Ear-piercing screams that shatter your sleep. Is it a night terror, wet bed, earache? As trusty a diagnostician as Dr. Mom or Dad may be, they don’t always have the answers.

In part three of our regular series, “Ask the Pediatrician,” we went back to the physicians at The University of Texas Medical School at Houston to compile commonly asked questions by parents... and their answers.

Print this out and keep it handy for those midnight moments.

1. Why do earaches always seem to be worse at night?

When we lie flat, pressure increases in the upper part of our bodies and in our heads, explains Dr. Laura J. Benjamins, assistant professor of pediatrics at the UT Medical School at Houston.

“It is more difficult to equalize the pressure behind the eardrum in this position, and if there is fluid behind the eardrum from an ear infection, the pressure increases even more, causing pain. Also, there are usually fewer things going on at night to distract us from the pain of an earache,” says Benjamins.

2. When should a child stop bedwetting?

Dr. Amalia Guardiola, assistant professor of pediatrics at the medical school, says bedwetting (also called nocturnal enuresis) is the involuntary passage of urine during sleep.

“Children should gain control of their bladders between 6 and 10 years old. After age 10, parents should be concerned and seek medical attention from their pediatrician,” Guardiola warns.

There are two types of nocturnal enuresis: primary and secondary. Primary enuresis means that the child hasn’t gained control of his/her bladder and “always wets the bed” at night. This usually occurs when the body makes more urine overnight than the bladder can hold and the child does not wake up when the bladder is full because the brain has not yet learned to respond to the signal. It is neither your child’s nor your fault. Physical causes are rare, but may include lower spinal cord lesions, congenital malformations of the genitourinary tract or diabetes.

Secondary enuresis means that the child gained control of his/her bladder, was able to stay dry through the night for at least six months, and then began to wet the bed again.

“There are many reasons that children wet the bed after being fully toilet trained. It might be physical, such as having a urinary tract infection, emotional such as the introduction of a new family member or just a change in sleep,” says Guardiola.

Do not punish your child for wetting the bed. Experts say this doesn’t help.

The most common treatments for bedwetting are:

• ensuring that your child goes to the bathroom at normal times during the day and evening
• making sure they do not hold their urine for long periods of time
• having your child go to the bathroom before going to sleep
• limiting fluid intake at least two hours before going to sleep
• and waking up the child in the middle of the night to use the restroom.

3. Are the “pedi drinks” sold in stores helpful for a child who has a stomach bug?

The American Academy of Pediatrics does encourage rehydrating your child with certain “pedi drinks” if the child has severe vomiting and diarrhea.

“To avoid severe dehydration and hospitalization for intravenous fluids, usually a pediatrician will encourage a parent to give their child a pedi solution. The pedi drinks in particular that are encouraged by pediatricians include Enfalyte, Pedialyte, CeraLyte and Rehydralyte,” says Dr. Mandie Svatek, assistant professor of pediatrics at the medical school.

In general, for a child who weighs less than 20 pounds, 2 to 4 ounces should be given for each vomiting or diarrhea episode. For a child who weighs more than 20 pounds, 4 to 8 eight ounces should be given.

According to Svatek, drinks such as Gatorade and Powerade may have too much sugar in them and lead to further loose stools. “You can attempt to rehydrate with these solutions, but it will be important to watch your child to make sure it isn’t increasing the bouts of diarrhea,” says Svatek.

Likewise, drinks that should be discouraged include soda products and juices that usually have excess amounts of sugar that the intestines cannot tolerate, leading to increased loose stools.

If an infant is on formula or breast milk, these are encouraged instead of pedi drinks as they should provide the sufficient hydration and nutrition that the pedi drinks cannot. If the infant cannot tolerate formula or breast milk and continues to vomit, then the pedi drinks may provide a sufficient substitute. Parents, however, should call their pediatrician for guidance.

4. I have heard that if my child has a fever, I should alternate between Tylenol (acetaminophen) and Motrin (ibuprofen). Why is that?

How to treat childhood fever is one of the most common questions from parents. A fever, a well-known defense mechanism for moderate illness, is usually caused by an upper respiratory tract infection or viral illness. High fevers are rarely dangerous but often leave a parent distressed, for understandable reasons. A fever is considered high when it is

• above 100.4 in infants younger than two months
• and 102.2 or higher in children older than two months

Acetaminophen (Tylenol) and ibuprofen (Motrin) are the two most common medications used to treat fevers. Both of these medications have been studied extensively and are proven to been safe when used separately for pain and fever in children.

