If you are frequently bothered with heartburn, the reflux of stomach acid up through the esophagus to the larynx may stimulate a bronchial spasm. It’s worse when lying down or if you take medications for asthma that relax the valve between the stomach and esophagus. Sometimes, acid from the stomach will irritate the lower esophagus and lead to constriction of your airways. If stomach acid backs up to your throat, it may drip down to the trachea, airways and lungs, leading to a severe reaction. This can involve airway irritation, increased mucus production, and airway tightening. Taking care of GERD and asthma with appropriate medications can often stop nighttime asthma.
Late Phase Response
If you are exposed to an allergen or asthma trigger, the chances are great that airway obstruction or allergic asthma will occur shortly afterward. This acute asthma attack ends within one hour. About 50% of those who experience an immediate reaction also have a second phase of airway obstruction within three to eight hours of exposure to the allergen. This phase is called the late phase response, and it is characterized by an increase in airway responsiveness, development of bronchial inflammation, and a more prolonged period of airway obstruction.
Many studies report that when allergen exposure occurs in the evening instead of in the morning, you are more susceptible to having a late phase response and are more likely to have one of greater severity.
Hormones that circulate in the blood have well‑characterized circadian rhythms that are seen in everybody. Epinephrine is one such hormone, which exerts important influences on the bronchial tubes. This hormone helps keep the muscle in the walls of bronchi relaxed so the airway remains wide. Epinephrine also suppresses the release of other substances, such as histamines, which cause mucus secretion and bronchospasm. Your epinephrine levels and peak expiratory flow rates are lowest at about 4:00 a.m., while histamine levels tend to peak at this same time. This decrease in epinephrine levels may predispose you to nocturnal asthma during sleep.
- What Parents Can Do About Nighttime Asthma
- Why is asthma worse at night?
- What can you do to help control asthma at night?
- When to Call Your Doctor About Nighttime Asthma
- When to Go to the ER if Your Child Has Asthma
- What Are Coughs?
- What Are the Different Types of Coughs?
- How Are Types of Coughs Diagnosed?
- How Are Coughs Treated?
- How Can I Help My Child Feel Better?
- When Should I Call the Doctor?
- Cough Symptoms & Causes
What Parents Can Do About Nighttime Asthma
Wheezing and coughing can be exhausting, especially when these symptoms disrupt your sleep. For children who suffer from asthma, it can be especially challenging to manage symptoms at night.
Asthma occurs when airways become constricted or inflamed. When asthma symptoms occur at night, it is often called nocturnal asthma (NA). Nocturnal asthma can refer to any type of asthma experienced at night including allergic, non-allergic, occupational, and exercise-induced.
Not everyone who has asthma will have symptoms at night. Children can often experience nocturnal asthma but underreport their symptoms, leaving parents without the whole story of their child’s condition. Trouble sleeping at night because of nocturnal asthma can significantly impact a child’s focus, attention and energy the next day, and cause chronic fatigue. Sometimes undiagnosed nocturnal asthma is the cause of sleep issues in children.
Why is asthma worse at night?
There are no proven reasons why asthma can be worse at night but several factors may include:
- Exposure to allergens. Dust mites, allergens, and mold can easily accumulate in bedding, pillows, and mattresses. For asthmatics, these tiny triggers can wreak havoc on their lungs.
- Reclining position. Lying down can cause accumulations of drainage or postnasal drip, decreased lung capacity and increased resistance in the airways.
- Gastroesophageal disease (GERD). Symptoms of acid reflux disease can make asthma worse. After lying down to sleep, stomach contents or acid can come back up into the esophagus. If your child wakes up from the discomfort, he or she may aspirate the acid into their airways, causing coughing and difficulty breathing.
- Air conditioning. Cooled airways can trigger asthma as airways lose heat. While many homes in Seattle do not have air conditioning, it’s important to remember when traveling and staying in hotels.
KNOW YOUR TRIGGERS
Each patient is different. Minimizing your child’s triggers can help avoid exposure and prevent symptoms from happening at all.
What can you do to help control asthma at night?
- Keep a clean bedroom environment.
- Make sure to change sheets regularly, wash bedding in hot water, and wipe down shelves, ledges or nearby furniture to minimize dust. Don’t let your child sleep in the same room with pets.
- Choose allergy-free linens. Make sure pillows have a cover and look for allergy-free materials.
- Sleep on a slight incline. Elevating the head 4-6 inches by adding blocks under the bed post can help with GERD symptoms. Sleeping on an incline can reduce acid regurgitation.
- Use a humidifier. Keep the air moist in your child’s room with a humidifier.
