Croup 2022

 

Croup

Croup is making the rounds.  The official name is Laryngotracheitis. For obvious reasons most people simply refer to it as Croup. Much of the time Croup is viral rather than bacterial; antibiotics are not an appropriate treatment. This illness causes inflammation in the upper airway. The air passages in the throat narrow due to the swelling. This often leads to breathing that is noisy and sometimes labored. Croup is so common that it was actually one of the first illnesses that I addressed in a blog post many years ago. It tends to afflict patients between the ages of 6 months - 6 years, but anyone can get it. Many seasonal viruses can lead to infections in the respiratory tract such as Croup. The most familiar ones include RSV and parainfluenza. Now it seems that the Omicron variant of Covid-19, is on that list. Omicron settles higher up in the respiratory tract rather than deep in the lungs, so that makes sense. Having Covid involvement does not impact the treatment. Take comfort in the fact that doctors are quite familiar with this and know what to do! Croup is quite contagious. Usually kids will start showing some symptoms within a day or two after the exposure. Some children who get exposed to this virus will end up with the symptoms of the common cold. Others get the classic croupy cough. (Think Darth Vader) There are actually two distinct presentations. Many patients will start off with a cold, sore throat, hoarse voice and mild fever. This progresses to the deep barky cough. Most kids are sick for 4 - 7 days. It is normal for the cough to linger for a week or so even when they are otherwise on the mend. Others have acute spasmodic croup. With this, it is typical for the symptoms to start without warning in the middle of the night. Your child may have seemed fine when they went to sleep but then they wake up in the wee hours sounding like a seal. This can freak out a lot of even the most hardy parents. Your job is to keep your cool and do your best to keep your child from getting any more agitated. Head into the bathroom and run a hot shower. Sit there in a steamy room (you don't need to be in the actual shower) and sing in a soft voice. See if you can get them calm. It is time to head to the emergency room if your child is excessively drooling and has a tough time swallowing, seems agitated, or breathing is getting more labored or is showing signs of “stridor” at rest (when not agitated or crying). More than half of the time, your child will be dramatically better by the time you get to the ER. Somehow getting out in the night air is quite helpful. The spasmodic type of croup usually lasts about three days. The kids seem to be almost normal during the day but the cough comes back at night. Take a deep breath, the first night is usually the worst. Running a humidifier during the night is often very helpful. If you are nerdy enough to have a hygrometer, 50% humidity is the sweet spot. For mild cases rest, steam and fluids will get you through. For more severe cases your child will likely get a dose of steroids that will calm things down. Dr. Ted’s Tidbits Croup can be really overwhelming for my patients. As soon as they hear a barky cough, they’re sprinting to the doctor’s office.  The barky cough just tells me that there is swelling in the larynx and trachea, which is almost always due to one of a multitude of viruses. That in and of itself, does not always need treatment, but you can call your doctor to ask what they think. I’m the most curious about stridor, the high pitched noise that can be heard when breathing in. I recommend looking up stridor on youtube videos. This happens when the swollen tissue collapses inward during inspiration, and always needs a call to the doctor.

Keep a Journal 2022

 

