Non-contact infrared versus axillary and tympanic thermometers in children attending primary care: a mixed-methods study of accuracy and acceptability

Gail Hayward*, Jan Y. Verbakel, Fatene Abakar Ismail, George Edwards, Kay Wang, Susannah Fleming, Gea A. Holtman, Margaret Glogowska, Elizabeth Morris, Kathryn Curtis, Ann van den Bruel

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    14 Citations (Scopus)
    50 Downloads (Pure)



    Guidelines recommend measuring temperature in children presenting with fever using electronic axillary or tympanic thermometers. Non-contact thermometry offers advantages, yet has not been tested against recommended methods in primary care.


    To compare two different non-contact infrared thermometers (NCITs) to axillary and tympanic thermometers in children aged

    Design and setting

    Method comparison study with nested qualitative component.


    Temperature measurements were taken with electronic axillary (Welch Allyn SureTemp (R)], electronic tympanic [Braun Thermoscan (R)], NCIT Thermofocus (R) 0803. and NCIT Firheatth Forehead. Parents rated acceptability and discomfort. Qualitative interviews explored parents' experiences of the thermometers.


    In total 401 children were recruited (median age 1.6 years, 50.62% male). Mean difference between the Thermofocus NCIT and axillary thermometer was 0.14 degrees C (95% confidence interval (CI) = 0.21 to -0.06 degrees C); lower limit of agreement was -1.57 degrees C (95% CI = -1.69 to -1.44 degrees C) and upper limit 1.29 degrees C (95% CI = 1.16 to 1.42 degrees C). A second NCIT (Firhealth) had similar levels of agreement; however, the limits of agreement between tympanic and axillary thermometers were also wide. Parents expressed a preference for the practicality and comfort of NCITs, and were mostly negative about their child's experience of axillary thermometers. But there was willingness to adopt which, was medically recommended.


    In a primary care paediatric population, temperature measurements with NCITs varied by >1 degrees C compared with axillary and tympanic approaches. But there was also poor agreement between tympanic and axillary thermometers. Since clinical guidelines often rely on specific fever thresholds, clinicians should interpret penpheral thermometer readings with caution and in the context of a holistic assessment of the child.

    Original languageEnglish
    Pages (from-to)E236-E244
    Number of pages9
    JournalBritish Journal of General Practice
    Issue number693
    Publication statusPublished - Apr-2020


    • acute disease
    • child
    • fever
    • primary health care
    • thermometers
    • FEVER
    • SKIN

    Cite this