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Daily Dose

How to Treat Croup

1.15 to read

Now that the weather seems to change daily, croup season is here. Have you heard the sounds of raspy, throaty voices in your house lately? This "noise" is ushering in croup season! Croup is an infection that causes swelling of the larynx (vocal box) and trachea (windpipe) that in turn makes the airway just beneath the vocal cords become swollen and narrow. When you have swelling and narrowing of the airway breathing becomes more difficult and noisy and the sound that is made, almost like that of a seal barking, is called being “croupy”. Croup is quite common in young children, but the sound the emanates from that child when they cough, can be scary and concerning for both parent and child. Children are most likely to get croup between the ages of six months and three years. As a child gets older croup is not as common as the trachea gets larger with age and therefore the swelling does not cause as much compromise. When you awaken in the middle of the night to hear your child “barking” in the next room you need to know what to do. Most croup is caused by a common virus, so croup is not treated with antibiotics. The mainstay for the treatment of croup is try and calm you child, as they may be scared both from the tight feeling in their chest, as well as the sound that is made when they are breathing and coughing. The best treatment for croup seems to be taking your child into the bathroom and turning the shower on hot. Let the steam from the hot water fill the room and sit in there and read a book or two to your child. Typically within five to 10 minutes (before the hot water runs out) the moist hot air should help your child’s breathing. They may still have the barking, croupy cough, but they should be more comfortable and will not look like they are having trouble breathing. If the moist steam does not work, and it is a cool fall night, go outside. That is right, taking your “croupy” child from the moist heat in the bathroom, outside to cool night air may also help open their airways. If your child is showing signs of respiratory distress, with color change with coughing (turning blue while coughing, red is always good), is retracting (using their chest muscles between the ribs to help them breath), is grunting with each breath, or seems quite anxious and having trouble breathing you should call for emergency help. If a child is having real difficulty breathing they may be admitted to the hospital to have supplemental oxygen or breathing treatments. Steroids have also been helpful when used for the correct patient population. Steroids may be used in both an outpatient and inpatient setting. Steroids help to reduce inflammation in the trachea and the symptoms lessen over several days. Steroids used in a short burst are not harmful to your child, and are indicated in a child who may have mild respiratory distress due their croup symptoms. Your child may have symptoms of croup for several days, and for some reason they always seem to be worse at night. Put your child to bed with a cool mist humidifier in their room for the next several nights, this will also help to provide moisture to their airway. It is not uncommon for some children to seem more “prone to croup” and may get it recurrently all fall and winter. Have the humidifier handy and in working order! That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Cough and Cold Medicine

1:30 to read

My husband has a cold (I have been fortunate not to have one) and he decided he needed some over the counter (OTC) “cold medicine”, despite the fact that I told him they don’t work!  At any rate, I stayed in the car while he went in to buy “some things.”  It wasn’t too long before he was back empty handed…..and asking for some help in deciding what to buy!  It seems that he was overwhelmed and confused by all of the different choices….so I thought this was a good time to review all of the “ingredients” in OTC cough/cold medications. But remember, OTC cough and cold products are not recommended AT ALL for children under the age of 4. 

Most of the products that are advertised and sold for treating coughs and colds contain either a decongestant, antihistamine, expectorant, or anti-jussive (for cough).  But many of the OTC medicines contain some combination of these ingredients and there are many similar products with different brand names. Just gazing at the row of choices is enough to confuse anyone….even a doctor.

The most common decongestant used in OTC products is phenylephrine but its effectiveness in reducing nasal congestion from the common cold has been inconclusive. Another decongestant, pseudo ephedrine (Sudafed) is available, but has become restricted (it is a precursor in the manufacturing of methapmphetamine) and is now found behind the counter. Both of these drugs are often found in combination with other ingredients.

Antihistamines are also in many products. First generation antihistamines include diphenhydramine (Benadryl) and chlorpheniramine and are known for their tendency to be sedating. Second generation non sedating antihistamines such as loratadine (Claritin), fexofenadine (Allegra) and cetirizine (Zyrtec) are also found in some preparations ( typically with wording “daytime”) and are not sedating. In either case antihistamines do not seem to help the common cold.  Antihistamines do help allergies which are histamine mediated while a cold is not.

