Sept. 22, 2004 -- As any parent who's been through it knows, croup can be a terrifying experience. The unmistakable barking cough that keeps everyone up all night usually resolves and rarely leads to severe problems, but try telling that to a parent trying to calm an inconsolable baby or young child in the wee hours.
Steroids are an effective treatment for kids with moderate to severe croup and have been shown to reduce the need to put these children on breathing machines. Now, new research shows that steroids can also be used in mild cases of croup.
For children with mild croup, treatment with the steroid dexamethasone shortened the duration of the disease and reduced the need for follow-up medical care in a study reported by researchers from the University of Calgary.
The findings are published in the Sept. 23 issue of The New England Journal of Medicine.
"This is an effective treatment without apparent side effects that can shorten the duration and severity of croup in children with mild symptoms," researcher David W. Johnson, MD, tells WebMD. "The evidence is unequivocal that children with croup can benefit from treatment with steroids regardless of the severity of their symptoms."
Most Cases Mild
Each year, approximately 3% of children under the age of 6 develop croup, a condition in which the airways become inflamed, leading to a characteristic seal-like barking cough. Because the coughing usually begins in the middle of the night, many kids with croup end up in hospital emergency departments even though the majority will not develop serious respiratory problems.
Children with mild symptoms and no evidence of respiratory distress are often sent home from the emergency department.
Only a few studies have evaluated steroid treatment in this group of patients, but the findings have been far from conclusive.
In this study Johnson and colleagues evaluated outcomes in 720 children with mild croup seen in hospital ERs, half of whom were treated with a single dose of dexamethasone and the other half with placebo.
Compared with kids in the placebo group of the study, half as many children treated with the steroid needed follow-up medical care and half as many still had croup symptoms 24 hours after treatment. In addition, the average amount of sleep loss, because of cough, was reduced by 30% in the steroid treated group, and the amount of stress experienced by the primary parent caregiver was also reduced.
"Oral dexamethasone therapy is simple, inexpensive, and effective," the researchers wrote. "Therefore, although the long-term effects are not known, we advocate dexamethasone treatment for essentially all children with croup."
Treatment Appears Safe
In an editorial accompanying the study, Boston pediatrician and professor of pediatrics Perri Klass, MD, writes that the small but important gains seen in the study population represent potentially major differences in the course of a single child's illness.
"A case of croup that is seen by the doctor as reassuringly mild can nevertheless mean sleepless nights, anxiety, and misery for the whole family," she writes. "That's still no reason to offer an intervention that doesn't actually help, but it's an excellent reason to offer one that shortens the illness and helps everyone get a better night's sleep."
In an interview with WebMD, Klass says steroids have been used for years in higher doses to treat children with asthma, but more study is needed to confirm their safety in children with mild croup.
"Mild croup certainly doesn't endanger the child's life, but it is still an illness that results in tremendous concern and misery to the child and the child's family," she says. "Croup is scary looking and scary sounding, and it is very hard for a parent to watch their child suffer with the awful sounding cough. We can now offer them a treatment that has a clear benefit."