Why Are They Always Sicker at Night?

It is absolutely true, and don’t let anyone tell you otherwise.

Maybe your little guy had a bit of a fever and a cough yesterday, or came home from preschool looking pale and wiped out with no appetite for dinner. You can pretty much bet that sometime past 9 PM, after your pediatrician is long gone for the day, he’ll start looking – and feeling – scary sick.

All of a sudden the temp is up above 103 and his eyes have that glazed, vacant look. Does his breathing seem to be more shallow? Is that cough constant now, and coming from deep in the chest? Sure seems like it, but could you be imagining things?

The dilemma: is he sick enough to call? Are you overreacting? Can it wait until morning? The short answer is, CALL. If your gut tells you something is seriously wrong you need to call — now. Every pediatrician worth her salt knows that kids really DO get sicker at night. They can’t help if you don’t call.

But why does it always happen that way? What is it about 9 PM that’s different from 11 AM? There are lots of factors in play, and here are some of them:

  • Body temperature rises naturally throughout the day whether we’re healthy or sick (that’s why basal body temperature is always taken first thing in the morning), so a fever that was mild earlier may spike to scary levels at night.
  • Levels of cortisol (an anti-inflammatory hormone) drop, and levels of histamines (which cause inflammation) rise at night, making everything, especially conditions like asthma and allergies, worse.  To add to the problem, allergens like dust mites live in bedding and bedrooms, aggravating the situation while kids sleep.
  • The change of position from upright to lying down increases blood flow to the head and neck. That’s why conditions like ear infections, croup, and nasal congestion get worse at night — more blood flow, more swelling.
  • Pain, itching, and other annoying symptoms are always worse when when kids are lying in bed with no distractions.  Focusing on a problem always makes it bigger.
  • Vomiting may not be more likely to happen at night, but it sure seems like it when you have to change all those sheets and pajamas, and then worry that you’ll have to do it all over again.

So now that you know it’s not your imagination, is there any remedy for those times when you’re not ready to call the doctor?

Here are some suggestions for your middle-of-the-night survival kit.

A reliable thermometer

Children’s Tylenol and children’s ibuprofen in age-approppriate dosage

Saline nose drops or spray and infant bulb syringe for babies

Prescription pain relief eardrops

A cool mist humidifier

Clean sheets and pajamas

Ice pops

An old, much loved Disney movie to pop into the DVD player

Lots of hugs

These supplies, along with plenty of patience, should help get you through the night.  Talk to your child’s doctor about added suggestions and the safest ways to apply these.  But don’t forget to trust your gut.  If you’re worried … CALL.

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?

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