When to Call Your Doctor About Nighttime Asthma
If your child suffers from asthma symptoms at night regularly, call your child’s doctor to discuss adjusting their treatment plan. Sometimes medications used to manage asthma may also cause sleep disturbances. Be sure to discuss with your child’s doctor if your child experiences bouts of insomnia while taking an asthma medication.
- Learn more about asthma
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- The Polyclinic Family Medicine Department
When to Go to the ER if Your Child Has Asthma
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What’s an Asthma Emergency?
As a parent of a child with asthma, you want to avoid the emergency room (ER) as much as possible. But it’s also important to know when going to the ER is the right choice.
Sometimes, kids with asthma need medical care very quickly. If any of these symptoms happen, see your doctor immediately, go to the ER, or call an ambulance:
- Your child has constant wheezing.
- Your child uses quick-relief medicines (also called rescue or fast-acting medicines) repeatedly for severe flare-up symptoms that don’t go away after 15–20 minutes or return again quickly.
- Your child has a lasting cough that doesn’t respond to inhaled quick-relief medicine.
- There are changes in your child’s color, like bluish or gray lips and fingernails.
- Your child has trouble talking and can’t speak in full sentences.
- The areas below the ribs, between the ribs, and in the neck visibly pull in during inhalation (called retractions).
How Can ER Visits Be Less Stressful?
Planning can make trips to the ER less stressful for you and your child. Here are some tips to try:
- Know the location of your closest ER. If there’s a children’s hospital ER nearby, go there and have the address and phone number handy (written on the asthma action plan, for instance).
- If you have other kids, try to make arrangements with a relative or other caregiver who can take them in an emergency. But don’t let the lack of a babysitter delay your trip to the ER. Someone can always come to the hospital later to pick up your other kids.
- Take a copy of your child’s asthma action plan or a note with the names and dosages of any medicines your child takes to share with the medical staff at the ER.
- Try to keep a written record of when your child uses a rescue inhaler.
How Can We Avoid a Trip to the ER?
Well-managed asthma is rarely life-threatening. Taking asthma medicines as prescribed can help prevent severe asthma flare-ups and the need for emergency care.
Be sure to schedule and keep follow-up visits with your doctor and
to track your child’s asthma.
It’s important to monitor your child’s asthma using the written asthma action plan your doctor helps you create. This plan will outline day-to-day treatment, symptoms to watch for, and step-by-step instructions to follow during a flare-up.
Taking asthma seriously and working to manage it can make it less likely that your child will need to go to the ER.
What Else Should I Know?
Many kids go to the ER simply because they didn’t have their quick-relief medicines handy. Your child should have this medicine available at all times, including at school, at sporting events, and while traveling.
Reviewed by: Aledie A. Navas, MD Date reviewed: March 2018
Sometimes children make funny or loud noises when they breathe. Your child’s doctor may tell you that he is wheezing. But what is wheezing? And why do children wheeze? And more importantly, what do you do when your child wheezes?
When we breathe, we move air into and out of our lungs. Breathing allows our body to get the oxygen it needs because oxygen is in the air we breathe. The air moves into and out of our lungs through a series of tubes that connect the mouth and nose to the lungs. Another word for the series of tubes is “airways.” If the airways become tighter or narrower for any reason, the air has trouble moving into and out of the lungs. When this happens, wheezing can occur.
A wheeze is a noise made when air cannot easily move through the airways in the lungs. It sounds a bit like a whistle. When a person makes this noise while breathing, we say he is wheezing. Sometimes, the wheezing is quiet and can only be heard by the doctor with a stethoscope. But sometimes the wheezing is very loud. True wheezing always comes from the chest. Wheezing is not the same thing as a loud noise or whistle that a child may make because of severe stuffy nose. Wheezing is also different from snoring.
The airways in the lungs can get tighter and cause wheezing by two main ways. One is that the thin layers of muscle around the airways can tighten, causing the airway to become more narrow. Another is that mucous and inflammation can line the inside wall of the airway, blocking the flow of air.
There are a few conditions that may make children wheeze. The most common reason children wheeze is asthma. Asthma is a chronic medical condition where a child’s airways are extra responsive to certain things, which we call “triggers.” When the child experiences one of these triggers, the airways respond by tightening and becoming inflamed. Common triggers are upper-respiratory infections (also known as “colds”), smoke, exercise or pollen. The tightening of the muscles around the airways causes the airways to narrow, which then causes the wheezing. The airways also get inflamed in response to the triggers, which also narrows the airways and causes wheezing. Inhaled medications, such as albuterol, help reverse the airway narrowing.
