We hear a lot about fevers, but rarely do we hear much about low body temperatures. Children with complex medical issues, however, often experience low body temperatures, especially if they have neurological issues or a disorder of the autonomic nervous system. In this article, we will take a look at when low body temperatures are a concern versus simply an annoyance, and how to handle episodes of low body temperature.
Cause is Key
A body temperature that is between 90F and 95F is not dangerous in and of itself. In other words, mild hypothermia or a low body temperature will not cause organs to fail or shut down.
What is more important is the cause of the low body temperature, which may or may not be dangerous. Some children routinely have a low body temperature, and typically this is not dangerous. But children who intermittently or suddenly develop low temperatures may have a more serious acute condition, such as sepsis or another severe infection.
“Normal” Body Temperatures
All children have their own thermostats. Some run near the average of 98.6F, while others run higher or lower. It is critical to know what your child’s average body temperature is. Any body temperature that is consistently between 95-100F is considered safe and normal. In order to determine your child’s typical body temperature, take his or her temperature twice daily (AM and PM) for about a week (when well). You should see an average temperature or range emerge.
Some children, especially children with significant neurological issues, always have low temperatures. Sometimes these children have normal temperatures during the day, but routinely drop their temperatures during the night. This, in and of itself, is not dangerous, as long as the body temperature is staying above 90F. It can, however, be uncomfortable for children to run low temperatures. Sometimes they do not sleep as well because they are cold or shivering. In some children, low body temperatures set off a cascade of other problems, such as low heart rates.
Some children regulate their temperatures most of the time, but drop them during periods of stress, fatigue, or illness. In many cases, these children have significant autonomic dysfunction. These low temperatures can be an important clue that something is brewing, and should be taken seriously. In many cases, low body temperatures occur with infections.
When To Get Checked
Any child with a temperature below 90F should receive immediate emergency care. Any temperature below 90F can be quite serious, and may lead to organ failure and other problems. Note that thermometers typically are not accurate below 93F, so it can often be difficult to get an accurate core temperature reading in a child with a low temperature. There are special low-temperature thermometers available for children who frequently have low temperatures.
A physician should perform a one-time evaluation of any child who routinely runs a low temperature between 90F and 95F to ensure that there is no pathological cause for the condition. As long as the child has been evaluated, the low temperature is not likely concerning. Low temperatures are just “normal” for some children.
Children who intermittently run low temperatures should have a plan in place for evaluation of the low temperature. If low temperatures only appear during illness or fatigue and are self-limited, they may not be dangerous. But if they tend to occur with serious infections, they may be a critical clue to diagnosing infection, and should be evaluated immediately. These children should have a plan in place to run blood or urine cultures, along with basic blood work, with every low body temperature, and should also be monitored carefully.
Children who experience low body temperatures due to stress or fatigue may simultaneously develop other symptoms of autonomic dysregulation, such as a low heart rate, low blood pressure, low or high blood sugar, or apnea. In many cases, simply warming the child will eliminate all symptoms. Monitoring is critical for these children, and emergency plans should be in place to make sure you know when to get emergency treatment.
If a child who normally regulates his temperature suddenly develops a low temperature, he should be assessed immediately for more serious conditions and infections.
Addressing Low Temperatures
Sometimes chronic low temperatures need to be fixed, while in other cases they do not. In addition, sometimes you cannot fix a low temperature, even if you want to.
If a child runs cold all the time, has no acute illnesses, and does not experience any effects from the low temperatures, you can simply accept the low temperature as “normal.” As long as your child is not uncomfortable, the temperature can be ignored.
If your child seems uncomfortable or is developing secondary effects, you can try to warm her up. Some children need to sleep with a hat, mittens, and a hot pack every night to stay comfortable. Bundling them up and using microwaveable hot packs or hot water bottles can help significantly. For children with severe temperature regulation problems who are having side effects, there are medical systems, such as the Bair Hugger, that can be used for warming. Warm fluids (by IV, enterally, or orally) can help, as can a hot bath. Be careful not to warm the child too quickly, as rapid rewarming can be dangerous to some children. In most cases, warming a child will relieve any discomfort or additional symptoms.
In summary, low temperatures are only a problem when the cause is unknown and the temperature is creating discomfort or secondary symptoms. If there is any doubt about the cause, make sure you get medical attention immediately.