Our First ER Visit – Croup!
I thought I’d briefly share some thoughts after our five-month-old son’s first visit to the emergency room. He had an attack of croup Friday night. Well, really, it was early Saturday morning, and we had to drive over to the ER at 2:30 a.m.
We didn’t know anything about croup. Zack had a cough for a couple days, but it seemed like nothing to worry about. But Friday night, he started sounding really bad. The cough sounded deep and his breathing was a bit labored. We discussed taking him to ER around midnight, but he calmed down enough to sleep and sounded better. So we knocked off, until about 2:30 a.m., when Zack woke up with a much worse cough and a terrible wheezy sound. The sound was so alarming that we decided to brave any mocking from hospital staff about us being hysterical first time parents, and we made the three mile trip to the emergency room.
To our surprise, our concerns were taken quite seriously. The doctor diagnosed Zack right away, based on his classic “barky cough,” as having croup. The wheezy noise turned out not to be wheezing at all, but the sound of air making its way through Zack’s narrowed trachea–a sound called stridor. Croup is an infection that causes swelling right around the vocal cords. And in fact, if untreated, the infection can be serious, since the swelling can cut off breathing. This rarely happens, but if you hear stridor when a child is at rest, it’s time to head to the emergency room. The cough most often worsens at night, and Zack’s middle of the night waking was another classic sign of croup.
If we’d known what to do at home, we would have taken Zack immediately into the bathroom and run a hot shower to build up a lot of steam. Moist air is very effective in alleviating the symptoms. Or we would have let him breathe directly from the cool moist air from a humidifier. If those actions didn’t work, then we would have had to take him to the hospital anyway.
In the ER, Zack got a shot of steroids, which he protested loudly. But it made him feel better in about ten minutes. The steroids reduced the inflammation in his trachea. (We’re hoping they will also make it possible for him to win the 2012 Olympics.)
Then we got a little nebulizer device that produced a fine water mist, and we had to hold that up to Zack’s face for a while. He eventually dropped off to sleep, his breathing much improved.
We left the ER at about 5:30 a.m. with instructions for home care.
This experience left me with a few musings, as intense experiences often can do. Besides that fact that just knowing about croup might be good for any readers of our blog who are new parents, a few of my mental meanderings over the past weekend have been applicable to what I think is our mission.
First, we were extremely grateful to the doctor and nurses who helped us. We came in with a problem that scared us, and they were quick, professional, respectful, and informative. Best of all, the whole situation was routine for them. Croup, in the days before antibiotics and vaccines, was often related to diptheria and was a terrible and sometimes deadly infant disease. Nowadays, croup is most often viral and easily managed. I am always happy to encounter such an illness–one along the order of “This used to kill a lot of folks but it really isn’t anything to worry about now.” Experiences like the one we had early Saturday morning remind me of how lucky we are to live in a time of modern medicine. Living in Los Angeles, I get to hear a lot about how, “Doctors don’t know everything.” There is often an antipathy to medicine and science among my friends, and it seems like everywhere you turn, there are quack herbalists, acupuncturists, and various holistic healers. They seem to be a hazard of our locale, and perhaps also of our industry. Although there are plenty of intelligent and driven people in the film and television business, it is nevertheless a business chock full of antiscientific thinking. As I’ve said before, I’m not a scientist but a writer, teacher, and actress. But I consider myself a rationalist, and sometimes it is tough to hold my tongue when I hear recommendations to try a magic tea or a high colonic, or when I hear for the Nth time a criticism of evil “Western medicine.”
I have to say, I love Western medicine. It granted me a safe childbirth, and it kept my son breathing clearly over the weekend. Go medicine!
Second, it may be trite, but an experience like Saturday’s makes me think of the many people in the world without access to medical care. Having a baby has made me acutely aware of the helplessness and pain parents must suffer when a child is sick. There really isn’t any way to imagine the scope of love that enters your life when you become a mother, and of course it goes hand in hand with a cavernous, awful and constant fear. So I’m proud that I sponsor a child monthly through a charitable organization. I hope it’s doing something for her. I get those letters, and I remember doing some research about the organization back when I first started contributing. But at this point, the automatic deduction from my account is hardly noticeable, and I kind of stopped thinking about the whole thing, until this weekend.
Third, I am not sure how I got so lucky, but I am grateful as all get out for my husband. We both really earned the titles of Rational Parents over the weekend. We never panicked and we never groused at each other, even when the straight shot to the hospital turned out to be under construction, and Jeff missed one of the detour turns. We’ve been losing a lot of sleep, but an experience like this can either bring you down or bring out the best in you, and this time around, it did the latter for us. (We don’t always receive such high marks in this area, but this weekend we were on our game.)
