Bark

For the last several days, Dane has had another cold. He gets so miserable when he gets congested... his face looks all pouty with his lower lip sticking out and snot hanging from both nostrils right down to the upper lip. After he coughs or sneezes, his perma-pale skin gets all red around the eyes. All together a very sad sight. But it gets worse for the little man. Yesterday, Dane woke up with a really bad cough. His cough sounded a lot like a seal barking...and immediately alarm bells started going off in my head. I have seen too many kids in the hospital with respiratory infections that were allowed to ferment several days too long and ended up being serious. So we bundled Dane up and brought him over the the Dupage Medical Group Urgent Care. Actually, they call it the "Convenient Care," which is a bit of a misnomer, since we sat in a waiting room for almost an hour before we were seen. Is this karma paying me back for me already making my patients wait for me? Anyway, they started taking a look at Dane. I gave them my somewhat-professional opinion: that Dane has croup. The good news was that they hooked Dane up to a pulse oximeter, to measure the oxygen saturation of his blood, and he was ranging between 96-99% (which is great). The urgent care doctor (yes, a Family Medicine doctor, of course :) ) listened to his chest and thought she heard some faint wheezing in his lungs. They gave him a nebulizer treatment to help open his lungs up, which the doctor thought worked well. She said the wheezing was decreased after the breathing treatment. Dane then got a chest x-ray, which was actually really funny (in a poor-Dane way) to see. They put Dane in this contraption that had him sit on a little bike seat and then get squeezed inside a plastic case with his hands above his head, to give the best exposure to his lungs. We really wished we'd brought our camera. (Dane, if you ever read this, we were nicer than some of our posts sound...)

This photo, obviously, is not of Dane, but its the only photo I could find of the x-ray contraption...

Anyway, the chest x-ray came back essentially normal. That is good because it means he doesn't have any pneumonia. After all of this workup, the doctor decided that Dane either had 1) Croup (I almost did the I-told-you-so dance) or 2) bronchiolitis.

A quick explanation, for those of you who care:
1) Croup is characterized by a barking cough. It is often caused by the parainfluenza virus (75% of the time). It is a "diagnosis of exclusion," which means that it is the diagnosis left on the table after you decide it can't be other causes (such as epiglottitis, foreign body aspiration, epiglotic edema, etc...) The barking cough and shortness of breath that infants with croup experience is due not to the infection itself but actually due to the inflammatory response to the infection. Croup is treated in several ways. First, by having the baby inhale humidified air (both by putting a humidifier in their room near the crib...we currently bought a second one and now have 2 humidifiers running in his room...and by bringing the baby into a bathroom filled with steam from a hot shower). Second, more severe croup is treated with corticosteroids to help reduce the inflammation. In our case, Dane was given a prednisolone (steroid) solution that we give him once per day for a total of 5 days, including the dose in the urgent care. Yet more severe cases of croup can require supplemental oxygen, nebulizer treatments, and, infrequently, intubation. In the end, croup is a self-limited disease, meaning that even if we did nothing it would probably go away like any other run of the mill cold...just scarier for us and more unpleasant for him.

2) Bronchiolitis is inflammation of the bronchioles, the smallest airways in the lungs (just before the lungs end up in the alveoli, where gas exchange happens). Again, this inflammation is often caused by a viral infection. While bronchiolitis can be caused by parainfluenza, it is most often caused by RSV (respiratory syncytial virus). The treatment, in reality, is fairly similar for bronchiolitis and croup. Steroids are not needed for true bronchiolitis but are sometimes given because giving them shouldn't hurt and might help reduce some inflammation. The mainstay treatments for bronchiolitis are bronchodilater drugs (albuterol) and antiviral drugs (ribavirin).

After they narrowed down Dane's problem to one of those two, they sent us home with oral steroids to give Dane for 5 days total plus a prescription for a nebulizer if he didn't seem to be getting better. We've been giving him the steroids but haven't needed the nebulizer yet. Larissa took Dane to the pediatrician's office today and she said he was looking pretty good. We're hoping he keeps getting better and that he shakes this cold soon. Keep praying for the little guy. :)