From the Guidelines
Fever in pediatric patients at night is most commonly caused by viral or bacterial infections, with the most significant risk being in infants under 3 months due to their immature immune system 1.
Causes of Nocturnal Fever
The causes of nocturnal fever in pediatric patients can be diverse, including:
- Viral infections such as the common cold, flu, or COVID-19, which can cause fevers that worsen at night due to natural fluctuations in body temperature and reduced cortisol levels during evening hours
- Bacterial infections like strep throat, urinary tract infections, or ear infections
- Other causes such as teething in infants, vaccinations, autoimmune disorders, or heat-related issues like overdressing a child at bedtime
Management of Fever
For managing fever, the following can be considered:
- Acetaminophen (Tylenol) can be given at 10-15 mg/kg every 4-6 hours, or ibuprofen (Motrin/Advil) at 5-10 mg/kg every 6-8 hours for children over 6 months, with dosage calculated based on the child's weight, not age
- Keeping the child hydrated, dressing them in light clothing, and maintaining a comfortable room temperature
When to Seek Medical Attention
It is crucial to contact a doctor if the child:
- Is under 3 months with any fever
- Appears very ill
- Has a fever lasting more than 3 days
- Shows concerning symptoms like difficulty breathing, rash, severe headache, stiff neck, or persistent vomiting According to the most recent and highest quality study, the risk of serious bacterial infections (SBIs) in febrile infants younger than 24 months is significant, with urinary tract infections being the most common SBI in this age group 1.
From the Research
Causes of Nocturnal Fever in Pediatric Patients
The causes of nocturnal fever in pediatric patients can be attributed to various factors, including:
- Infections, which can be self-limiting or serious and life-threatening if not diagnosed and treated appropriately 2
- Physiologic mechanisms that have beneficial effects in fighting infection, with fever being a normal physiological response to illness that facilitates and accelerates recovery 3, 4
- Prostaglandins playing an important role in fever production, with antipyretics such as acetaminophen and ibuprofen effective in fever reduction by inhibiting prostaglandin synthesis 5
Assessment and Management
When assessing and managing nocturnal fever in pediatric patients, it is essential to:
- Establish whether the temperature has been measured and, if so, how, with the height of the temperature recorded and the device used noted 2
- Enquire about any skin changes or rashes, contact with infectious illnesses, and foreign travel 2
- Record other vital signs, including heart rate, respiratory rate, and capillary refill time, and examine the child for focal signs indicating the site of infection 2
- Assess hydration and posture, tone, fontanelle (if patent), presence of a rash, neck stiffness, and level of consciousness 2
Parent Education and Guidance
Parent education and guidance are crucial in managing nocturnal fever in pediatric patients, including:
- Defining fever and its benefits in fighting infections 3, 6
- Demonstrating how to take temperatures and guidelines for retaking temperatures in febrile children 6
- Recommending when to use antipyretics and appropriate dosages 3, 6
- Emphasizing the importance of monitoring activity, observing for signs of serious illness, and encouraging appropriate fluid intake 3