Nighttime Fever in Children: Causes and Solutions

Nighttime fever

Hello, Director Zhao.
My niece has been frequently experiencing fever and cold symptoms since the Lunar New Year.
Since January, she has been visiting the clinic regularly and has been continuously taking medication, yet she still often coughs, has a runny nose, or has a fever.
Her symptoms fluctuate between better and worse.
Is this what is referred to as an allergic reaction? How should we manage this, and why has seeing doctors not been effective? Recently, for some unknown reason, she has been developing a fever every night, with temperatures gradually rising to around 38.5°C, but during the day, she shows no unusual symptoms.
Her activity level and appetite are also good.
The clinic doctor could not provide a clear explanation.
Could you please advise what might be the cause and whether we need to seek further examination at a larger hospital?

Yaya, 20~29 year old female. Ask Date: 2004/05/18

Dr. Zhao Yongkang reply Pediatrics

Hello,
1.
As you mentioned, it is highly likely that this is an allergic reaction.
Allergies typically present with chronic cough in the respiratory tract, which may be more pronounced in the early morning or at night.
There may also be symptoms such as chest tightness, deep breathing difficulties, sneezing, runny nose, or itchy nose upon waking, and these symptoms can fluctuate over time.
2.
Generally speaking, allergies themselves should not cause fever in children.
If there is a fever present, it is more likely associated with a concurrent infection, so I recommend having a physician conduct a further examination.
3.
In addition to medication prescribed by a physician for allergies, it is important to minimize exposure to allergens.
Avoid stuffed animals, plush toys, and other soft furnishings at home.
Refrain from using blankets, carpets, upholstered furniture, spring mattresses, foam mattresses, and coconut fiber mattresses unless they are encased in allergen-proof covers.
It is advisable not to keep pets such as cats and dogs, and to avoid exposure to secondhand smoke.
Thank you for your inquiry!
Best regards,
Dr.
Zhao Yongkang
Director, Pediatric Department
Hsinchu Hospital

Reply Date: 2004/05/18

More Info

Understanding nighttime fever in children can be a perplexing issue for many parents, especially when the child appears to be healthy during the day but experiences fever and discomfort at night. In your niece's case, the recurrent fevers, cough, and runny nose since the beginning of the year suggest that there may be underlying factors contributing to her symptoms.

Potential Causes of Nighttime Fever
1. Infections: Viral infections are common in children and can lead to intermittent fevers. Conditions like viral upper respiratory infections or even mild cases of influenza can cause symptoms that fluctuate, with fever often being more pronounced at night.
2. Allergies: Allergic reactions can manifest as respiratory symptoms, including coughing and nasal congestion. Allergies can also lead to post-nasal drip, which may worsen at night and cause coughing or discomfort.
3. Environmental Factors: Poor ventilation in the child's sleeping environment or excessive bedding can lead to overheating, which might be mistaken for fever. It’s important to ensure that the child’s sleeping area is well-ventilated and that they are not overdressed for sleep.

4. Periodic Fever Syndrome: This is a group of disorders characterized by recurrent episodes of fever without an apparent cause. These episodes can last from a few days to a week and may be accompanied by other symptoms like fatigue or irritability.

5. Underlying Medical Conditions: Conditions such as autoimmune disorders or infections that are not easily diagnosed (like certain types of bacterial infections) can also cause recurrent fevers.

Recommended Actions
1. Keep a Symptom Diary: Documenting the child’s symptoms, including the timing of fevers, associated symptoms, and any potential triggers (like exposure to allergens or changes in environment) can provide valuable information for healthcare providers.

2. Consult a Pediatrician: Given the persistence of symptoms and the lack of improvement with treatment, it may be beneficial to consult a pediatrician who specializes in infectious diseases or a pediatric allergist. They can perform a thorough evaluation and may recommend specific tests, such as blood tests or allergy testing.

3. Consider a Referral to a Specialist: If the pediatrician suspects an underlying condition, they may refer you to a specialist for further evaluation. This could include a hematologist for blood disorders or a rheumatologist for autoimmune conditions.

4. Monitor Fever Patterns: Keep track of the fever's pattern—when it occurs, how high it gets, and how long it lasts. This information can help the doctor determine if there is a specific pattern that indicates a particular condition.

5. Manage Symptoms at Home: While waiting for a definitive diagnosis, managing symptoms with appropriate fever reducers (like acetaminophen or ibuprofen) can help keep the child comfortable. Ensure the child stays hydrated and rests adequately.

Conclusion
Nighttime fevers in children can be caused by a variety of factors, and while it can be frustrating when initial treatments do not yield results, further investigation is often necessary. It’s crucial to work closely with healthcare providers to identify the underlying cause and develop an effective treatment plan. Your niece’s well-being is paramount, and with careful monitoring and appropriate medical guidance, it is possible to find a resolution to her symptoms.

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