Hipotermie post febrila de 9 nopți consecutive - #20674

Neata Bianca

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

Dr. Arsha K Isac

I am a general dentist with 3+ years of working in real-world setups, and lemme say—every single patient teaches me something diff. It’s not just teeth honestly, it’s people… and how they feel walking into the chair. I try really hard to not make it just a “procedure thing.” I explain stuff in plain words—no confusing dental jargon, just straight talk—coz I feel like when ppl *get* what's going on, they feel safer n that makes all the difference. Worked with all ages—like, little kids who need that gentle nudge about brushing, to older folks who come in with long histories and sometimes just need someone to really sit n listen. It’s weirdly rewarding to see someone walk out lighter, not just 'coz their toothache's gone but coz they felt seen during the whole thing. A lot of ppl come in scared or just unsure, and I honestly take that seriously. I keep the vibe calm. Try to read their mood, don’t rush. I always tell myself—every smile’s got a story, even the broken ones. My thing is: comfort first, then precision. I want the outcome to last, not just look good for a week. Not tryna claim perfection or magic solutions—just consistent, clear, hands-on care where patients feel heard. I think dentistry should *fit* the person, not push them into a box. That's kinda been my philosophy from day one. And yeah, maybe sometimes I overexplain or spend a bit too long checking alignment again but hey, if it means someone eats pain-free or finally smiles wide in pics again? Worth it. Every time.

91 days ago

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

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Dr. Bharat Joshi

I’m a periodontist and academician with a strong clinical and teaching background. Over the last 4 years and 8 months, I’ve been actively involved in dental education, guiding students at multiple levels including dental hygienist, BDS, and MDS programs. Currently, I serve as a Reader at MMCDSR in Ambala, Haryana—a role that allows me to merge my academic passion with hands-on experience. Clinically, I’ve been practicing dentistry for the past 12 years. From routine procedures like scaling and root planing to more advanced cases involving grafts, biopsies, and implant surgeries. Honestly, I still find joy in doing a simple RCT when it’s needed. It’s not just about the procedure but making sure the patient feels comfortable and safe. Academically, I have 26 research publications to my credit. I’m on the editorial boards of the Archives of Dental Research and Journal of Dental Research and Oral Health, and I’ve spent a lot of time reviewing manuscripts—from case reports to meta-analyses and even book reviews. I was honored to receive the “Best Editor” award by Innovative Publications, and Athena Publications recognized me as an “excellent reviewer,” which honestly came as a bit of a surprise! In 2025, I had the opportunity to present a guest lecture in Italy on traumatic oral lesions. Sharing my work and learning from peers globally has been incredibly fulfilling. Outside academics and clinics, I’ve also worked in the pharmaceutical sector as a Drug Safety Associate for about 3 years, focusing on pharmacovigilance. That role really sharpened my attention to detail and deepened my understanding of drug interactions and adverse effects. My goal is to keep learning, and give every patient and student my absolute best.

90 days ago

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

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Dr. Aarav Deshmukh

I am a general physician with 8 years of practice, mostly in urban clinics and semi-rural setups. I began working right after MBBS in a govt hospital in Kerala, and wow — first few months were chaotic, not gonna lie. Since then, I’ve seen 1000s of patients with all kinds of cases — fevers, uncontrolled diabetes, asthma, infections, you name it. I usually work with working-class patients, and that changed how I treat — people don’t always have time or money for fancy tests, so I focus on smart clinical diagnosis and practical treatment. Over time, I’ve developed an interest in preventive care — like helping young adults with early metabolic issues. I also counsel a lot on diet, sleep, and stress — more than half the problems start there anyway. I did a certification in evidence-based practice last year, and I keep learning stuff online. I’m not perfect (nobody is), but I care. I show up, I listen, I adjust when I’m wrong. Every patient needs something slightly different. That’s what keeps this work alive for me.

89 days ago

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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