Hipotermie post febrila de 9 nopți consecutive - #20674
Dear Doctor, Could you please help us with a problem concerning my daughter? I would greatly appreciate a response from a physician. My daughter is 2 years and 8 months old. For approximately one year, I have noticed that after viral illnesses or episodes of fever, her body temperature drops at night during sleep. So far, this has occurred three times, and each episode lasted 2–3 nights before her temperature returned to normal. Currently, however, she has experienced 9 consecutive nights in which her temperature drops to around 35°C, and it would likely drop further if we did not place warm water bottles near her. During the day, she is well, her temperature is normal, she is active, plays, and eats. However, we are very concerned at night and fear letting her sleep alone. Routine lab tests have come back within normal limits, but we do not know the cause and are unsure what should be done to stabilize her temperature. We have consulted three pediatricians so far, but none could determine the cause. Initially, it was suggested that this could be a reaction to antipyretics, but it has now been 9 days, and the temperature has still not stabilized. We are from Câmpulung Argeș. We went to the hospital there when her temperature was 34.9°C, but they only performed routine tests and said they did not know what was happening. We visited another city, where we were told they had not encountered such cases before and recommended consulting an immunologist and a neurologist. In another place, we were advised to try endocrinology as well. At the endocrinology consultation, the doctor said she is developing normally and there does not appear to be any problem. However, for our peace of mind, we were asked to do cortisol, FT4, TSH, and ACTH tests. These tests can only be done on Monday, and we are worried that something might worsen before then. Could you please advise us on where we should seek help, which specialists to consult, or what steps we should take to investigate this issue? Thank you very much for your time and guidance!
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Doctors’ responses
Hello,
Most likely cause is temporary post-viral thermoregulation immaturity or autonomic imbalance, which is uncommon but usually benign and self-resolving
Serious endocrine or neurological disease is unlikely because the child is well during the day
Planned tests (cortisol, ACTH, TSH, FT4) are appropriate mainly for reassurance
Home care: keep child comfortably warm, avoid overheating, monitor gently
Urgent care needed only if temperature <34°C or alarming symptoms appear
If it persists beyond a few weeks, pediatric neurology plus endocrinology are the most helpful specialists
I trust this helps Thank you
Hello dear It seems post viral response in children. It will improve with time. Following precautions can be taken Good hydration Night warming measures Adequate diet Protection from infection Hopefully improvement will occur Regards
Considering the symptoms you’re describing, your daughter’s situation is understandably concerning, though it’s reassuring she is normal and active during the day. For these recurring episodes of nighttime hypothermia following febrile illnesses, while her lab tests are within normal limits, it’s important to continue exploring potential underlying causes. The suggestion from one consultant to look into immunology and neurology was on the right track. Moreover, pursuing the hormonal tests like cortisol, FT4, TSH, and ACTH – as recommended by the endocrinologist – is a sound step. These can provide insights into any underlying endocrine disorders that might not be apparent through routine screening. Meanwhile, keep monitoring your daughter closely, and log any additional symptoms or patterns you notice. Her high activity level during the day is good and might indicate that the underlying condition isn’t seriously detrimental to her health, but it doesn’t rule out possible neurological or autoimmune considerations. If your current testing options are geographically limited, contacting pediatric specialty clinics in larger cities with more extensive diagnostic capabilities might be necessary. Even if it’s a logistical challenge, it might provide answers. Considering hypothermia during sleep and the lack of clarity from routine tests so far, a more thorough examination with specialists experienced in rare pediatric metabolic or mitochondrial disorders might be beneficial – they’re sometimes associated with temperature regulation issues. It’s also vital to keep ensuring she is hydrated, well-nourished, and protected from cold environments during the nighttime, as you’ve been doing. Placing warm water bottles around her, ensuring she has plenty of blankets, and maintaining a warm room temperature is advisable while awaiting further medical advice. If at any point her condition worsens, or if you notice changes in her daily functioning, appetite, or behavior, don’t hesitate to seek immediate medical care. Stay attentive, but remain cautious about online recommendations and ensure any treatment or management plans are discussed with a healthcare professional who can provide individualized guidance based on your daughter’s full medical history and current presentation.
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