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F.A.Q. - Your questions answered

Whether you are new to TACOMA HEALTH or an established patient, we understand that many of you have important questions that need to be answered. We have carefully composed a list of our patients' most frequently asked questions about all topics regarding being a patient here at TACOMA HEALTH. Please take a moment to carefully read over these questions and see if your inquiry may be in the answers provided.

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Why Kids Get Sicker at Night
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. 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: 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, (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 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.
Why it's worse at night: Whether the infection is in the middle ear or in the ear canal (also called swimmer's ear), these puppies can hurt. Lying down increases the collection of fluid and puts extra pressure on the inflamed tissue.
What to do: Ibuprofen (for kids older than 12 months) or acetaminophen can help relieve the ache, but you can also try this remedy for severe pain from middle ear infections: "Heat a tablespoon of olive oil in the microwave so it's warm -- but not hot -- to your touch," says Dr. Leeds. "Put two to three drops of the warm oil in your child's affected ear. It relaxes the membranes and brings almost instant relief." Applying a warm, damp washcloth to your child's ear also can help.
Why it's worse at night: Body temperature rises naturally in the evening, so a fever that was slight during the day can easily spike during sleep.
What to do: First, take your child's temperature (do it rectally if she's under 6 months old -- and, ideally, for as long as she'll allow this method). Any fever above 100.4°F in an infant under 3 months warrants an immediate call to the doctor. Same goes for an elevated temp in any child that's accompanied by lethargy, vomiting, diarrhea, stiff neck, or an unusual rash.
Otherwise, try a dose of acetaminophen, wait half an hour, and check the temperature again, says Dr. Leeds. "If it hasn't begun to come down and she's older than a year, give your child some ibuprofen, too," she adds. "You can use these medications together, separated by half an hour. Just remember that acetaminophen can be given every four hours, and ibuprofen can be given every six to eight hours."  In the meantime -- and if you're not too delirious -- you can give your child a room-temperature bath to help cool her down. And definitely help her stay hydrated by offering some water (or formula or breast milk if she's a baby) before she goes back to sleep. Call the doctor in the morning to check in; she may want you to bring your child in.
Itchy skin
Why it's worse at night: When your child is lying still, it's a whole lot easier to focus on the itchiness, whether it's due to poison ivy, bug bites, eczema, or even sunburn. And if the itchy skin is rooted in some kind of allergy, you've got the higher nighttime levels of histamines to thank.
What to do: Take some advice from Tyler Bingham of Lynn Haven, Florida, whose 4-year-old daughter has eczema. "Katie's skin is always itchier at night," says Bingham. "So before she goes to bed, we use a moisturizing body wash, then I'll massage a dry-skin lotion, usually one from Aveeno, onto her legs, where her eczema is the worst. The massage calms her and the lotion soothes. If need be, I also run a cool-mist humidifier in her room to keep the air moist."
Stuffy nose
Why it's worse at night: Too bad kids can't sleep standing up like horses -- then their nasal passages wouldn't swell more when they sleep!
What to do: For immediate relief, use saline nose drops or spray. Both will moisten the membranes and loosen the secretions, making it easier for your child to blow out the mucus, or for you to remove it with a bulb syringe if you have a baby. "My nine-month-old, Hamza, hated the bulb syringe whenever I used it on him," says Diana Malikyar, who lives in Stone Mountain, Georgia. "But then I laid him down in front of the bathroom mirror so he could watch me doing it. Once it stopped taking him by surprise, he was very willing to let me use it."
You may be tempted to offer your child a decongestant, but they're no longer recommended for kids under 2, and many doctors advise against giving them to older kids. There's no evidence that they work, and some that they could cause harm. And unless you're positive the stuffiness is due to allergies, steer clear of antihistamines, too.
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