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Why kids get sicker at night

  • Story Highlights
  • A dropping cortisol level in the body may be a factor in asthma worsening at night
  • Lying down increases fluid collection and puts extra pressure on inflamed ear tissue
  • Body temperature rises in the evening, so a fever that can easily spike during sleep

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By Laura Flynn McCarthy
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It started around 1 a.m. My son, Liam, was 14 months old, and the noises coming from his room didn't seem completely human: There was a sort of honking bark followed by a whistle-y kind of breathing.

Illnesses can strike at inconvenient hours especially when your child awakens at night with symptoms.

I ran into his room, my heart racing with worry, and I found him sitting up in his crib, looking scared and tired. I picked him up, took his temperature -- no fever -- and called the doctor.

"It sounds like croup," the doctor said. "Wrap him up in a warm blanket, sit outside with him, and call me back if his cough and breathing don't improve in ten minutes." Huh? This was early spring in New Hampshire. Sit outside?

It had to be worth a shot. I wrapped Liam up so that only his frightened little face was exposed, put on my winter coat, and stepped onto our screened-in porch. We sat on the rocking chair, moving back and forth, looking at the stars, and listening to the croaking tree frogs.

Within 15 minutes his throat gradually, miraculously cleared. The coughing stopped, his breathing sounded normal, and believe it or not, he had fallen back to sleep.

In the meantime, my husband had set up a modern version of outdoor night air -- a cool-mist humidifier -- in Liam's room. I put him back in his crib, and he slept through the night. I, on the other hand, kept checking in on him every hour or so, but that's what mothers do.

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 unusual, 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.

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 Dr. Santiago Martinez, 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. Interactive guide to allergies

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.

Got an asthmatic? You know what to stock: a bronchodilator, which immediately opens the airways; a peak flow meter to monitor your child's breathing; and preventive medications such as leukotriene inhibitors or inhaled steroid medications, which work to keep inflammation in check long-term. Learn more about the symptoms and treatment of asthma

"If your child is having more than two flare-ups of asthma a week -- whether it's just a chronic dry cough or wheezing -- or if she's not responding well to the bronchodilators, her condition is not well controlled and she should be reevaluated by a doctor," says Martinez. "Virtually everyone can get their asthma under control if it is diagnosed and treated early. In some cases, asthma and allergies may just be seasonal problems, and treatment can be stepped up or reduced, depending on the need."

Preventive steps to reduce the allergens can go a long way, too. That may mean keeping your child's windows closed, banning Fluffy and Fido from her room, and encasing her bedding in allergy-proof covers. 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. 5 drug-free cures for colds, colic, constipation, and more

What to do: "Begin by giving your child a dose of children's ibuprofen to reduce the severity of the swelling in his airways and relieve the discomfort," says Dr. Andrea Leeds, a pediatrician in Bellmore, New York, and a member of the committee on practice and ambulatory medicine for the American Academy of Pediatrics. (If your child is younger than 12 months, skip ibuprofen unless your doctor has already given you the OK to use it.) "Then strip him down to his diaper or underpants, turn on the shower full blast, and sit in the steamy bathroom with him for fifteen minutes." After that -- and this is the most important part, says Leeds -- dress him, wrap him up in a blanket, and take him outside in the cool night air (or, if it's summertime, hold him in front of the open freezer door or an air conditioner for at least five minutes).

The steam relaxes the airways and vocal cords, while the cold air reduces the swelling; this combination often controls symptoms until the next day, when you can go to the doctor. (Like my doctor, yours may recommend one strategy or the other; if you notice a clear improvement, as we did with just the cold air, it's usually fine to stop there.)


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. Either way, it's smart to check in with your doctor in the morning; your child may need an antibiotic to clear the infection if it's not improving on its own (as many do). If your child is prone to them, ask about getting prescription eardrops to numb the pain next time around.


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. Feverish kid? Find out if she should see a doctor

Otherwise, try a dose of acetaminophen, wait half an hour, and check the temperature again, says Leeds. "If it hasn't begun to come down and she's older than a year, give your child some ibuprofen, too," she adds. "You can use these medications together, separated by half an hour. Just remember that acetaminophen can be given every four hours, and ibuprofen can be given every six to eight hours." (Write down the time of each dose to help you keep track.) 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. Call the doctor in the morning to check in; she may want you to bring your child in. What kind of cough is it? Find out with an interactive symptom checker

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.

What to do: Take some advice from Tyler Bingham of Lynn Haven, Florida, whose 4-year-old daughter has eczema. "Katie's skin is always itchier at night," says Bingham. "So before she goes to bed, we use a moisturizing body wash, then I'll massage a dry-skin lotion, usually one from Aveeno, onto her legs, where her eczema is the worst. The massage calms her and the lotion soothes. If need be, I also run a cool-mist humidifier in her room to keep the air moist."

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. "My nine-month-old, Hamza, hated the bulb syringe whenever I used it on him," says Diana Malikyar, who lives in Stone Mountain, Georgia. "But then I laid him down in front of the bathroom mirror so he could watch me doing it. Once it stopped taking him by surprise, he was very willing to let me use it."

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. There's no evidence that they work, and some that they could cause harm. And unless you're positive the stuffiness is due to allergies, steer clear of antihistamines, too.


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 it's just run-of-the-mill vomiting, do your best to clean up and calm down your child. Comfort him with a cool, wet washcloth on his forehead and face, then let him go back to sleep, with a plastic bowl or other container by his bed in case he feels sick again. 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. "You can also try opening up a can of pears or peaches and giving the child one tablespoon of the syrup inside every fifteen minutes," says Dr. Philip Itkin, clinical associate professor of pediatrics at the University of Nebraska Medical College in Omaha. "It really helps settle the stomach and keeps him hydrated." An ice pop is a good alternative, too.

Elisa Pollack Kandel is no stranger to middle-of-the-night vomit sessions. "My four-year-old daughter has a weak stomach, and one night she threw up a grand total of fourteen times, beginning at 3 a.m.," says Kandel, who lives in Merrick, New York. "Since then, I've learned to keep hand towels in her night-table drawer and a plastic wastepaper basket by her bed. Plus, the minute I hear her cough at night, I run in and pull back the top sheet and comforter. It really cuts down on the laundry! And whenever pillows go on sale, I buy a couple." Now that's what we call prepared.

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 two) 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

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