Q: Why does my child always seem to get sick at night, but then appear
to be well the next morning? I either take him to the pediatrician and
try to convince her that my son really is sick (like when my car runs
perfectly for the mechanic) or I don’t take him and he gets sick again
as soon as the sun goes down (and my pediatrician’s office closes!)
San Mateo, California
A: You may feel like this only happens to your child, but you are not
alone! This happens to everyone, no matter what the age. There are
three primary reasons for this. First, the pressures in our bodies
change when we are horizontal. Lying down increases congestion, ear
pain, postnasal drip, sore throats, and several types of cough.
Additionally, our bodies are on a 24 hour clock called the Circadian
Rhythm. Hormone levels rise and fall according to this daily cycle.
Some hormones help us to wake up in the morning, others help us to
sleep at night. These same hormones affect how we feel pain. During
the day high levels of cortisol, a stress hormone, keep us from
feeling some of the pain and keep our fevers in check. At night our
fevers rise and our discomfort increases. As if this weren’t enough,
throughout the day our senses are barraged by gigabytes of stimuli
every second, and our brains are busy processing all the data. At
night the amount of stimuli we are bombarded with is drastically
reduced. This gives our brains an opportunity to pay more attention to
this already increased level of pain. These factors combine to greatly
amplify symptoms at night. Feeling better in the morning doesn’t mean
that you are better.
Obviously there are times that your child is so sick at night that you
will need to call your pediatrician for immediate care. If your son is
sick at night, but not sick enough to require urgent medical care, it
is still appropriate to take him to the pediatrician in the morning,
even if your child appears better. A good rule of thumb is, if you
wouldn’t want your son (or yourself) to have another night like the
last one, then it is time to consult your pediatrician.
Cukup jelas ya. Adanya irama sirkardian dalam tubuh kita mempengaruhi
hal ini juga. Namun prinsipnya, kita harus menguasai kapan anak perlu
dibawa ke dokter, dan ini sudah sering dibahas di milis (silakan lihat
arsip milis, atau guideline demam di websehat).
Angka 72 jam tidak menjadi patokan resmi, karena demam bisa saja
berlangsung hanya malam hari, namun 5 hari berturut-turut, dan
kemudian hilang dengan sendirinya. Guideline yg cukup singkat dan
mudah dipahami bagi anak Anda yg berumur 9 bulan ini bisa dibaca di