Host: Many times pediatricians get call in the middle of the night when kids make that funny barking sound and they think it's -- I think it's called croup. What is croup?
Michael Marcus: Croup is a condition where the upper portion of the throat begins to close down due to some trigger. The trigger could be a viral infection. It could be an allergy. But regardless of what's triggering the event, when the upper portion of the throat closes, it makes it difficult for the child to breathe, and you hear that very characteristic barking type of cough.
Host: What can parents do in that case, when maybe they don't end up going to the emergency room.
Michael Marcus: Well, the first thing to realize is, croup is usually much less -- much less severe than it sounds. The sound of the croupy cough can be quite scary, but it doesn't really reflect the degree of blockage in the throat. What we generally recommend, is for the parent and child to go into the bathroom, turn on the shower and let the steam fill the room. Many times the steam from the shower is enough to relieve the spasm and make the breathing much more easy.
Host: But if your kid has a lot of trouble breathing, we guess that it's an emergency, isn't it?
Michael Marcus: Well, absolutely. So if it doesn't work by bringing the child into the shower, into the steam, or if the breathing difficulty is so labored that the child is truly not getting air in properly, then you absolutely do not waste any time and you certainly want to seek medical attention immediately. Call an ambulance or going to the emergency room will be perfectly appropriate in that setting.
Host: Most likely if the kid does get to an emergency, give something called steroids.
Michael Marcus: Steroids are very common treatment for croup. Steroids are already found anti-inflammatory medication that relieves the inflammation, relieves the swelling and relieves the spasm, that's the cause of the blockage in breathing.
Host: Sometimes they give it by injection, sometimes they give it by local, is that true.
Michael Marcus: It's correct. There are several different ways to give steroids. We give it in the way that's easiest for the child to tolerate. So the child is able to swallow and cooperate. We certainly give it by mouth, but many times the children aren't such labored breathing and are so scared at that point, that the best way to give the medication effectively is with the shot.
Host: Sometimes in some hospitals, they actually a thing like an adrenaline shot. Is that effective?
Michael Marcus: Adrenaline is another medication that we give that relieves the spasm. Adrenaline is given by an injection. It works even more quickly than the steroids would work, and it certainly is an effective emergency treatment. The thing that is limited by the fact that adrenaline is a medicine that only lasts for about 15 or 20 minutes. When the medicine wears off, the symptoms can come right back. So it's never sufficient to give adrenaline alone. It's merely the first and most rapidly acting of a series of medications that we use.
Host: And sometimes they have something in kids like a thing called a rebound.
Michael Marcus: As the adrenaline wears off in that 20 minute period, sometimes the symptoms of croup come back, and they may come back even worse than they originally were shown, and that is the rebound period. That's the reason that when adrenaline is given, patient continue to be monitored for period of time even if they seem to be well. We have to be careful that the rebound does not occur.
Host: That's so common, now that years ago there was a form of croup like illness called epiglottitis, but we seem not be seeing, because we have been vaccinating these kids against a certain infection, is that true?
Michael Marcus: That's very true. Epiglottitis is a form of infection that does block the upper airway, and it is a truly life threatening infection, because the degree that it blocks the upper airway could totally stop a child from breathing. The most common bacteria for epiglottitis, is a bacteria called Hemophilus influenza, and it is a bacteria that we now routinely vaccinate all children for. As soon as we have started vaccinating children for this bacteria, we never see this form of epiglottitis.
Host: Thank you.
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