According to Dr. Ebony Williams, assistant professor of pediatrics at the medical school, in the past several years many pediatrician and emergency room physicians have encouraged parents to alternate between Tylenol and Motrin to help reduce high fever.

“Although this is common, there is very little medical information about whether this is a safe practice. Nevertheless, several early studies do suggest that it is effective. In one study, patients who were given alternating doses of Tylenol and Motrin had lower mean body temperatures, more rapid reduction of fever and less absenteeism from school. There is a need for further research to determine whether alternating Tylenol and Motrin is a safe practice in children,” says Williams.

Williams also adds that acetaminophen and ibuprofen act by two different mechanisms. The medications also are metabolized by different parts of the body. Acetaminophen is metabolized in the liver and works by inhibiting prostaglandin production (prostaglandins increase inflammation in the body.) Ibuprofen, part of a class of drugs called NSAIDs (non-steroidal anti-inflammatory drugs) also is an anti-prostaglandin, but it is metabolized through the kidneys.

5. My child is sleepwalking, what should I do?

Dr. Christopher Greeley, associate professor of pediatrics at the medical school, says sleepwalking is a normal part of some children’s sleeping. It does not signify that your child is abnormal in any way.

“I would talk with my patient’s parent to try and determine the cause. It could be an illness, stress or medications they are taking. Nonetheless, safety is most important,” Greeley warns.

Safety measures include:

• placing gates at stairwells
• locking doors, especially those that lead to the outside or a basement
• placing unsafe objects such as knives out-of-reach
• placing children in the bottom bunk of a bunk bed, not the top.

Dr. Holly D. Smith, assistant professor of pediatrics at the medical school, adds that sleepwalking usually happens with boys more often than girls. “It usually occurs in children between 6 and 16 years old,” says Smith.

“Please understand that there are variations to sleepwalking. It may not just be that they are walking in their sleep. Some children can even perform complex tasks in their sleep, such as reading a book or watching television. If you find them sleepwalking, simply guide them back to bed. Occasionally, medications can be administered to treat sleepwalking, but that [necessity] is rare in children,” says Greeley.

6. Is my child having a nightmare or a night terror?

A nightmare is a dream involving an unpleasant emotion, such as fear or pain. Most individuals will average one nightmare per month and studies indicate that about one-fourth of children will have one nightmare per week.

A night terror is a behavior that occurs while the person is asleep. It may include facial expressions, such as grimaces or screams and moans, or agitation and fearfulness. The individual may even be sweating and have dilated pupils.

“Night terrors are most common in children between 2 and 7 years of age, but can start as early as 18 months,” says Dr. Abby Geltemeyer, assistant professor of pediatrics at the medical school. “It is estimated that 3 percent of all children have them. They may be triggered by stress, sleep deprivation, or certain medications.”

Night terrors occur 30 to 90 minutes after falling asleep, whereas nightmares occur later in the sleep cycle, usually in the second half of the night. During a night terror, Geltemeyer says, it is difficult to awaken the child or stop the behavior, but luckily, these last less than 30 minutes. Rarely does the child remember the night terror; while on the other hand, many of us can recall details of a nightmare.

7. My child is grinding her teeth at night, what should I do? Can it hurt her teeth?

Teeth grinding is usually a subconscious activity that may occur during sleep or when the child is wide awake. According to Dr. Lynnette Mazur, professor of pediatrics at the medical school, the clinical signs vary from minor to extensive damage of the teeth; from jaw pain to headaches. Teeth grinding can cause fractures of the teeth, muscle fatigue and mouth pain.

The causes of teeth grinding are:

• malocclusion—ill-fitting upper and lower teeth
• anatomical causes, such as the very shape of the jaw and teeth
• psychological stress
• iron-deficiency anemia
• neurological disorders
• pinworms

“For children who are grinding their teeth because their teeth or jaw have an unusual shape, a dentist, oral surgeon or orthodontist can remedy the situation. If psychological stress is the factor, parent and child counseling can be extremely helpful,” Mazur advises.

Researchers do not know why there is a connection between pinworms and teeth grinding, but there is a relationship. Mazur says one of the warning signs of pinworms is scratching. “If your child is scratching her bottom, a quick look for pinworms first thing in the morning is needed, followed by a call to the pediatrician for treatment,” Mazur said.

Another solution would be to wear a bite guard. It will help protect the teeth.

 

 

Last Updated: 12-10-2008

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