Anti-tussives or cough suppressants are commonly found in OTC cold medications, as cough is one of the most irritating aspects of a cold.  Dextromethorphan acts on the cough center in the brain to suppress coughing. It is the main ingredient in many OTC cough syrups but may also be found in many cough and cold combos in either liquid or pill form.

Guaifenesin is an expectorant and is found in many products, but again has not been found to have a measurable effect on mucous production from a cold.

Lastly, there are many products that are advertised to help with the “aches and pains” of a cold including acetaminophen and ibuprofen which may be found in combination with some of the above ingredients.

So…you have to read labels and make sure you “know” what you are getting. Too many people do not realize that they may be taking the same medicine but with different brand names, and this could cause an overdose.  

But the take home message is that “we” spend billions of dollars on these OTC products with continued studies showing minimal if any effect on the common cold when compared to placebo!  

I would spend my money on some Vicks, honey, and chicken soup and forgo the confusion on the cough and cold aisle.

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Treat Your Child's Cough & Cold!

Daily Dose

It's Croup Season!

1.45 to read

It is definitely fall and all around the country, the temperatures are cooling off and the chill is in the air at night. With the cooler temperatures more of those pesky viruses come out and once again I am seeing croup.

Croup is a viral upper respiratory infection that causes swelling of the trachea and larynx (voice box) which causes young children to cough and at times to bark like a seal. This hoarse raspy cough is most problematic in younger children who have smaller airways.  

Children often go to bed at night with nothing more than a little runny nose, and then suddenly awaken with this barking cough. Many times the noise emanating from the child’s room sounds more like a sick animal than your previously healthy toddler and may be alarming to both parents and the child.  

Whenever you awaken to a croupy child, the first thing to do is turn on the hot shower and shut the bathroom door as you head down the hall to your child’s room.  After getting your child, grab several of their favorite books and head back to the steamy bathroom. Sit in the bathroom and try to calm your child down and let the steam work.

Typically in several minutes (or until the hot water runs out) their coughing should improve and they will relax. Remember, they have suddenly awakened and are trying to figure out what is going on as well so they may appear to be tired and anxious as well.

In most cases the steam and humidity will help to relax the airway. If the steam doesn’t seem to be working after 5– 10 minutes try going outside into the cool night air. Many times a frantic parent will put their child into the car for a trip to the ER, only to find the child perfectly calm and no longer coughing on arrival to the hospital. The reason being, the cool air has also helped to calm the coughing.

If your child is having stridor (a high pitched squeal) when they breath in and appears to be having any respiratory distress with pulling of their ribs when they are breathing (called retractions), then you need to call your doctor. If they are coughing and turning bright red while coughing be reassured that they are still moving air well. You should not see any duskiness or blue color and if you do call 911. (Remember the adage blue is bad, and red is good).

If by morning your child is having continued symptoms you may want to see your doctor as steroids (given orally or by injection) may be used to help shrink the airway swelling. Most cases of croup do not require hospitalization. After several days of croup your child will probably be well.  

Lastly, older children and adults may also get the virus that causes croup, but with larger airways will simply show signs of laryngitis and being hoarse.

That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Can a Little Cough Ease the Pain of a Shot?

A study that was published in an ssue of Pediatrics caught my eye online. The title “Cough trick may reduce pain of routine immunizations” seemed relevant to my practice so I decided to preview the study a little early.A study that was published in an issue of Pediatrics caught my eye . The title “Cough trick may reduce pain of routine immunizations” seemed relevant to my practice so I decided to preview the study a little early.

