Asthma and allergies
why they're worse at night: If your child has asthma or certain allergies, you're probably all too familiar with the challenges of helping her through the wee hours. There are many factors at play: "The body's level of cortisol drops at night, and cortisol has some preventive effects on asthma," says Santiago Martinez, M.D., pediatric allergist and clinical assistant professor of medicine at Florida State University Medical School in Tallahassee. Plus, the levels of histamine rise, aggravating many allergy and asthma symptoms. And finally, some allergens, such as dust mites and pet dander, may be more prevalent in a child's room, increasing her exposure while she sleeps.
what to do: If your child has an allergy attack at night, an antihistamine should quell her symptoms (ask your doctor for the best one to have on hand for your child). Should you find that her attacks are frequent and occur year-round, you may want to consider immunotherapy shots, which introduce tiny amounts of the allergen into the body, slowly allowing immunity to build.
Got an asthmatic? You know what to stock: a bronchodilator, which immediately opens the airways; a peak flow meter to monitor your child's breathing; and preventive medications such as leukotriene inhibitors or inhaled steroid medications, which work to keep inflammation in check long-term.
"If your child is having more than two flare-ups of asthma a week -- whether it's just a chronic dry cough or wheezing -- or if she's not responding well to the bronchodilators, her condition is not well controlled and she should be reevaluated by a doctor," says Dr. Martinez. "Virtually everyone can get their asthma under control if it is diagnosed and treated early. In some cases, asthma and allergies may just be seasonal problems, and treatment can be stepped up or reduced, depending on the need."
Preventive steps to reduce the allergens can go a long way, too. That may mean keeping your child's windows closed, banning Fluffy and Fido from her room, and encasing her bedding in allergy-proof covers. You can also consider using HEPA filters in your vacuum and a HEPA air filter -- these are designed to trap the minuscule particles that can aggravate symptoms.
why it's worse at night: This barking-seal cough is usually the result of a viral infection that has settled in the upper airway and voice box, and typically strikes while the child has a cold. Because it causes swelling of the vocal cords, the cough also may be accompanied by noisy, rapid breathing. Croup is almost always at its worst at night, partly because blood flow to the respiratory tract changes when a child lies down. Plus, dry air can aggravate it.
what to do: "Begin by giving your child a dose of children's ibuprofen to reduce the severity of the swelling in his airways and relieve the discomfort," says Andrea Leeds, M.D., a pediatrician in Bellmore, New York, and a member of the committee on practice and ambulatory medicine for the American Academy of Pediatrics. (If your child is younger than 12 months, skip ibuprofen unless your doctor has already given you the okay to use it.) "Then strip him down to his diaper or underpants, turn on the shower full blast, and sit in the steamy bathroom with him for fifteen minutes." After that -- and this is the most important part, says Dr. Leeds -- dress him, wrap him up in a blanket, and take him outside in the cool night air (or, if it's summertime, hold him in front of the open freezer door or an air conditioner for at least five minutes). The steam relaxes the airways and vocal cords, while the cold air reduces the swelling; this combination often controls symptoms until the next day, when you can go to the doctor. (Like my doctor, yours may recommend one strategy or the other; if you notice a clear improvement, as we did with just the cold air, it's usually fine to stop there.)