A Guide to Hypothermia in Babies: How to Identify and Prevent Low Body Temperatures

Hypothermia — a condition in which a person’s body is losing heat faster than it can produce it — is very common in infants. The Centers for Disease Control and Prevention note that babies are one of the most at-risk groups for this serious condition. Hypothermia is a major health risk for babies, and while it is not often the direct cause of infant mortality, complications associated with it contribute to a substantial proportion of neonatal deaths globally.

Registered nurses (RNs) are frequently expected to understand basic infant health and safety factors like core body temperature, both in the field and as part of their certification exam upon completing nursing school. What is a good temperature for a baby? What are the risk factors and symptoms of hypothermia? What can caregivers and medical professionals do to ensure the warmth and wellbeing of infants? This guide will provide answers to all of these questions and provide advice to help you prevent this condition.

What Temperature Is Dangerous for a Baby?

The average body temperature for newborns ranges from 97.9°F to 100.3°F. However, an infant’s body temperature can vary greatly.

Because babies have higher metabolic activity and have larger body surface areas relative to their body weight, babies often have higher body temperatures than adults. Further, babies also experience higher water loss from the skin, which makes them more susceptible to body temperature fluctuations.

There are several different ways you can measure a baby’s temperature, and the approach you use may result in slight temperature variations. Most pediatricians suggest that, for babies up to two years in age, rectal measurements are most accurate, followed by armpit readings. Review the chart below to find the average temperature for babies, based on the method it was taken:

Measurement MethodNormal Temperature Range
Rectum97.9°F to 100.4°F
Armpit94.5°F to 99.1°F
Mouth95.9°F to 99.5°F
Ear96.4°F to 100.4°F

A measurement above or below these ranges should be a red flag for parents; a reading that above these ranges may indicate a fever, while a reading below them may indicate hypothermia.

Risk Factors for Low Body Temperature in Infants

To maintain a normal temperature, several systems of the body have to work together, and environmental factors can complicate an infant’s ability to maintain their body temperature. As a result, low body temperature can be attributed to many potential factors:

  • Cold Environment: If the surroundings are cold or the temperature is low, it may result in hypothermia. This is particularly likely if the baby isn’t wearing clothes that are warm enough in the cold environment. Excessive air conditioning is also harmful to babies.
  • Low Oxygen Levels: Infants experiencing hypoxemia — a condition in which the body is not able to process enough oxygen to the blood — may have abnormally low body temperatures. This can result from poor air quality at home, which may occur if someone in the household smokes.
  • Nutritional Deficiencies: Nutritional deficiencies may also lower the temperature of the body and inhibit the body’s ability to thermoregulate in cold environments. In particular, deficiencies in vitamin B12 and iron can result in low body temperature.
  • Low Birth Weight: A low birth weight can make an infant more susceptible to hypothermia. This is particularly a risk factor for newborns who weigh less than 3.3 lbs, and low weight can also lead to a variety of other negative effects.
  • Primary Immunodeficiency Disorders: Medical disorders that impact the immune system can cause hypothermia. A baby who experiences such conditions may have deficiencies in their immune system that reduces their body temperature to dangerous levels.
  • Infections: If your child has an immunodeficiency, they may develop a low body temperature due to infections. This may also be a side effect of medications used to treat infections.
  • Neurological Issues: The part of our brain that regulates body temperature is called the hypothalamus, and certain neurological conditions can inhibit its function. Toddlers suffering from neurological problems such as multiple sclerosis and Shapiro syndrome may experience hypothermia.

Symptoms of Hypothermia in Babies

To recognize whether a baby is suffering from hypothermia or not, parents, caregivers, and medical personnel should look for any symptoms that the baby might be showing. There are many symptoms of hypothermia, and the specific signs that a baby demonstrates may indicate the severity of their condition.

There are three stages of hypothermia: mild, moderate, and severe. These can serve as a guideline for determining and assessing the level of hypothermia in your child:

  • Mild Hypothermia (96.8°F to 97.5°F): A baby experiencing mild hypothermia may exhibit symptoms including fussiness, poor feeding, shivering, rapid breathing, and vomiting. They may have low energy levels and occasionally emit weak cries. Their skin may be cold to the touch and appear reddish.
  • Moderate Hypothermia (89.6°F to 96.6°F): The signs described above may become more evident in an infant with moderate hypothermia. Violent, uncontrollable shivering is common. In addition, they may have difficulty moving.
  • Severe Hypothermia (Below 89.6°F): If a young one has severe hypothermia, they are at major risk of experiencing permanent, potentially fatal, damage. They may lose consciousness, enter a coma, experience shallow breathing, or have a weak or irregular pulse. The last of these may be particularly noticeable when listening to the apical pulse.

What to Do if a Baby Has a Low Body Temperature

If your child is exhibiting any of the signs listed above, it’s time to take action. Mild or moderate symptoms can be mitigated by following some key steps. Severe symptoms, however, warrant immediate medical intervention.

