne University Hospital and University of LausanneLausanneSwitzerland

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