Monday, September 13, 2010

Why Kids Get Sicker at Night

I saw this article from parenting magazine and wanted to remember it, so I put it on here:

Why Kids Get Sicker at Night
Sickness never comes at a convenient time, but when your child awakens in the middle of the night with distressing symptoms, chaos often follows.

Everyone is half asleep and not thinking clearly. The doctor's office is closed, and you don't know whether you should call and wake him or try to deal with the ailment yourself.

Let's relieve some of the stress of that decision right now: Anytime you think your child's health may be in serious danger -- for instance, he has a high fever and is acting poorly, has trouble breathing, has a strange rash, or is having a seizure -- call your doctor (or 911) immediately. And almost any symptom in a baby under 4 months old merits an immediate call to the doctor, no matter the time.

9 Pediatric Emergency Essentials
So what are you supposed to do the other 97 percent of the time when your child wakes up at 2 A.M. worse off than when he went to bed?

Symptoms of many children's illnesses routinely worsen at night, and though there's nothing life-threatening about them, they can make your child miserable.

Fortunately, with a little planning and the help of our middle-of-the-night health guide, you'll have what you need to get your kid (and you!) feeling better by morning.

Asthma and allergies
Why they're worse at night: If your child has asthma or certain allergies, you're probably all too familiar with the challenges of helping her through the wee hours.

There are many factors at play: "The body's level of cortisol drops at night, and cortisol has some preventive effects on asthma," says Santiago Martinez, M.D., pediatric allergist and clinical assistant professor of medicine at Florida State University Medical School in Tallahassee. Plus, the levels of histamine rise, aggravating many allergy and asthma symptoms. And finally, some allergens, such as dust mites and pet dander, may be more prevalent in a child's room, increasing her exposure while she sleeps.

What to do: If your child has an allergy attack at night, an antihistamine should quell her symptoms (ask your doctor for the best one to have on hand for your child). Should you find that her attacks are frequent and occur year-round, you may want to consider immunotherapy shots, which introduce tiny amounts of the allergen into the body, slowly allowing immunity to build. You can also consider using HEPA filters in your vacuum and a HEPA air filter -- these are designed to trap the minuscule particles that can aggravate symptoms.

Why it's worse at night: This barking-seal cough is usually the result of a viral infection that has settled in the upper airway and voice box, and typically strikes while the child has a cold. Because it causes swelling of the vocal cords, the cough also may be accompanied by noisy, rapid breathing.

Croup is almost always at its worst at night, partly because blood flow to the respiratory tract changes when a child lies down. Plus, dry air can aggravate it.

Why it's worse at night: Whether the infection is in the middle ear or in the ear canal (also called swimmer's ear), these puppies can hurt. Lying down increases the collection of fluid and puts extra pressure on the inflamed tissue.

What to do: Ibuprofen (for kids older than 12 months) or acetaminophen can help relieve the ache, but you can also try this remedy for severe pain from middle ear infections: "Heat a tablespoon of olive oil in the microwave so it's warm -- but not hot -- to your touch," says Leeds. "Put two to three drops of the warm oil in your child's affected ear. It relaxes the membranes and brings almost instant relief." Applying a warm, damp washcloth to your child's ear also can help.

Why it's worse at night: Body temperature rises naturally in the evening, so a fever that was slight during the day can easily spike during sleep.

What to do: First, take your child's temperature (do it rectally if she's under 6 months old -- and, ideally, for as long as she'll allow this method). Any fever above 100.4°F in an infant under 3 months warrants an immediate call to the doctor. Same goes for an elevated temp in any child that's accompanied by lethargy, vomiting, diarrhea, stiff neck, or an unusual rash.Otherwise, try a dose of acetaminophen, wait half an hour, and check the temperature again. In the meantime -- and if you're not too delirious -- you can give your child a room-temperature bath to help cool her down. And definitely help her stay hydrated by offering some water (or formula or breast milk if she's a baby) before she goes back to sleep.

Itchy skin
Why it's worse at night: When your child is lying still, it's a whole lot easier to focus on the itchiness, whether it's due to poison ivy, bug bites, eczema, or even sunburn. And if the itchy skin is rooted in some kind of allergy, you've got the higher nighttime levels of histamines to thank.

Dealing with an allergic rash or lots of bites? An antihistamine can bring relief. A topical cortisone cream can help as well, but again, avoid using this type of product before you have specific instructions from your ped.

Stuffy nose

Why it's worse at night: Too bad kids can't sleep standing up like horses -- then their nasal passages wouldn't swell more when they sleep!

What to do: For immediate relief, use saline nose drops or spray. Both will moisten the membranes and loosen the secretions, making it easier for your child to blow out the mucus, or for you to remove it with a bulb syringe if you have a baby.

You may be tempted to offer your child a decongestant, but they're no longer recommended for kids under 2, and many doctors advise against giving them to older kids.


Why it's worse at night: It's not that kids are necessarily more likely to throw up at night; it's more that it feels about ten times worse because you usually end up having to change bedsheets, clean up rugs, change and wash pajamas -- all when you're bone tired. Then you have to worry that it could happen again. (Oh, and it's pretty awful for your kid.)

What to do: First, make sure your child isn't throwing up anything green or bloody; if he is, call the doctor, as this could indicate a more serious condition. Same goes for vomiting accompanied by pain in the lower right side of the abdomen. If he's still awake an hour later but hasn't vomited again, try giving him small sips of flat cola or ginger ale, if you have it.

The middle-of-the-night survival kit: A little preparation can go a long way toward making those 2 A.M. sick calls easier. Some things to have on hand:

In the medicine chest:
• Pain and fever relievers. Stock both children's ibuprofen and children's acetaminophen (or the infant formulations for kids under 2) and jot down the correct dose for each approved by your doctor.
• A children's antihistamine and cortisone cream (with doctor-approved instructions)
• Saline nose drops or spray
• Nasal aspirator
• Medicine dropper
• Prescription pain-relief eardrops (if your child is prone to infections)
• Petroleum jelly
• Digital thermometer

In the kitchen:
• Olive oil
• Canned peaches or pears in syrup
• Ice pops
• Flat cola or ginger ale

In his room:
• Cool-mist humidifier
• Facial tissues

Original post can be found here.

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