Night Sweats in Children: Advice for Referrers

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.

• 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)

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

Safer Sleep for Babies - Temperature. The Lullaby Trust.

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

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.