WEDNESDAY, Sept. 22, 2004 (HealthDayNews) -- It's the middle of the night and your child, who's been sick with a cold, is making the strangest noises you've ever heard; it almost sounds like a seal barking.
That sound is the hallmark of croup, a catchall term used to describe common symptoms that can occur with a number of respiratory viruses.
And a new study finds that treating mild cases of the disease with the steroid dexamethasone offers some benefits.
Most cases of croup are mild, and get better on their own in a couple of days. But, that's little comfort to a parent who's been up for hours in the middle of the night with a constantly coughing child.
That's why Canadian researchers conducted a trial to see if treatment with dexamethasone could help children with mild cases of croup.
They found that a one-time oral dose of dexamethasone, which is used to treat more severe cases of the croup, showed "small, but important clinical and economic benefits."
"Both as a primary-care physician and as a mother, I was glad to see someone looking seriously at the milder form of the disease," said Dr. Perri Klass, who wrote an editorial accompanying the study in the Sept. 23 issue of the New England Journal of Medicine. She is an associate professor of pediatrics at Boston University School of Medicine.
"Often we don't seriously think about the stress and anxiety of the mild forms of the disease," she said. "Before you think about using some kind of intervention, you need to know if it will make a measurable difference."
While croup is possible any time during the year, according to the National Institutes of Health, the disorder is most common in the northern hemisphere October through March. Children between 3 months and 5 years old tend to be the ones most affected, and some children have it more than once in any given year.
In the new study, the researchers treated 720 children who had mild croup with either a single dose of dexamethasone or a placebo. The children were recruited from four different pediatric hospitals across Canada.
Doctors grade croup on a scale from zero to 17, and to be eligible for the study children had to have a score of less than two, the researchers said.
The researchers followed the children to see if they had to return to their health-care provider for additional treatment, and also assessed symptoms on days one, two and three after treatment. They also calculated economic costs, parental stress and the number of hours of sleep lost by the child.
Fifteen percent of the untreated group had to return to their doctor for follow-up care within seven days, while only 7.3 percent of the treated group needed additional care.
The researchers also calculated economic costs to society (Canada has government-sponsored health care), and found treatment saved an average of $21 per child.
Children who were treated with dexamethasone lost slightly less sleep than those who didn't receive medication, and their parents reported slightly less stress.
Dr. Frank McGeorge, program director for emergency medicine at Beaumont Hospital in Royal Oak, Mich., said the cases in the study were very, very mild cases of croup. "The question is whether or not this is even a disease that needs to be treated at all. You're talking about a group that most pediatricians would consider not at a particular risk of worsening, and would be highly likely to improve if left alone," he said.
McGeorge pointed out, however, that giving a dose of dexamethasone for croup is already fairly standard practice in emergency medicine.
"If they're sick enough to show up in the ER, their illness is probably severe enough that treatment will be of benefit," McGeorge said. He added that while this study probably won't change his practice much, it might make him consider giving a dose of dexamethasone in milder cases.
Because it's just a one-time dose, neither Klass nor McGeorge expressed concern about side effects from the medication. But both pointed out, as do the authors of the study, that no long-term studies have been done to see if there are any long-term effects.
If you're worried about your child's cough or concerned about his or her breathing, Klass added, "I don't think you can say this too many times -- anything that seems to be compromising a child's airway is extremely serious and should be watched. It's never a bad idea to check in with your doctor if you're worried about a young child's breathing."
More information
To learn more about croup, visit the National Library of Medicine.