When a young child gets a cold, the virus that causes the cold often causes the child to wheeze. Since the airways in a baby’s lungs are so much smaller than an adult’s, just a little bit of inflammation from the virus can actually cause the baby to have difficulty breathing. Wheezing can be one of these symptoms. When a virus causes these symptoms in a baby, the condition is called “bronchiolitis.” Respiratory syncytial virus (RSV) is the name of the most common virus that causes bronchiolitis, but other viruses can cause bronchiolitis as well. Unlike with asthma, medications like albuterol don’t usually help bronchiolitis much. As with a cold, there is no cure except time.
If your child is diagnosed with bronchiolitis, it’s best to support the child through the illness. It’s important to make sure your baby is drinking in order to stay hydrated. Do not use over-the-counter cough or cold medicines for infants and young children. These medicines are not recommended in children younger than four because they have not been shown to work, and they can have dangerous side effects. Most importantly, call your doctor or seek medical attention if your baby wheezes, has difficulty breathing, is not drinking, is acting very sick or has a fever. Babies with bronchiolitis seem to have a higher chance of wheezing again during early childhood, but this does not mean they will have asthma or will wheeze for the rest of their life.
Other things can also make a child wheeze. For example, if a child with allergies is exposed to something he is allergic to (like peanuts), the child may have a severe reaction and wheeze. If a child chokes on something, such as a piece of food or a small toy, a child may wheeze. A virus can also cause older children to wheeze on occasion as well, even if they do not have asthma. But these are all much less common causes of wheezing.
Don’t forget, if you are worried that your child is having trouble breathing, you should seek medical attention. If your child ever stops breathing, turns blue or gray, has severe difficulty with their breathing, or has any other emergency, call 911. It can be difficult to tell why a child is wheezing, and your child’s doctor can help determine what is wrong and what to do.
Author Laura Lawler, M.D., FAAP, is chief of Pediatric Hospitalists at Christiana Care.
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What Are Coughs?
Coughs are one of the most common symptoms of childhood illness. A cough can sound awful, but usually isn’t a sign of a serious condition. In fact, coughing is a healthy and important reflex that helps protect the airways in the throat and chest.
What Are the Different Types of Coughs?
Sometimes, though, a cough needs a doctor’s care. Understanding the different types of cough can help you know when to handle them at home and when to call your doctor.
The most common types of coughs are:
- “Barky” Cough
- Whooping Cough
- Cough With Wheezing
- Nighttime Cough
- Daytime Cough
- Cough With a Fever
- Cough With Vomiting
- Persistent Cough
Barky coughs are usually caused by swelling in the upper airway. Most of the time, a barky cough comes from croup, a swelling of the larynx (voice box) and trachea (windpipe). Younger children have smaller airways that, if swollen, can make it hard to breathe. Kids younger than 3 are most at risk for croup because their airways are so narrow.
A cough from croup can start suddenly, often in the middle of the night. Most kids with croup will also have stridor, which is a noisy, harsh breathing that happens when the child inhales (breathes in).
Whooping cough (pertussis) is an infection of the airways caused by the
Bordetella pertussis. Kids with pertussis will have spells of back-to-back coughs without breathing in between. At the end of the coughing, they’ll take a deep breath in that makes a “whooping” sound. Other symptoms are a runny nose, sneezing, mild cough, and a low-grade fever.
Whooping cough can happen at any age, but is most severe in infants under 1 year old who did not get the pertussis vaccine, which is part of the DTaP vaccine (diphtheria, tetanus, acellular pertussis). It’s is very contagious, so all kids should get the pertussis shot at 2 months, 4 months, 6 months, 15 months, and 4–6 years of age.
Cough With Wheezing
If your child makes a wheezing (whistling) sound when breathing out (exhaling), this could mean that the lower airways in the lungs are swollen. This can happen with asthma or with the viral infection bronchiolitis. Wheezing also can happen if the lower airway is blocked by a foreign object. A child who starts to cough after inhaling something such as food or a small toy should see a doctor.
Lots of coughs get worse at night. When your child has a cold, the mucus from the nose and sinuses can drain down the throat and trigger a cough during sleep. This is only a problem if the cough won’t let your child sleep.
Asthma also can trigger nighttime coughs because the airways tend to be more sensitive and irritable at night.
Cold air or activity can make coughs worse during the daytime. Try to make sure that nothing in your house — like air freshener, pets, or smoke (especially tobacco smoke) — is making your child cough.
Cough With a Fever
A child who has a cough, mild fever, and runny nose probably has a common cold. But coughs with a fever of 102°F (39°C) or higher can sometimes be due to pneumonia, especially if a child is weak and breathing fast. In this case, call your doctor immediately.
