Comments on: Our First ER Visit – Croup! http://www.rationalmoms.com/2008/11/23/our-first-er-visit-croup/ Rational moms of the world unite! Fri, 23 Jul 2010 14:46:29 -0700 http://wordpress.org/?v=2.8.6 hourly 1 By: Rational Moms » Blog Archive » Thoughts on Sleep http://www.rationalmoms.com/2008/11/23/our-first-er-visit-croup/comment-page-1/#comment-652 Rational Moms » Blog Archive » Thoughts on Sleep Mon, 19 Jan 2009 18:44:43 +0000 http://www.rationalmoms.com/?p=288#comment-652 [...] 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 [...] [...] 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 [...]

]]> By: Janet Sorensen http://www.rationalmoms.com/2008/11/23/our-first-er-visit-croup/comment-page-1/#comment-311 Janet Sorensen Tue, 02 Dec 2008 19:50:49 +0000 http://www.rationalmoms.com/?p=288#comment-311 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 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

]]> By: Dr. Chuck http://www.rationalmoms.com/2008/11/23/our-first-er-visit-croup/comment-page-1/#comment-303 Dr. Chuck Sat, 29 Nov 2008 20:28:42 +0000 http://www.rationalmoms.com/?p=288#comment-303 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 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. 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.

]]> By: Julie http://www.rationalmoms.com/2008/11/23/our-first-er-visit-croup/comment-page-1/#comment-297 Julie Thu, 27 Nov 2008 20:18:13 +0000 http://www.rationalmoms.com/?p=288#comment-297 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! 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!

]]> By: Chris H. http://www.rationalmoms.com/2008/11/23/our-first-er-visit-croup/comment-page-1/#comment-296 Chris H. Thu, 27 Nov 2008 19:17:29 +0000 http://www.rationalmoms.com/?p=288#comment-296 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. 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.

]]> By: Julie http://www.rationalmoms.com/2008/11/23/our-first-er-visit-croup/comment-page-1/#comment-276 Julie Tue, 25 Nov 2008 16:22:19 +0000 http://www.rationalmoms.com/?p=288#comment-276 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. 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.

]]> By: Victor http://www.rationalmoms.com/2008/11/23/our-first-er-visit-croup/comment-page-1/#comment-271 Victor Mon, 24 Nov 2008 21:47:48 +0000 http://www.rationalmoms.com/?p=288#comment-271 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. 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.

]]> By: davery http://www.rationalmoms.com/2008/11/23/our-first-er-visit-croup/comment-page-1/#comment-270 davery Mon, 24 Nov 2008 16:48:30 +0000 http://www.rationalmoms.com/?p=288#comment-270 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 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

]]> By: Julie http://www.rationalmoms.com/2008/11/23/our-first-er-visit-croup/comment-page-1/#comment-269 Julie Mon, 24 Nov 2008 07:57:47 +0000 http://www.rationalmoms.com/?p=288#comment-269 Yeah, I was kidding about that. And also about the 2012 Olympics. Zack will be four then. Yeah, I was kidding about that. And also about the 2012 Olympics. Zack will be four then.

]]> By: Diane http://www.rationalmoms.com/2008/11/23/our-first-er-visit-croup/comment-page-1/#comment-267 Diane Mon, 24 Nov 2008 05:34:46 +0000 http://www.rationalmoms.com/?p=288#comment-267 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! 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!

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