The study was performed at The University of Nebraska and involved 68 children (small sample size) and they were all receiving vaccines at either the pre-kindergarten visit (age four to five years) or at the 11 to12-year-old visit when routine immunizations are again given. In this study the children were all instructed to COUGH while getting their vaccines and then the children as well as their parents and nurses were surveyed to see how painful the procedure seemed. For the kids they used visual scales (pictures of painful faces) to demonstrate degree of pain. There have been numerous studies done in previous years looking at methods to reduce pain during simple office visits for immunizations. Strategies from the use of topical anesthetics (EMLA cream), to sucking on sucrose dipped nipples for babies, to blowing bubbles to distract patients have all been used. In many of these cases the cost or time involved in these strategies was prohibitive for routine use in a busy office or clinic setting But, in this study, the time and cost was NONE as the children were taught to give one BIG cough prior to the injection and then coughed again at the time of injection. What a wonderful discovery! Easy, efficient and no training necessary for staff. In this study it wasn’t clear that it helped all children, and interestingly it seemed to be more effective in certain racial groups than others? In the meantime, while the academic and research docs are at work, I am going to try this approach in my own office I hate the four to five-year-old shots almost as much as the children and parents and have watched my own children scream and yell while getting all of those vaccines. Not fun for anyone. If that screaming, yelling and anxiety can be even slightly diminished by a cough or two, why not? It seems so easy. (I still think a lollipop at the end is helpful too). I guess we could all do a study on the “combo technique” of a cough followed by sugar and see what results we all get. Maybe get it published in Pediatrics next year? So, if you are headed to the doctor in the near future, and you know that it is time for immunizations, why not try “coaching” your child on the “cough trick” and see what you think. If your doctor isn’t aware of this study let them know it will be published in the next few weeks, but you can read it on line now. That’s your daily dose, we’ll chat again tomorrow. Send your question of comment to Dr. Sue!

Daily Dose

How To Treat A Cough

1.30 to read

It is FINALLY March which often is the last month that our pediatric office is inundated with illness. I can now honestly tell exhausted parents (and our nurses) that this could possibly be their child’s last cold of the 2013-2014 winter season. I would still keep my fingers crossed as well.

But, with that being said I still hear coughs throughout the exam rooms and the beeping of the pulse oximeter measuring a child’s oxygenation. These are sounds I rarely hear once we hit April-May.  Parents continue to be concerned about their child’s cough and parent’s and children alike are tired.... often due to sleep disruption due to coughing.  

While numerous remedies to suppress nightime cough have been tried, most of the studies done in children ( over 1 year of age) showed no benefit with either dextromethorphan (found in many OTC cough and cold preparations) or diphenhydramine (Benadryl).  On the other hand, there have been 3 randomized controlled trials showing the effectiveness of honey on reducing nighttime coughing brought on by an upper respiratory infection (also known as a cold.)

Honey has been used for a variety of medicinal uses for thousands of years, but like many other things (Power Rangers, Hello Kitty, Rocky and Bullwinkle), the use of honey is making a comeback!!  While different types of honey have been tried (the first study used Buckwheat honey, others have tried eucalyptus and citrus honey,) the type of honey used has not been found to be significant. There has yet to be a study done using the traditional clove honey we all have in our pantries.  

The mechanism for how the honey works to suppress the cough is still unclear. Some feel it is the antioxidant effect of honey, as well as its antimicrobial effects.  Others postulate that the sweet taste may  even reduce the central sensory nerves urge to cough.  Whatever the mechanism, most parents and children don’t care if they just can stop coughing at night!

Honey may safely be used in children OVER the age of 1 year.  The typical dose is 1/2 tsp for children between 1-5 years, 1 tsp for 6-11 years and 2 tsp for older children.

Give it a try on those last hacking coughs this month....spring is just around the corner.

Daily Dose

Cold & Cough Relief!

1:30 to read

Although it is just getting really cold across the country, it feels as if we have been in full cold and cough season for awhile.  The office sounds like what I call “kennel cough” as every child seems to be coughing…. even those who are just coming for check ups.

Parents often ask, “what is the best way to keep from catching a cold?” and the answer continues to be, “wash your hands and try not to touch your hands to your eyes, nose and mouth”.  Easy enough for an adult (well maybe not), but trying to tell your toddler not to put their hands in their nose or mouth is nearly impossible! That is one reason that children get so many colds in the first several years of life. Toddlers typically get the most colds as they have just started having playmates with whom they share not only toys but their germs…all part of growing up.

