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January 1996

Comparison of Rectal, Axillary, and Forehead Temperatures

Author Affiliations

From Goroka Base Hospital, Papua New Guinea. The authors are now affiliated with Royal Children's Hospital, Parkville, Victoria, Australia.

Arch Pediatr Adolesc Med. 1996;150(1):74-78. doi:10.1001/archpedi.1996.02170260078013

Objective:  To assess whether axillary and forehead temperatures accurately reflect the rectal temperature (the criterion standard).

Design:  Prospective study with calculation of paired axillary-rectal and forehead-rectal temperature differences and their SDs.

Setting:  Referral hospital.

Participants:  Convenience sample of 120 patients, with 20 patients in each of six age groups (ie, <1 month, 1 to 5 months, 6 to 11 months, 12 to 23 months, 2 to 14years, and adults).

Results:  In newborns, the rectal temperature was equal to the axillary temperature plus 0.2°C for each week of age up to 5 weeks; forehead strip thermometers gave inaccurate readings in this age group. In patients older than 1 month, the mean difference (SD) between the rectal and axillary temperatures was 1.04°C (0.45°C); thus, the axillary temperature was adjusted by adding 1°C, and no adjusted axillary temperature differed from the rectal temperature by more than 1°C. The mean difference (SD) between the forehead temperature that was measured by the best forehead liquid crystal strip thermometer (FeverScan) and the rectal temperature was 0.14°C (0.60°C); 10 forehead temperatures differed from the rectal temperature by more than 1°C.

Conclusions:  Previous studies that have suggested that axillary and forehead temperatures do not provide a reliable guide to the rectal temperature have all used inappropriate methods of analysis (correlation coefficients or sensitivity and specificity); previous studies that have based their conclusions on the correct method of analysis (paired differences and their SDs) have all found that the axillary temperature gives a good indication of the rectal temperature. The axillary temperature can be measured safely at any age, and the axillary temperature plus 1°C is a good guide to the rectal temperature in patients older than 1 month. Forehead strip thermometers are easy to use, but they do not estimate the rectal temperature as accurately as the axillary temperature does.(Arch Pediatr Adolesc Med. 1996;150:74-78)