Pediatric Fever – Myth 2/10: Can we determine fever by touch?

Myth #2: My child feels warm, so she has a fever. 

We hear this one all the time. Parents don’t have a thermometer at home, or maybe they just don’t trust it. So the question is….does the parent know by touching their child, if a true fever is present? What does the evidence tell us? This is part 2 of a 10-part series where I will busting what I consider to be the top 10 myths involving pediatric fever.

Banco L, 1984¹

This 1984 study published in the American journal of diseases of children assessed a mother’s ability to tell if their kid has a fever by palpation. 

• Results
  • Febrile: Correct 52.3% of the time (Increased to 90% if fever > 38.9° C)
  • Afebrile:Correct 93.9% of the time

Katz-Sidlow RJ, 2009²

Here’s a similar study from 2009 looking at mothers ability to determine presence of fever by touch alone. They found that over 50% of parents rely on palpation alone to determine fever, even if they have a thermometer at home. They also showed that parents overestimate presence of fever with a positive predictive value of only 33%. However, they did confirm that the child is likely to not have a fever if parents feel they do not have one.

So how do doctors and nurses stack up to parents in regards to determining fever by touch? As it turns out…doctors and nurses are parents too…

Okposio MM, 2012³

• This 2012 study published in the Nigerian journal of pediatrics shows that we are all pretty decent at determining when a child does NOT HAVE a fever…
• But….we are all pretty much the same amount of terrible when determining if true fever is present

The odds are literally that of a coin flip when guessing if a fever is present. I know you think you have magic powers…but you just don’t. 

But what about historical fevers?B

A historical fever is when the parents say child is febrile at home, but there is no fever upon arrival to ED. 

Yarden-Bilavsky H, 2010⁴

A 2010 study of 399 neonates < 28 days old looked at the rate of serious bacterial infections in patients with historical fever 

• 143 of them had a fever by history alone That is, they had a fever at home reported by the parents, but were afebrile on presentation.
  • ~ 8% ended up having a Serious Bacterial Infection.
  • buuut….a huge point to make here is that 100% of those in this study were due to a urinary tract infection
• 246 of the patients in this study had a true documented fever.
  • ~ 18% ended up having a serious bacterial infection 
  • Included urinary tract infections, bacteremia and pneumonia. 
• Bottom Line:
  • The risk may be lower, but you CANNOT disregard historical fevers. 
  • You should still be doing a full septic workup on historical fevers in children less than 30 days old. 
  • If you are set on not doing anything for a neonate with…at the VERY LEAST, you should be checking the urine.

Lets summarize the evidence….

• Tactile temperatures are correct only 50% of the time for fever.
• It is much better for estimating if there is no fever, but this certainly should not be used in clinical medicine.
• 8% of purely historical fevers will end of having a serious bacterial infection, and in studies, all of these were due to a urinary tract infection. 
• You should still be doing a full septic workup on historical fevers in children less than 30 days old. 

So, for our second myth questioning if a mother’s touch can determine if a fever is present…I would consider this BUSTED

References

1. Banco, L., & Veltri D. (1984).Ability of mothers to subjectively assess the presence of fever in their children. Am J Dis Child, 138(10):976-978. 
2. Katz-Sidlow RJ, et al. (2009). Fever determination in young infants; prevalence and accuracy of parental palpation. Pediatr Emerg Care, 25(1):12-4.
3. Okposio MM, Abhulimhen-Iyoha BIm. (2012). Accuracy of mother’s touch in assessing the presence of fever in children. Niger J Paed, 39(2):56-59. 
4. Yarden-Bilvasku H, et al., (2010). Serious bacterial infections in neonates with fever by history only versus documented fever. Scand J Infect Dis, 42(11-12):812-6. doi: 10.3109/00365548.2010.492783

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Nicholas McManus

Emergency Physician at Lake Michigan Emergency Specialists - Core faculty member at West Michigan EM Residency - Michigan State University COM Clinical Faculty - Founder of Banana Bag Blog

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