Cough With Vomiting
Kids often cough so much that it triggers their gag reflex, making them throw up. Also, a child who has a cough with a cold or an asthma flare-up might vomit if lots of mucus drains into the stomach and causes nausea. Usually, this is not cause for alarm unless the vomiting doesn’t stop.
Coughs caused by colds due to viruses can last weeks, especially if a child has one cold right after another. Asthma, allergies, or a chronic infection in the sinuses or airways also might cause lasting coughs. If your child still has a cough after 3 weeks, call your doctor.
How Are Types of Coughs Diagnosed?
If you’re concerned about your child’s cough, call your doctor. Depending on the type of cough, other symptoms, and how long it’s lasting, the doctor might want to see your child.
Many health care providers now offer telemedicine visits, which can save parents a trip to the office (especially for a nighttime cough). “Video chatting” lets doctors see and hear a child cough, and often this is enough to make a diagnosis or rule out a serious problem. Hearing the cough will help the doctor decide whether (and how) to treat it.
How Are Coughs Treated?
Most coughs are caused by viruses and have to just run their course. Sometimes, this can take up to 2 weeks. Doctors usually don’t prescribe antibiotics because these only work against bacteria.
Unless a cough won’t let your child sleep, cough medicines are not needed. They might help a child stop coughing, but they don’t treat the cause of the cough. If you do use an over-the-counter (OTC) cough medicine, call the doctor to be sure of the correct dose and to make sure it’s safe for your child.
Do not use OTC combination medicines (like “Tylenol Cold”) — they have more than one medicine in them, and kids can have more side effects than adults and are more likely to get an overdose of the medicine.
Cough medicines are not recommended for any children under 6 years old.
How Can I Help My Child Feel Better?
To help your coughing child feel better:
- For a “barky” or “croupy” cough, turn on the hot water in the shower in your bathroom and close the door so the room will steam up. Then, sit in the bathroom with your child for about 20 minutes. The steam should help your child breathe more easily. Try reading a book together to pass the time.
- A cool-mist humidifier in your child’s bedroom might help with sleep.
- Sometimes, brief exposure to cool air outdoors can relieve the cough. Make sure to dress your child appropriately for the outdoor weather and try this for 10–15 minutes.
- Cool beverages like juice can be soothing and it is important to keep your child hydrated. But do not give soda or orange juice, as these can hurt a throat that is sore from coughing.
- You should not give your child (especially a baby or toddler) OTC cough medicine without first checking with your doctor.
- If your child has asthma, make sure you have an asthma action plan from your doctor. The plan should help you choose the right asthma medicines to give.
- Cough drops are OK for older kids, but kids younger than 3 years old can choke on them. It’s better to avoid cough drops unless your doctor says that they’re safe for your child.
When Should I Call the Doctor?
Always call your doctor if your child is coughing and:
- has trouble breathing or is working hard to breathe
- is breathing faster than usual
- has a blue or dusky color to the lips, face, or tongue
- has a high fever (especially if your child is coughing but does NOT have a runny or stuffy nose)
- has any fever and is younger than 3 months old
- is younger than 3 months old and has been coughing for more than a few hours
- makes a “whooping” sound when breathing in after coughing
- is coughing up blood
- has stridor (a noisy or musical sound) when breathing in
- has wheezing when breathing out (unless your doctor already gave you an asthma action plan)
- is weak, cranky, or irritable
- is dehydrated; signs include dizziness, drowsiness, a dry or sticky mouth, sunken eyes, crying with little or no tears, or peeing less often (or having fewer wet diapers)
Reviewed by: Patricia Solo-Josephson, MD Date reviewed: May 2018
Cough Symptoms & Causes
There are several different types of coughs, including:
These coughs are usually caused by croup brought on by allergies, change in temperature at night, or most commonly a viral upper respiratory infection.
When a young child’s airway becomes inflamed, it may swell around the vocal cords, making it harder to breathe.
Children younger than 3 years of age have croup most often because their windpipes are narrow – some children have it practically every time they have a respiratory illness.
Croup can occur suddenly in the middle of the night, which can be frightening for both you and your child.
Although most cases can be managed at home, if you suspect your child has croup, call your child’s doctor to determine whether your child needs to visit him or her.
The “whooping” sound actually occurs after the cough, when the child tries to take in a deep breath after a round of several coughs in a row.
If your child makes a “whooping” noise (which actually sounds like “hoop”) after severe bouts of rapid coughing, it is most likely a symptom of pertussis (whooping cough) – particularly if your child has not received her diphtheria/tetanus/pertussis (DTaP) vaccinations.