Keep a Journal

It’s the first week of the New Year. This is often the time when people find themselves making all sorts of plans for how to generally improve aspects of daily life. And then there are most parents who don’t want to hear about resolutions. Getting through the day intact is a win. Having five minutes of privacy when you poop would be an even bigger win (dream on). I hear you. All those grandiose plans about cutting down on sugar and screen time don’t end up lasting all that long anyway. But for any of you who are feeling ambitious, I have a suggestion for one resolution that is fairly easy to keep. This will be useful and has the potential to bring plenty of smiles in the years ahead. Start keeping a journal! Sure, we all take a lot of photos and movies these days, but there is nothing like the written word. If you haven’t done it from the beginning, it is never too late to start. Having things written down can be a valuable resource. I am not advocating keeping a list of every time your child pees (yes there are parents who do that; you know who you are) but knowing how often your child has had strep throat, an ear infection or any significant illness can be quite handy. Especially if you have more than one child, it is often easy to get things mixed up. I have had more than one patient who has said, “I know one of my kids got a rash on Amoxicillin, I am just not sure which one.” I actually started keeping a general journal when I found out that I was pregnant for the first time. Clearly you don’t need to write things daily, but keeping track of milestones and fun things that kids come up with can create a wonderful database of stuff that you are sure to refer to and enjoy as your children grow. My journal unfortunately does have some huge gaps, when I never got to it; just do the best you can. Keeping record of milestones and illnesses alone makes keeping a journal worth the effort, but immortalizing memories and anecdotes is what makes it fun and even more valuable. We have tracked all kinds of odd statistics. My daughter Lauren has been on 428 flights. My youngest daughter Alana has been on 287. Two of Lauren’s flights were skydiving expeditions and both of my girls have managed to be at the controls flying a private plane. (This mom knows how to feel somewhat proud and somewhat horrified at the same moment.) Yes of course we are tracking my grandson Elliot who is already up to 9 flights! If you give me a moment I can also retrieve all sorts of random facts, like the first movie they ever saw in a movie theater and when they lost their first tooth. Is there something fun about the milestone? Write it down!  For Elliot, I was lucky enough to be with him when he crawled for the first time. He didn’t seem all that interested in getting from point A to point B and Lauren had just invested in a little crawling ‘master class’ from a physical therapist that she follows on instagram. As those things go, buying it was the only thing necessary, because the crawling happened before she had a chance to even look at it. We were playing in their living room when the baby spotted a small but nasty little piece of a chewed up dog toy a few yards away from him. You could almost see his little brain working as he locked on that target and off he went. He never looked back, and as is often the case, most of his early destinations were not towards the little toys that we would shake enticingly. But let him spot a little piece of fuzz, and he was off on a mission. What started out as my personal musings written in a notebook, morphed into a family journal when I transferred it to a word document. If you like you can create a shared document that both parents can add to. Google drive worked for us, but there are tons of apps out there that would do just as well. (Make sure you backup any important documents!) In our journal (both kids share the same one) daddy’s voice was written in italics. My husband Sandy had the wonderful habit of documenting conversations. The following was from when Alana was seven and daddy was picking her up from school: Alana: I'm doing a picture in reds and pinks. Sandy: Why? Alana: Because Van Gogh had a red period. Sandy: You're learning about Van Gogh? Alana: Yeah. And then I'm going to do a painting in different shades of blue. Sandy: Why Alana: Because Van Gogh also had a blue period. Sandy: Well that's terrific. Alana: And Miss Price is going to bring a real artist to class so he can teach us. Sandy: Well that will be very exciting. Alana: But it won't be Van Gogh because he's dead! In our case I am delighted that we were able to track early milestones like first words and motor skills. Over the years random facts like teachers names, the revolving door of boyfriends and life events have all been documented. One of my favorite posts recounts about the time that 5 year old Lauren and I took a family ceramics class at the local Randall museum. At the start of the first class, the instructor had everyone get a feel for the clay. We stretched and pulled it into all sorts of shapes. As we played, the teacher asked ”Who knows where clay comes from?” Lauren was never shy. Without missing a beat, she called out the answer in a loud, authoritative voice. “Cows! Clay comes from cows!” There was a moment of stunned silence as all the grown ups at the table did our very best not to break out in laughter. “Hmmm”, said the teacher, handling it very nicely. “Great guess, but it actually comes from the earth.” Cows?? I remember that being one of the hardest giggles I ever had to stifle. Laughing in the face of my five year old was not something I wanted to do. Kids do come up with some wonderful stuff. Another one that became part of family lore was the time that 3 year old Alana bit her sister: Mommy: “Alana, why did you bite your sister?! You know you shouldn’t bite!” Alana: “I forgot not to.”  That “I forgot not to” line still comes up every once in a while. When does it stop?? My kids say never. They especially insist that I keep up with their flight tallies! (We still count every take off.) You might be dealing with any of the more challenging aspects of parenting like sleep deprivation, the “terrible twos” or teens that are giving you a run for your money. Warning - time zips by. Blink and they are out of the nest. Carpe Diem! The online journal is a great way to capture moments forever. Grandparents might want to start their own version. A new friend that I met on my recent trip recounted an experience. Her twin grandsons were visiting. Clearly she wasn't in the habit of locking the bathroom door. One of her 5 year old grandsons showed up in her bathroom while she was in the shower. He was wearing a hat and carrying a fishing pole: “Grandma, You need to stay where you are for a bit. There is a triceratop in your bedroom, but don’t worry about it, I’ve got this.” Capture your moments!!