Finally, on a more somber note, the ready access we had to emergency services reminds me that there are fewer and fewer of them in recent years in Los Angeles. I recently shot a commercial in which I played a nurse, and our set was the closed down RFK Hospital, in Hawthorne. Just a little internet research turned up the fact that in 2004, this was one of six Los Angeles emergency rooms to close its doors. Over two dozen emergency rooms and trauma centers in LA have closed since the 1980s. The article I read said that closures were largely due to the cost of covering uninsured patients. As it happens, my mother works in the insurance industry and was a nurse for many years, and she cites the financial problems of hospitals as also caused by capitation. Essentially, Zack’s visit to the ER, which perhaps cost $400 or $500, will only earn the hospital something like $125. The rest of that money goes to the insurance company, thanks to capitation.
After receiving such great treatment for only a $50 copay, I am horrified to think of entire areas of the city without adequate emergency room services. And of course life for the uninsured is equally horrifying. I have no idea how to approach such a problem, and Los Angeles, like the rest of the country, is financially backsliding. New hospitals are probably not a priority. I can only hope our next presidential administration can make some headway into the nation’s healthcare crisis, as I definitely wish the positive experience we had at our local hospital for any parent.
Diane Said,
November 23, 2008 @ 10:34 pm
Just to clarify, I’m pretty sure the steroids your son received are not anabolic steroids (”performance enhancing”) so Zack will have to find another way to the 2012 Olympics!
Julie Said,
November 24, 2008 @ 12:57 am
Yeah, I was kidding about that. And also about the 2012 Olympics. Zack will be four then.
davery Said,
November 24, 2008 @ 9:48 am
As a parent in LA myself, I share your frustrations at the “woo” level in this city. I have arguments with people about the “evils” of western medicine all the time.
I have a three year old and have gone through the exact situation that you described above. It is truly a scary moment and I am grateful that not only do I live in the western world but am afluent enough to have good medical coverage.
I must take a small exception with your post about how to treat croup however. There is no scientific evidence that supports the hot/cold moist air treatment. This is a “home remedy” that lingers from the 19th century. Almost all studies have found that it is not effective.
See this wiki article, specifically the treatment section, and if you do a search online you’ll find much of the same information.
http://en.wikipedia.org/wiki/Croup
Anyway, keep flying the flag of rationality.
d
Victor Said,
November 24, 2008 @ 2:47 pm
Yes, it’s real scary the first time (and still worrying even when you know what to do). In Zurich there’s a free 24-hour medical advice hotline, staffed by doctors, and they also gave us the run-a-hot-shower-and-sit-in-the-bathroom advice … with the addition of 5 minutes out on the balcony every 20 minutes or so. The combination of steam and cold air (it was winter time) did the trick, although it took a few hours. The next day we went straight out and borrowed a humidifier, an ultrasonic one which gives a cool steam.
We also love the safety net of “western” medicine but if there’s a tried and trusted “old wives” treatment, with ingredients that can be found around the home, then we’ll take that over the stress of a hospital visit.
Julie Said,
November 25, 2008 @ 9:22 am
Davery,
Interesting, I read the same Wikipedia article, but everything else I read on line said the steam and moist air would work. And our exit instructions from the hospital said the same. We didn’t find another piece of information that said the moist air thing was ineffective.
Chris H. Said,
November 27, 2008 @ 12:17 pm
My now 20 year old son got croup several times between 1 and 3 years old. The home remedy included cool moist air (I think it helps to keep the irritation down in the throat). Sometimes I would have him in the bathroom with the shower running (there is a scene the movie “Terms of Endearment”, http://www.imdb.com/title/tt0086425/, of the mom giving that treatment to the little girl). We called it the “pampering disease” because the symptoms got worse when he got upset.
Unfortunately he did get severe enough to go to the emergency room about four times, one time with a blood-ox level in the 70% range (anything below 100% is worrisome, by the way, that was on Thanksgiving). Back then the treatment included epinephrine, which has its own problems and required an overnight stay hooked to a heart monitor. There was also a blow-by tube with extra oxygen.
During one of his times in the emergency room a couple of doctors came by with a camera on a tube to check to see if he had epiglottitis, which is very very serious. They did not find that, and remarked that they were seeing less and less epiglottitis since the introduction of the Hib vaccine just a couple of years before, from http://www.emedicinehealth.com/epiglottitis/article_em.htm …”Epiglottitis caused by Hib has a unique distribution in that it typically occurs among children aged 2-7 years and has not been reported among Navajo Indians and Alaskan Eskimos.”
