Why Sniffles Hit Hardest at Night
Ella Brooks

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When your child wakes up coughing or complaining of an earache, it’s tough to know what to do. And many common ailments -- from asthma to croup -- worsen in the wee hours.

Lying down plays a role in most colds and sinus symptoms “because it causes secretions to drain into the throat and may obstruct drainage happening during the day,” says Dr. Michael Steiner, pediatrician and director of the Child & Adolescent General Clinic at the University of North Carolina at Chapel Hill. “Plus, any pain, discomfort or fever will seem worse when children and parents are tired.”

Children may also feel more sick at night because they’re less distracted by activities, adds Dr. Mobeen H. Rathore, chief of Pediatric Infectious Diseases and Immunology at Wolfson Children’s Hospital and the University of Florida College of Medicine in Jacksonville.

Learn how to help your little one feel better when he’s sick at night, no matter the ailment. Just remember, says Rathore: Call the pediatrician whenever you’re unsure or concerned, day or night.

EARACHES

This common childhood pain is usually caused by a bacterial or viral infection in the ear (sometimes due to a nasty cold or allergies). Fluid builds up behind the eardrum, and lying down adds pressure to spots that are already sore and inflamed.

Treatment: According to the American Academy of Pediatrics, approximately 80 percent of children with middle ear infections recover without antibiotics. Shocking, since about 50 percent of antibiotics for American preschoolers are prescribed for ear infections! If the pain isn’t severe, help your child feel more comfortable with a pain reliever such as acetaminophen, says Rathore. (Don’t use aspirin, which has been associated with a rare but potentially deadly condition called Reye’s syndrome.) A warm compress may also help.

When to call the doc:

Chronic ear infections can cause hearing problems, so it’s important to monitor symptoms. Red-flag symptoms include severe ear pain and discharge from the ear.

STUFFY NOSE OR SORE THROAT

Symptoms from the common cold tend to flare up at night. “When you lie down, the airways are more likely to become clogged with mucus,” says Dr. Neil Schachter, author of The Good Doctor's Guide to Colds and Flu and the medical director of the respiratory care department at Mount Sinai Medical Center in New York City.

Treatment:

While there is no cure for the common cold, moms can employ a few simple, reliable tactics to help kids feel better. In addition to age-appropriate OTC remedies, a humidifier or steam from a hot shower may also ease congestion so your child can breathe easier. Rathore suggests using acetaminophen to relieve sore throat. Schachter also suggests gargling with salt water before bed “to remove virus-laden mucus from the throat, which relieves both sore throat and coughing.”

When to call the doc:

Routine colds don’t require a doctor’s care, but watch out for any other unusual symptoms, including a high fever, distressed breathing, or a sore throat that’s severe or lasts longer than a week.

CROUP

Most common in children 5 or under, croup causes swelling in the trachea and larynx. It’s usually caused by a virus and characterized by a loud, barking cough. “Croup symptoms seem to worsen at night, possibly because the upper airway naturally relaxes during sleep, so it narrows,” says Steiner. “It’s also possible that using a heater at night dries out the air and makes symptoms worse.”

Treatment:

Although mist treatment was long thought to manage croup, a 2006 study published in the Journal of the American Medical Association found that high humidity didn’t seem to help moderate to severe cases. Still, for mild bouts, a warm, steamy bathroom may soothe symptoms. A dose of children’s ibuprofen or acetaminophen can bring down swelling of the airways. More severe cases may require a prescription drug to open airways.

When to call the doc:

If your child makes noisy and high-pitched sounds when inhaling, struggles to breathe, develops blue or grayish skin, or has a fever of 103.5 F or higher, it’s time to see the doctor.

ASTHMA

A poll by the market research firm Harris Interactive found that 45 percent of asthmatic children have woken up in the middle of the night due to asthma. “There are variations in pulmonary function through the day and night due to circadian rhythms,” says Steiner. “At night, pulmonary function decreases slightly, which is likely responsible for symptoms being worse.”

Treatment:

If your child is asthmatic, you already know how to keep things under control: Preventive, long-term control medications reduce inflammation in the airways, and a quick-relief medication should be used when necessary.

Your child’s late-night asthma could also be triggered by a common bedroom allergen like dust mites. Corral the critters by keeping the room clean and uncluttered. Use a vacuum with a high-efficiency particulate air (HEPA) filter once or twice weekly. Once a week, wash bedding and stuffed animals in hot water that’s at least 130 F. And finally, encase the mattress and pillows in an airtight zippered cover.

When to call the doc:

If you notice that nocturnal asthma is disrupting your child’s sleep, make an appointment to review his asthma action plan. The pediatrician may need to adjust the type and/or timing of medications.