Infants with pertussis usually do not “whoop” after the prolonged episodes of coughing, but they may not get enough oxygen or they may even stop breathing with this disease.
In infants and very young children, pertussis can be deadly, so call your child’s doctor right away.
Cough With Wheezing:
When coughing is accompanied by a wheezing sound as your child exhales (breathes out), it is a sign that something may be partially blocking the lower airway.
This might be caused by swelling from a respiratory infection (such as bronchiolitis or pneumonia), asthma, or an object stuck in her airway.
Call your child’s doctor unless your child has this problem often and you have medicine, such as an inhaler or nebulizer, with instructions on how to use the medicine for home treatment of your child’s asthma.
If the cough and wheezing do not improve with medication, call your child’s doctor.
Although wheezing usually during exhalation, stridor (pronounced: stry-door) is noisy, harsh breathing (some doctors describe it as a coarse, musical sound) that’s heard when a child inhales (breathes in).
Most often, it’s caused by swelling of the upper airway, usually from viral croup.
However, it’s sometimes caused by a more serious infection called epiglottitis or a foreign object stuck in the child’s airway.
If your child has stridor, call your child’s doctor immediately.
When a child suddenly starts coughing, it may mean she has swallowed some food or liquid “the wrong way” (into the airway) or something (a bit of food, vomit, or perhaps even a small toy or coin) is caught in her throat or airway.
Coughing helps clear the airway and may even continue for a minute or so simply because the throat or airway is irritated.
But if the coughing does not seem to improve or your child has trouble breathing, call your child’s doctor.
Do not try to clear the throat with your finger because you might push the obstruction even farther down the windpipe.
Lots of coughs get worse at night because the congestion in a child’s nose and sinuses drains down the throat and causes irritation while the child lies in bed. This is only a problem if your child is unable to sleep.
Asthma can also trigger nighttime coughs because the airways tend to be more sensitive and become more irritable at night.
Allergies, asthma, colds, and other respiratory infections are the usual culprits.
Cold air or activity can make these coughs worse, and they often subside at night or when the child is resting.
You should make sure that nothing in your house, like air freshener, pets, or smoke, is making your child cough.
Cough With a Cold:
Because most colds are accompanied by a cough, it’s perfectly normal for your child to develop either a wet or dry cough when she has a cold.
The cough usually lasts about a week, often after all other symptoms of the cold have disappeared.
Cough With a Fever:
If your child has a cough, mild fever, and runny nose, chances are she has a simple cold.
But coughs with a fever of 102 degrees Fahrenheit (39 degrees Celsius) or higher can mean pneumonia, particularly if your child is listless and breathing fast. In this case, call your child’s doctor immediately.
Cough With Vomiting:
Children often cough so much that it triggers their gag reflex, making them throw up.
Usually, this is not cause for alarm unless the vomiting persists.
Also, if your child has a cough with a cold or an asthma flare-up, she may throw up if lots of mucus drains into her stomach and causes nausea.
Coughs caused by colds can last weeks, even up to three weeks, especially if your child has one cold right after another.
Asthma, allergies, or a chronic infection in the sinuses or breathing passages might also be responsible for long-term coughs.
If your child’s cough lasts for more than a month, you should schedule a visit with your child’s doctor.
Cough in Young Infants:
Coughing can wear out babies younger than 6 months, so keep a close eye on any cough your infant develops.
These infants are also the population that is most at risk for complications from respiratory syncytial virus (RSV), which is most common in the winter. RSV causes colds and ear infections in older children and adults, but in young babies, it can cause bronchiolitis and pneumonia and lead to severe respiratory problems. The disease starts out like a normal cold but becomes worse until the child has wheezing, a cough, and difficulty breathing.
Some children may have to be admitted to the hospital to receive oxygen and fluids.
When should I call my child’s doctor?
Most childhood coughs are nothing to be concerned about. However, in some instances you should consult a doctor, just to be safe. Call your child’s doctor if your child:
has trouble breathing or is working hard to breathe
has a blue or dusky color to the lips, face, or tongue
has a high fever (particularly in a young infant or in the absence of congestion or a runny nose; contact your child’s doctor for any fever in an infant younger than 3 months of age)
is an infant (3 months old or younger) who has been coughing for more than a few hours
makes a “whooping” sound when she breathes after coughing
is coughing up blood (if your child has had a nosebleed recently, this usually is not a problem)
has stridor when inhaling
has wheezing when exhaling (unless you already have home asthma management instructions from your child’s doctor)
is listless or cranky.