I am so glad the treatment for croup has changed, since it is much less stressful at home than in the hospital.
Julie Said,
November 27, 2008 @ 1:18 pm
Interesting. Our son has now progressed to having a “reactive” airway. Apparently Reactive Airway Disease is the term for childhood asthma. But we don’t know if Zack has this yet. He could just be having a reactive airway after an episode of croup. And this could be his only episode of any of this. OR–he could turn out to be a croupy baby. He also has a little eczema, and asthma runs in my family. I never had it, but my mother suffers from it, and my brother had it as a kid and outgrew it. Apparently, asthma, allergies, and eczema are all related. One in three babies with eczema will get asthma. So we will have to see how all of this plays out with Zack. He could have nothing at all, or he could have repeated episodes of croup and reactive airway.
For now, he is wheezy and we are using some medicine in the nebulizer my mom gave us. (Grandma wasn’t using hers.) Our pediatrician gave us samples of albuterol to put in there.
Another interesting connection is food allergies. Our doctor said we should definitely wait until six months to introduce solid foods, because delaying solids helps to avoid food allergies. Since Zack now has a few red flags for the whole allergy/eczema/asthma connection, I’m really glad we did wait. We have been just about dying to introduce solids, because the boy is so big and it really is quite something to feed him only breast milk. I envy moms who only feed their babies every two hours. Oh for that. So we wanted to sneak in some rice cereal, but we have been good. December 10th is solids day!
Dr. Chuck Said,
November 29, 2008 @ 1:28 pm
The evaluation and treatment of croup has changed several times over the years. Although humidified air, either from the shower in the bathroom or a “croup tent” in the hospital, is commonly used, the data to date do not support its use (Moore M., Little P.: Humidified air inhalation for treating croup: a systematic review and meta-analysis. Fam Pract 24. (4): 295-301.2007, also see a Cochrane Review on the subject at http://www.cochranereview.org). Sitting in a steamy bathroom with your child probably calms him enough to decrease his work of breathing. The harder a child tries to inhale, the more his upper airway collapses and the worse his stridor sounds. Forcefully holding a mask over a child’s face in the ER may actually upset him enough to make the stridor worse.
The mainstay of croup treatment is a dose of a cortisone-type steroid. A single dose of dexamethasone usually lasts two or three days. Inhaled epinephrine may also be used in severe cases.
In the past, any child who presented to the emergency room with stridor received an x-ray of hs neck to rule out epiglottitis, a much more serious, often fatal disease. As mentioned above, the Hib vaccine has practically eliminated this disease.
Parents should be warned not to be falsely reassured by their child’s improvement the morning following an exacerbation of croup. The stridor often returns the following night if steroids are not prescribed.
I see several patients who have recurrent bouts of croup. Some of these chidren have abnormal narrowing of their tracheas for various reasons. Others may simply have normal but smaller than average laryngeal anatomy. Occasionally a child with asthma will have breathing patterns which can be confused with croup, as noted above.
Janet Sorensen Said,
December 2, 2008 @ 12:50 pm
I read that wikipedia thing and a related study. But it takes more than a study or two to rule a treatment in or out. Sometimes I think these things are overreported. And I write for a health care quality improvement foundation.
My daughter (age 4) had to go to the ER Friday night, the day after Thanksgiving. Ok, again, it was actually Saturday morning at 3 a.m. Same scenario, except she was almost gasping, and I did not know what was going on. I called the nurse’s line because I know you can die of malnutrition waiting in the ER around here and wanted to make sure we could get in before the GP clinic opened in the same hospital…but the nurse said bring her in right away, I’m calling the ER to let them know she’s coming. By the time we got there, the stridor and gasping had stopped. They said that’s common because — drumroll — the cold, damp night air was good for croup. (We live in Arkansas, so it’s more like cool air, not terribly cold. It was about 35 or 40 degrees I think.) They gave her a big dose of steroids and said if it happened again to take her outside, and if that didn’t work after a couple of minutes, to bring her back in right away. I asked about the warm steamy bathroom treatment, and they said that can work but not to do it if the kid is running a fever, which she was. It was on the fact sheet they gave me but she said not to do it. Besides, she said it’s quicker to take the kid outside and time is obviously critical when you’re losing oxygen.
I just love settling these arguments. lol
Rational Moms » Blog Archive » Thoughts on Sleep Said,
January 19, 2009 @ 11:44 am
[...] a daycare virus. Zack and my husband were running high fevers this weekend. Because Zack has gotten croup, we were too anxious to let him sleep alone. He ended up back with me for two nights. I know this [...]