KIDS’
COUGHS SEEM TO BECOME HORRIBLE AT NIGHT. WHY IS THAT?
Young
children may, several times a year, have a virus that triggers swelling of the
vocal cords, arrives swiftly, typically in the middle of the night, and results
in a child who is acutely short of breath, and scared! The
respiratory tract around the airways and vocal cords has a rich blood
supply. When inflammation strikes, that
supply amps up, and when a child lies down, the area around the vocal cords is
literally engorged with increased blood flow and swelling. Rather than breathing through an air column
the size of a pencil, your child is breathing through one the size of a skinny
straw. When a child lies down, the area around the
vocal cords is engorged with increased blood flow
WHAT CAN WE DO TO HELP?
We want
to get the child upright, cool and humidify the air. To some, that might mean steaming in the
shower for 10-15 minutes, hovering over a vaporizer, or simply bundling up and
going outside in the cool air (or in the summer, to a room cooled by the AC, or
opening the freezer door and hovering there for a few minutes). Typically this will ease the bark and you can
put your child back to sleep, typically with a dose of pain relief so the cough
doesn’t hurt him and scare him more)
WHEN IS IT TIME TO SEE A DOCTOR?
If the
bark is only there with crying, but silences with rest you are good to wait
until the next morning for a visit. However if the bark (called stridor) is
there at rest, persists, and your child is struggling for breath, off to the
ER!
LET’S DISCUSS EARACHES. WHY ARE THEY SO PAINFUL AT
BEDTIME?
Having had them myself, and experiencing them
many times with my son, it is so true that nights are really tough. Earaches
typically arise when there is either an internal infection (otitis media) typically
during or after a cold, or swimmer’s ear (or otitis externa), occurring after
moisture breaks down the protective coating of the ear canal and painful
inflammation occurs. Pain is worse at night, again because of low
cortisol levels. Lying down also backs up drainage into the middle ear, causing
pressure on the eardrum and pain. With
swimmer’s ear, even the ear touching a pillow can cause excruciating
discomfort, and pain is always worse without daytime distractions.
HOW CAN WE HELP ALLEVIATE THE PAIN?
Alleviate pain with oral pain relief. If your child has had a cold, and develops an earache, you can put some warm olive oil into the ears and plug with cotton (if there are no PETubes or drainage). The oil coats the eardrum and can soothe pain to get you through the night until you can see your doc the next day. Sleeping on a warm compress helps as well. For kids with ear pain, no colds, and a history of being at the pool, the beach, submerged, oral pain relief overnight is the name of the game, as you don’t want to put anything into that ear except medication – otherwise there may be more pain. For prevention of swimmer’s ear, routinely dry the ears and instill 3-5 drops of white vinegar or rubbing alcohol in each ear after swimming, shake it out, and dry gently with a blow dryer on cool. This changes the environment of the ear canal and can prevent those painful episodes.
ASTHMA/ALLERGIES: Children with asthma often are up at night, short of breath, coughing, or in distress.
WHY IT HAPPENS: Cortisol provides a protective cushion during the day for a child with asthma – decreasing swelling of the inside of the airways, and holding back histamine release. At night, especially if a child has been triggered by smoke, a viral illness, or even a day in the park, cortisol isn’t there to protect and as a result airway linings swell, and histamine elevations cause excessive mucous production in the bronchi, leading to coughing, spasm, and asthma. For an allergic child, lower cortisol and increased histamine release, coupled with the possibility that dust mites and pet dander are typically highly concentrated around the bed, an allergic child may get worse just by being in his/her bedroom.
HOW TO HELP: For children allergic to dustmites, dust or pet danders, keeping the bedroom door closed to prevent animal visitors should be the rule. A hypoallergenic dust cover for the mattress, box spring and pillow often is helpful. Talk to your allergist about substituting synthetic material in pillows and comforters if your child is allergic to feathers. And get rid of miniblinds, dust ruffles, and canopies – they are dust catchers. Vacuum often, or better yet, take carpeting out of the room. For your asthmatic child, make sure that not only are your emergency inhaled medications (bronchodilators) up to date and in the house, but that your child’s controller medications (inhaled steroids) are being regularly given, especially during cold and flu season.
WHEN TO SEE YOUR DOC: If your child has 2 or more asthma attacks each week, the asthma is poorly controlled, and a new action plan needs to be developed with your doctor. If bronchodilators given fail to control symptoms of asthma, or if shortness of breath or cough worsens despite medication, a call to your doc, and/or a trip to the ER is indicated!
EARACHES
Having had them myself, and experiencing them many times with my son, it is so true that nights are really tough. Earaches typically arise when there is either an internal infection (otitis media) typically during or after a cold, or swimmer’s ear (or otitis externa), occurring after moisture breaks down the protective coating of the ear canal and painful inflammation occurs.
WHY IT HAPPENS: Pain is worse at night because of low cortisol levels. Laying down also backs up drainage into the middle ear, causing pressure on the eardrum and pain. With swimmer’s ear, even the ear touching a pillow can cause excrutiating discomfort, and pain is always worse without daytime distractions.
WHAT TO DO: Alleviate pain with oral pain relief. If your child has had a cold, and develops an earache, you can put some warm olive oil into the ears and plug with cotton (if there are no PETubes or drainage). The oil coats the eardrum and can soothe pain to get you through the night until you can see your doc the next day. Sleeping on a warm compress helps as well. For kids with ear pain, no colds, and a history of being at the pool, the beach, submerged, oral pain relief overnight is the name of the game, as you don’t want to put anything into that ear except medication – otherwise there may be more pain. For prevention of swimmer’s ear, routinely dry the ears and instill 3-5 drops of white vinegar or rubbing alcohol in each ear after swimming, shake it out, and dry gently with a blow dryer on cool. This changes the environment of the ear canal and can prevent those painful episodes.
WHEN TO SEE YOUR DOC: If pain persists into the morning, if pus or drainage from the ears, or just a miserable child, see your doctor.
CROUP
If you wake up and hear barking in your house, it may not be your dog. Young children may, several times a year, have a virus that triggers swelling of the vocal cords, arrives swiftly, typically in the middle of the night, and results in a child who is acutely short of breath, and scared!
WHY IT HAPPENS: The respiratory tract around the airways and vocal cords has a rich blood supply. When inflammation strikes, that supply amps up, and when a child lies down, the area around the vocal cords is literally engorged with increased blood flow and swelling. Rather than breathing through an air column the size of a pencil, your child is breathing through one the size of a skinny straw.
WHAT TO DO: We want to get the child upright, cool and humidify the air. To some, that might mean steaming in the shower for 10-15 minutes, hovering over a vaporizer, or simply bundling up and going outside in the cool air (or in the summer, to a room cooled by the AC, or opening the freezer door and hovering there for a few minutes). Typically this will ease the bark and you can put your child back to sleep, typically with a dose of pain relief so the cough doesn’t hurt him and scare him more.
WHEN TO SEE A DOC: If the bark is only there with crying, but silences with rest you are good to wait until the next morning for a visit. However if the bark (called stridor) is there at rest, persists, and your child is struggling for breath, off to the ER!
Board certified pediatrician Dr. JJ Levenstein, MD, FAAP Take parenting classes instructed by Dr. Levenstein online by visiting www.momassembly.com. To learn more about parents' concerns with kids go to her Facebook page at www.facebook.com/CallingDoctorJJ .