I remind parents that coughs are there for a reason. While they are a huge nuisance, and cause a lot of sleepless nights for both the child and parent, a cough is there to keep the lungs clear, and a cough is actually protective. In other words, coughing helps you clear the lungs of mucus that comes with a cold and helps to prevent pneumonia and secondary infections.  But, with that being said, learning to cover your mouth when you cough is not only polite, but it is also protective for others. It is a big day when your children learn to cover their mouths with the crook of their arms (better than the hand). Who knew as a parent this would be a milestone for your child?

Whenever your child is sick and has a cough and cold it is important to not only listen to their cough but to actually observe how they are breathing.  Parents send me videos or voicemails of their child coughing, but I am usually more interested in seeing their chest and watching their breathing. Your child may have a huge productive cough and sound terrible, but have no respiratory distress. With that being said, your child may also have a tiny little non-productive cough and be struggling to breath. In most cases the visual is more important than the audible.

To help symptoms like stuffy noses, try irrigating your child’s nose with Little Remedies® Sterile Saline Nasal Mist and then suctioning his or her nose to clear the mucus and make it easier for him or her to breath, a warm bath or shower before bed to open up airways and a cool mist humidifier in the bedroom.

Don’t panic if your child gets sick, as each time they fight off a cold and cough they are actually boosting their immune system…small victories.  It is not unusual for a toddler to get 6 - 7 colds in one season (and their parents get half as many as that from them). Once your child turns about 3 you will see that he or she doesn't get a cold every other week and also seems to handle the viruses a bit more easily.

If your child has any difficulty breathing you need to call your pediatrician! For more information on these products visit





Daily Dose

Treat a Cough

1.00 to read

Everywhere you go, I bet you hear someone coughing. 

Coughing is irritating but it’s your body’s way to get rid of material that builds up in your lungs and upper airway passages. 

I know the first thing you want to do to stop your child’s cough is head to your local pharmacy and buy an over the counter cough medicine.   Remember, the American Academy of Pediatrics does not recommend using cough medicines in children under the age of 6. 

I know people swear by over the counter medicines but research shows they are not very effective in treating cough & cold symptoms in adults.  So why would they work in children?  

One of the best treatments for a cough is honey. A child over the age of one year may have a teaspoon of honey to help with a nighttime cough. There are several products on the market and it seems that any type of honey will help your child feel better. 

You can also place a cool mist humidifier in your child’s room at night to add some moisture to the air.  Dry heat can only irritate your child’s airways. 

I know, I sound like a broken record, but many of the viral illnesses going around right now are best treated with plenty of fluids, rest and time.  And, a little patience goes a long way too. 

I’m Dr. Sue with The Kid’s Doctor helping parents take charge.

Daily Dose

Don't Touch The T-Zone!

A lesson from a 4 year old patient!Well, even though spring is officially here, we are still seeing a lot of coughs, colds and lingering RSV in our community. Thankfully, flu is on the way out!

While I was examining a child with upper respiratory symptoms, I was taught a very clever bit of information.  Mind you, I am always learning from my patients, but this time it was from a very precocious 4 year old little boy. He had been coughing and I noticed that he was coughing into his hand. I told him that another way to cover his cough would be to cough into his elbow. While we were talking about the benefits of this form of cough hygiene, I demonstrated how to do this. He listened attentively and covered his next cough with his elbow. Quick study and a good listener! After finishing examining him, I was talking to his mother about her child’s illness.  The little boy interrupted and said, “Dr. Sue, I have something to teach you too”.  “You need to tell everyone not to touch the T-Zone”. Now I am used to talking to teens about the T-Zone and acne, but why would this 4 year old know about the T-Zone?  Well, he quickly told me “you should not touch your eyes, nose or mouth; this is the T-Zone”. If you touch the T-Zone, you might get germs and then get sick”.  What a clever way to teach a child about keeping their hands off of their faces!  It was one of those “ah-ha” moments for me. So now, not only do I talk about coughing into your elbow, I have added don’t touch the T-Zone to my “shtick” about preventing colds and coughs. Out of the mouth of babes! Do you have any clever tricks you talk about with your kids?  Share with us! I would love to pass it on.


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