Big Kid

Are Children's Symptom's Worse At Night When They're Sick?

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Do Children's Symptoms Get Worse At Night?Why is it that your 5-year-old’s fever, congestion, and pain suddenly worsen at nightfall when the pediatrician’s office is closed?

Is it simply a matter of your weary child noticing their symptoms while lying quietly in bed? Maybe. But there are also real changes occurring late in the evening and during sleep, which may contribute to increased severity in their illness symptoms.


At bedtime, your sick child’s anxiety may grow simply because of the dark or imagined monsters under the bed. Isolation and silence at nighttime may also contribute to how they perceive their discomfort.

Physical Changes

During sleep, a child’s symptoms may grow more severe. For example, with an ear infection, lying down is painful because of an increase in  fluid in the ear canal (which places pressure on inflamed ear tissue). This explains earaches (and crying!) flaring up in the middle of the night. Also, fever burns in the evening, and prevalent health conditions such as asthma worsen at night.

Asthma affects 20 million Americans and involves a narrowing and clogging of the bronchi tubes in the lungs. At night bronchi narrow in everyone, increasing resistance to air flow. Not a problem for kids without asthma, but in asthmatics such constriction at night may bring on an attack.


Chronobiology relates to circadian rhythms and how internal timing mechanisms affect our biology. At night, two important internal hormones that relax the airway—cortisol (a steroid) and epinephrine (adrenaline)—taper off. In fact, since both hormones have an anti-asthma effect on the body, synthetic versions are administered to break severe asthma attacks.

Allergens in Bedroom

Unfortunately the air children breathe at night in their rooms may host common allergens including pet dander and dust mites which can set off a reaction.

Comfort Ideas for Nighttime

In addition to your pediatrician on speed dial, it may be possible to ease your child’s pain and illness at night by keeping these items close at hand:

• Compassion, patience and lullabies
• Rocking chair, ice pack and soft music
• Children’s antihistamine
• Children’s pain reliever
• Humidifier
• Ear drops
• Popsicles
• Thermometer
• Saline nose spray

Michele Ranard is a professional counselor/tutor and a freelancer.

Published: April 2013