Baby 411 & Toddler 411 Blog

Croup is here

 

I hope everyone had a wonderful day of celebration, family time, football, and rest yesterday! Unfortunately, germs don't take a vacation. So, I am in the office today seeing kids who are spending their holiday feeling crummy. The biggest player this week is croup. Croup is caused by a handful of viruses, but it's different than the common cold. I always know when croup season has arrived when my little patients cough like a barking seal and sound like Demi Moore or Darth Vader. Here is some handy info:

Q. Why is croup special compared to the common cold?

A. Croup-causing viruses like the upper airway, right where the voice-box resides.  A swollen voice-box causes the barking cough and hoarse voice.

Q. Why do kids have a problem with it?

A. The smaller your airway is to begin with, the smaller it will be when it is swollen from a viral croup infection. Your airway gets larger as you age. Kids under age three are the most affected. And, adults (yes, like you) are the least affected. So, a baby might have trouble catching his breath with croup and an adult might just have a hoarse voice (or “laryngitis”).

 Q. How long does the virus last?

A. Croup is a 3-Night illness. For some unknown reason, croup is always worse at night and not really a problem during daylight hours (when your doctor’s office is open). At least it doesn’t last as long as most winter respiratory viral infections!

Q. When is croup a serious problem?

A. It’s a problem if your child makes a really high-pitched noise as he breathes—kind of like Darth Vader (called “stridor”) and looks like he is struggling to catch his breath. Here is a good example of stridor.

 Q. What should I do if my child sounds like Darth Vader?

A. Take your child into the bathroom and steam it up by running a hot shower. The steam helps relax the airway enough so your child can breathe comfortably. Alternatively, you can try walking out into the cold night air or opening up the freezer and letting your child breathe that air in (if you live in a warm locale like I do). If your child breathes more easily after that, great! See his doc the next day for evaluations and treatment. If he continues to have trouble, head to the nearest emergency room.

Q. Does my child need antibiotics for croup?

A. No. Because croup is caused by a virus, there is no antibiotic to make the infection go away. Time is the cure. But, if your child has stridor (a.k.a Darth Vader) on the first night, you have two very long nights ahead of you! Using a prescription steroid medication by mouth or by injection will help reduce the swelling in the airway. If your child has significant trouble breathing, he may also need an aerosolized breathing treatment given in a medical office or hospital setting.

Do all ear infections need antibiotics?

The Journal of the American Medical Association published a report last week that reviewed the existing scientific literature on the standard treatment of ear infections with antibiotics. The purpose? To see if healthcare providers should be giving even fewer antibiotic prescriptions than they already are. There are a growing number of highly antibiotic-resistant bacteria so we've got a potentially big problem on our hands—no medicine to treat these germs! So, we are trying to hold off on using our antibiotic "ammunition" unless we really need to.

So, what did the report find? Up to 80% of ear infections will clear up on their own without antibiotics.  This isn't really a newsflash for most clinicians. We know that a good number ear infections will clear on their own without treatment (particularly in older kids).But, will that change how doctors and parents approach treatment of ear infections?

Here's what I currently do in my own practice. For children who are over 2 years of age, I offer the wait and see approach. I will hand a parent a prescription (ideally Amoxicillin and not a bigger gun antibiotic) and tell them to fill it if the child is not improving. However, if that older child is running a significant fever (like 102 or higher) and has other signs of a systemic infection, not just an ear infection, I would treat that child at the time of diagnosis. For kids under 2 years of age (especially if they are running a fever), I treat ear infections when there is no question that the baby has a really bad ear infection! Those kids are not verbal enough to tell a parent if they are feeling better and have a higher risk of complications from an ear infection (e.g. mastoiditis—a very serious complication where the bacterial infection invades the skull bone and requires surgical drainage and IV antibiotics) that I don't feel comfortable waiting around to see if they improve without antibiotics.

What people need to realize is that antibiotics are not risk-free. Besides the emergence of superbugs, diarrhea, yeast infections, allergic reactions are all possible (and unpleasant side effects). And, that is why I am more likely to refer to an ENT doctor for possible PE tubes than continuing to throw antibiotics at a child with recurrent ear infections.

On the other hand, ear infections are really miserable!! Most adults have no idea how much they really hurt unless they have had one beyond childhood. So here's the bottom line: look at the scientific evidence and discuss it with your doctor. If you feel comfortable supportively caring for your child at home and waiting to see if your child improves before filling that prescription, that is usually the best course. If treating with antibiotics will help shorten the duration of that pain for some kids, it is not something we can completely discount.

 

 

 

 

Expecting 411 in People Magazine

People Magazine interviewed Expecting 411 author and OB/GYN Dr Michele Hakakha about issues pregnant women face today. Is it okay if you drank 3 martinis before you knew you were pregnant? Is it safe to fly during pregnancy? Will you ever have sex again? Is there really a pregnancy book out there that won’t scare the heck out of you? Click on the link to see Dr Hakakha’s interview and find out the answers!

Expecting 411/Baby 411 doc & USA Today team up on Monday

How can I keep my kids healthy this winter? Can my child get the flu nasal spray instead of a shot? Will the flu vaccine cover for H1N1? Can I get the flu vaccine if I am pregnant or breastfeeding? If you have any of these burning questions (or others), here is your chance to get the answers. Participate in a live chat with Dr Ari Brown and Liz Szabo of USA Today via twitter on Monday, November 15, at 2-3 PM EST. Here is the link for more information.

Peanuts and pregnancy: risky or not?

A study published today in the Journal of Allergy and Clinical Immunology revisits the age-old question of this generation: “Is it risky to eat peanuts during pregnancy?”

In 2000, the recommendation was to avoid peanuts during pregnancy to reduce the risk of a child developing a lifelong peanut allergy. Then in 2008, medical groups changed their minds and said not to worry about it. The scientific research has flip-flopped, and thus, the advice has too.

In this recent study, pediatric allergy experts looked at over 500 babies, 3—15 months of age, who were already known to have allergies. These babies had a significant allergic reaction to cow’s milk and/or eggs, a skin test reaction to cow’s milk and/or eggs, and/or moderate to severe eczema (an allergic skin condition, sometimes due to a food allergy). Also noteworthy: over 60% of the parents of these kids also had allergic disease. (This is really no surprise because allergies are hereditary!) It’s important to keep in mind that the study participants were already predisposed to allergies.

The researchers asked moms to report on their peanut consumption during the 3rd trimester of pregnancy. (Reality check: do you really think moms are able to remember exactly how much peanut butter or pad thai they ate 3—15 months after delivery?!) So, this is a weakness of the study.

But, the results are significant. Moms who said they ate peanuts products at least twice a week in their 3rd trimester were more likely to have a baby with abnormal blood/skin test levels showing a sensitization to peanuts. But let’s be clear: these children did not have allergic reactions after eating peanuts. Their lab results just showed a likelihood of peanut allergy.

And, what about indulging in a Reese’s peanut butter cup while nursing? Good news. This study did NOT show an association with peanut consumption while breastfeeding. So, go for it.

What does this all mean for you?

This is an intriguing study that is worthy of follow-up. It wouldn’t hurt to limit peanut intake during pregnancy (less than twice a week) if a pregnant woman or her partner has known allergic disease. But, this dietary restriction probably isn’t applicable to all pregnant couples at this point, given conflicting results in the scientific research to date.