Fifteen-minute consultation: Paediatric night sweats—when to reassure and when to investigate

3-year-old Susie has been referred to the medical paediatric clinic by her general practitioner with sweating at night; her parents change Susie’s pillowcase whilst she is asleep at around 11pm as her hair looks wet with sweat. Her mother has searched ‘ sweating overnight ’ on the internet and is worried that her child has cancer. What should you do? Night sweats are a common complaint in young children in the general paediatric clinic, either as the presenting complaint or as a symptom mentioned in the context of other concerns. Despite this, available literature on the subject is scarce.1 2 How do we limit over-investigating these children and mitigate parental anxiety, while ensuring timely detection of serious pathologies such as malignancy or infection? This article aims to provide a structured approach to the management of paediatric night sweats. ### How are night sweats defined? 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.1 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.3 4 Conversely, night sweats may be the presenting clinical manifestation of certain serious medical conditions (including malignancy, infection, autoimmune disease and obstructive sleep apnoea).1 It is important to be aware of the red flag features to look out for. ### What are the underlying physiological mechanisms responsible for sweating? The autonomic nervous system has an essential role in human thermoregulation. The skin’s blood vessels and sweat glands are innervated by sympathetic nerve fibres.2 Regulation of sweating involves both complex thermoregulatory and non-thermoregulatory mechanisms.5 Core body temperature (Tc) decreases as a result of sweating. The preoptic anterior hypothalamic region …