If you suspect that a baby has hypothermia, do the following:

  1. Take the baby’s temperature, preferably using a rectal thermometer, to confirm if they have hypothermia.
  2. Attempt to increase their temperature by swaddling them, adding extra layers of clothing, feeding them a warm drink, or using your body heat. You may also consider setting your home’s thermostat to at least 77°F and using hot packs on the baby’s body.
  3. Assess whether these measures are helping by monitoring for symptoms and checking their temperature again.
  4. If the baby’s temperature is not improving in regards to a normal range (as described earlier in this guide), seek emergency medical help. Go to an emergency room if medical help is not readily available.

How to Reduce a Newborn’s Risk of Hypothermia

When it comes to managing a baby’s temperature, there’s much more medical staff and parents can do beyond watching for symptoms. There are many ways you can reduce a baby’s temperature and prevent hypothermia. Indeed, these preventative measures can be enacted from the moment the child is born.

In a practical guide on this subject titled “Thermal Protection of the Newborn,” the World Health Organization (WHO) offers a set of 10 interlinked procedures called the “warm chain.” These are designed to maximize a newborn’s thermal protection and prevent heat loss. These practices are commonly learned by professionals such as certified nurse midwives, neonatal nurse practitioners, and pediatric nurses.

The 10 procedures of the warm chain include:

  1. Delivering the child in a warm, clean room — the temperature should be between 77°F and 82.4°F. The room should be equipped with two absorbent towels, bedding and blankets, and suitable baby clothes. After delivery, these can be used to maintain the newborn’s temperature.
  2. Dry the baby immediately after birth with a dry towel, while the cord is still attached. The baby should then be covered with a second dry towel, and a pre-warmed cap should be placed on their head.
  3. If the baby is not breathing after drying, resuscitation is necessary. They must be kept warm during resuscitation. This includes wrapping the baby in a warm blanket and potentially keeping him or her under an additional source of heat for a period of time.
  4. There must be skin-to-skin contact between the baby and the mother. Body heat from the mother can help the child maintain a healthy temperature. If skin-to-skin contact is not possible, the baby should be dried, wrapped, and placed in his or her mother’s arms.
  5. Breastfeeding as soon as possible can give the newborn calories with which it can generate body heat. As the WHO notes, the colostrum (the first milk) is “ rich in nutrients and antibodies, and is all the nourishment and liquid a baby needs.”
  6. Postpone bathing and weighing until at least six hours after birth. Both of these procedures can result in a rapid loss of heat. When they are carried out, they should be completed quickly.
  7. Proper bedding and clothing should be available for the newborn for their first few days after birth. The WHO states that a good rule of thumb is to keep in mind that newborns generally need one or two more layers of clothing or bedding than adults. Further, newborns should always have a cap on, as the lack of one can result in substantial heat loss.
  8. Keep the mother and baby together. Ideally, parents should be with their newborn for 24 hours a day. This can help the child maintain their body heat and breast-feed when needed.
  9. Ensure warm transportation. If the baby needs to be transferred from one area of a hospital to another, or to another hospital entirely, they should be kept warm at all times.
  10. Awareness of the importance of thermal protection for healthcare providers and parents. Anyone involved in the care of newborns should be aware of the above best practices.

Strategies for Parents to Avoid Hypothermia

Thermal protection concerns do not end once you leave the hospital along with your newborn. There are some useful strategies that parents can employ to keep their baby warm, safe, and healthy.

Maintaining Skin-to-Skin Contact With Kangaroo Care

As noted above, a mother and her newborn should be kept together. A popular strategy to do this is known as kangaroo care. Particularly useful for preterm newborns, kangarooing is a technique that helps maintain the temperature of the newborn, increases the availability of breastfeeding, and improves mother-infant bonding.

Kangaroo care involves the following steps:

  • Keep the baby naked over the mother’s chest, inside her clothing.
  • Let the baby feed as often as they want, but the position of the mother must allow the baby to stay upright.
  • Keep the baby in warm environments. If the temperature is too low, properly dress them, making sure to cover his or her head.
  • Visit a doctor for regular checkups, vaccinations, and to record weight changes.
  • If the mother is not close to the baby, any other family member must perform the method, and the baby must be covered in a warm blanket or several layers of clothing.

If the baby is born with no sign of distress not too prematurely, then this method can be administered to him or her at home. However, if the baby is born underweight, then they may need special care. Consult with a doctor to discuss the best approach for your specific circumstances.

Maintaining Temperature During Transport

From the moment a parent is able to take their newborn home, they should be aware of the importance of maintaining their baby’s body temperature. This is particularly important during transport, where environmental conditions can change drastically and babies may be exposed to areas with many germs.

  • Ensure that the temperature of the baby is stable before travel. Measure the baby’s temperature and always take remedial measures before traveling. If you don’t have a thermometer available, touch the child’s head, hand, feet, and abdomen to determine if they are warm.
  • While traveling, keep the baby on the chest of the mother.
  • Dress the baby suitably and cover their hands, feet, head properly. Avoid changing their clothes or undressing them too frequently.
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