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Night Sweats in Children: Advice for Referrers

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Night sweats are subjective reports (often parental) involving an exaggeration of the normal circadian temperature rhythm. They are defined as sweating that occurs solely or predominantly at night. The clinical significance of night sweats, particularly within the paediatric population, remains controversial. Although severe night sweats can be both distressing and disruptive to sleep, in most cases the child is completely unaffected, apyrexial, and awoken by a worried parent.

Conversely, night sweats may be the presenting clinical manifestation of certain serious medical conditions (including malignancy, infection, autoimmune disease, and obstructive sleep apnoea). It is important to be aware of the red flag features to look out for.

Who to refer

Red flags - in the context of a child presenting with night sweats that require urgent assessment:

  • Growth faltering (weight or height)
  • Persistent fatigue +/- malaise
  • Daily fevers (i.e. ≥ 5 days history with no other identifiable cause)
  • Persistent cough +/- diarrhoea
  • Recurrent infections (i.e. ≥ 3 severe bacterial infections within 12-months)
  • Lymphadenopathy (with no other identifiable cause e.g. intercurrent viral illness / URTI) - please see Referral Guide for lymphadenopathy
  • Hepatosplenomegaly
  • New cardiac murmur
Please include the following points from the history in the referral letter

The mainstay of the diagnosis lies within the history and it is important to clarify the characteristics of night sweats:

  • Do they leave the child drenched - such that they require a change of nightwear +/- bedclothes?
  • How frequently do they occur? (i.e. per. week)
  • Are there any accompanying daytime symptoms?
  • Fevers should be excluded with certainty (if there is concurrent fever then differentials such as infection or malignancy become more likely diagnostic possibilities)
  • Any other symptoms (e.g. cough, diarrhoea, palpitations, headaches)
  • Recent travel abroad; TB contact

If there is any doubt regarding the presence of fever, ask the parents to measure and document twice daily temperatures (morning and evening) for a 5-day period, and if there are concerns about a prolonged fever with no source then the child should be referred to the hospital acutely.

Please include the following points from the clinical examination in the referral letter
  • General appearance (including nutritional status)
  • Temperature, heart rate and blood pressure
  • Weight and height; plot measurements on an age-appropriate growth chart (and ideally compare to previous measurements)
  • Any pathologically enlarged lymph nodes (cervical, axillary, and inguinal lymph node chains)
  • Oral candidiasis; pallor +/- petechiae of mucous membranes
  • Hepatosplenomegaly
  • Respiratory system abnormalities
  • Signs of hyperthyroidism (e.g. lid-lag or exophthalmos, thyroid mass, thyroid nodules)
  • Cardiac murmur; peripheral stigmata of endocarditis
  • Neurological findings if indicated (dependent on the history given)
Suggestions for management when no underlying pathological cause is identified

If both the history and examination of the child do not indicate any underlying pathological aetiology, then parental reassurance should be given. No investigations are required.

Providing parental reassurance:

  • Acknowledge that caregivers may have searched for information on the internet and looked at websites relating to adults with overnight sweating
  • Ask parents what they are worried about specifically, and what they may have discovered from their own research
  • Where suitable, offer age-appropriate information to the child

Managing night sweats:

  • Offer practical advice e.g. dressing the child in breathable, loose-fitting nightwear, use lighter bedding, reduce temperature of home heating overnight (aim for a sleeping environment of 16 – 20°C
  • Avoid caffeine and sugary foods – especially in the afternoons / evening
  • Explain the benefits of maintaining a healthy weight
  • Practise good sleep hygiene, alongside relaxation techniques prior to bedtime
Useful resources for parents

Safer Sleep for Babies Fact Sheet 6 - Temperature. The Lullaby Trust.

The box below outlines some useful resources for children with sleep issues - which healthcare professionals and caregivers alike can explore. 

Useful Resources for Parents of Children with Sleep Issues:  

The Children’s Sleep Charity: for children and young people with sleeping issues (now officially merged with The Sleep Council; accessible via: sleepcouncil.org.uk)
Tel: 01302 751 416
Email: info@thesleepcharity.org.uk
Website: www.thechildrenssleepcharity.org.uk 

Cry-sis: support for crying and sleepless babies aged ≤ 12-months
Tel: 08451 228 669
Email: info@cry-sis.org.uk
Website: www.cry-sis.org.uk

Sleep Scotland: for children aged 18-months to 18-years
Sleep Support Line via Tel: 0131 258 1258
Email: sleepsupport@sleepscotland.org
Website: www.sleepscotland.org

Health Visitor (for pre-school children)
Public Health / School Nurse (for school-age children)

 

Useful resources for health professionals

Ryan A, Higgins P, Bland R.M. Fifteen-minute consultation: Paediatric night sweats – when to reassure and when to investigate. Archives of Disease in Childhood – Education and Practice 2023; 108: 22 - 28.

So H.K, Li A.M, Au C.T, Zhang J, Lau J, Fok T.F et al. Night sweats in children: prevalence and associated factors. Arch Dis Child 2012; 97(5): 470 - 473.

Editorial Information

Last reviewed: 03 October 2023

Next review: 31 October 2026

Author(s): Aoife Ryan, ST7 Paediatrics & Ruth M Bland, Consultant Medical Paediatrics