Wednesday, May 23, 2007

Croup: My Child has a Very Bad Cough!

This is a common scenario in kids suffering from Croup:

Parents bring their young child into the clinic clearly very distressed (both parents and child). The child is breathing noisily and has a cough that sounds like a seal barking. Everyone is very stressed except for the Doctor because he thinks to himself: "Ah, Croup! Now I can do some magic and make myself look like a hero!"

The Doctor quickly examines the child to assess the severity of the Croup and determines that it is not severe enough to require immediate admission. He then goes to the dispensary and reappears with a dispensing cup of "magic potion". The parents then hastily force the child to drink the yucky powdery medicine to which the child protests vehemently with even louder "Barks".

The Doctor then asks the patients to bring the child out of the clinic for a while so that the other patients in the waiting room can have some peace and quiet.

An hour or two later, the parents return into the consultation room obviously relieved. The "magic potion" worked its miracle. The child is now sleeping peacefully, the noisy breathing has stopped and the child no longer coughs as severely. The parents are so appreciative and thank the doctor and nurses profusely for their help. The Doctor thinks to himself: "Gee, I love my job!"

Now this of course is a case of mild Croup and it is a common scenario that we see in the clinic. Sometimes Croup can be very severe and even fatal. So it is important to have your child checked by your Doctor who will determine if the child needs to be admitted to hospital. If you are in any doubt, just bring the child to Accident and Emergency.

What is Croup?

Croup is a common viral infection of the upper airways. The virus affects the windpipe (trachea) and the voicebox (larynx) causing inflammation and narrowing of the airways, and hence difficulty breathing.

It usually occurs in young children between 6 months to 3 years of age, but it can affect kids up to 6 years old.

Symptoms of Croup.

The child may start by having a runny nose and fever and then progress to have noisy breathing, hoarse voice and a loud barking cough. It is important that parent recognize when croup becomes an emergency. This is when the child looks very sick (toxic) and tired and is having very noisy breathing (stridor) at rest. Another sign that it is very serious is when you look at the chest and you can see the ribs prominently when the child is breathing in (retractions). These are signs that you need to seek medical attention straightaway.

What usually happens in cases of mild Croup?

Mild Croup can be treated without hospital admission. The illness may last around 5 days with the first 2 days being the worse. The child does not need antibiotics since it is a viral infection.

Can Croup be dangerous?

Severe croup can be rapidly fatal as the passage of air in the voice box and larynx get so narrow that the flow of air into the lungs is severely limited. The child will need to be treated immediately with a procedure to put an airway tube into the throat so as to ensure that air can get into the lungs.

What to do?

In the Singapore context where clinics are readily available, it is best to just bring your child to your family doctor if you suspect your child is having Croup. If it is severe, bring the child straightaway to KK Children's emergency. However, if it is a mild case, Croup can be treated at the clinic. The doctor can give a immediate dose of steroids which can have amazing results. The child may improve markedly within 1 to 2 hours after giving the medication and can then be looked after at home. However it is important to note that the child should be observed closely over the next few hours to make sure the condition does not start deteriorating again.

The doctor may prescribe some fever medication and simple cough and cold syrups for the child. It is also useful to prop the child up and help the child relax by watching some TV or reading a book. Moist air can also be useful. You can do this by turning on the hot shower in the toilet for a while before giving your child a bath or by using a humidifier.


Croup is a common illness affecting younger children. It is usually mild and can be treated at home with the help of your family doctor. However, there are some instances where Croup can be so severe that the child will need to be admitted to hospital. So it is important for parents to be able to recognize severe Croup and seek medical attention immediately.

More information can be found here


Murtagh, John 2004, Patient Education, McGraw Hill Australia 4th Ed

Tuesday, May 15, 2007

When is a Flu not a Flu?

A Flu is not a Flu when it is just a Cold.

Lately there seem to be an increase in patients coming into the clinic complaining of "Flu". But what the layperson calls "Flu" and what the Doctor considers "Flu" is quite different.

When the Doctor says you have got a "Flu", we mean that you have a condition known as Influenza. Influenza is a condition that is caused by the Influenza virus. There are lots of viruses and bacteria that cause people to have fevers and runny noses. So how does the Doctor know if the condition you have is Influenza or just a normal cold?

The truth of the matter is that the Doctor cannot be 100% sure. But we can look at the signs and symptoms and make a "best guess". The only way to confirm that you have the Influenza virus is to do a lab test.

However you can tell the difference between a "Flu" and a "Cold" by noting the different characteristics:

We all get cough and colds round the year. But occasionally, you get a bout that is so bad you feel as if you have been sat on by a Sumo Wrestler. Your bones and joints are all aching and your fever rises faster than the housing prices. When you feel like this, you might well be suffering a real "Flu".

If you are having a "Flu", you will be infectious to others a day before the onset of the symptoms and throughout the period when you are suffering from the illness. You might also feel very lethargic for up to 10 days. The Influenza virus spreads through droplets. So everytime you sneeze and cough you are helping to spread the virus around.

What you can do:
  • Visit your Doctor and make sure you get an accurate diagnosis. It could be other things like bacterial pharyngitis which can be treated with antibiotics.
  • Make sure you isolate yourself from other people so you don't spread the virus.
  • Take lots of fluids and rest in bed as much as you can.
  • There is a new medication called Tamiflu which may be prescribed depending on the patients' needs.
  • Avoid getting the flu by vaccination. This vaccination is currently recommended for young children with chronic diseases like asthma, the elderly, pregnant mothers or if you are going to be in a situation where there is a high chance that you get the Flu.
More information on the Flu can be found by clicking here

Friday, May 04, 2007

Ear Wax and Cotton Buds

My son used to be quite restless and active in kindergarten. One day teacher began to complain that he doesn't seem to want to listen to instructions in class. They suspect that he was just being naughty and rebellious. I knew my son was active, but he is usually a very obedient boy, so I wondered if there was anything wrong with his ears. When I examined his ear, lo and behold, it was chock full of ear wax! After I syringed out the ear wax, the teachers stop complaining that he was not listening to instructions in class.

Impacted ear wax is one of the commonest cause of temporary deafness both in adults and children. Our ear produces wax to protect the ear canal and to give it a waterproof coating. But sometimes for some reason, there is a build up of ear wax which causes symptoms of deafness, itching, earache and sometimes even infections.

The usage of cotton buds to clean the ear is a common practice globally. It is one of the common causes of impacted ear wax. The tip of the cotton bud acts like a ram rod and pushes the wax deeper into the ear canal while it cleans the sides of the ear canal. Everyone knows how satisfying it is to have your ear canals cleaned, which explains why people continue to do it.

I once had a patient with 80% deafness in one ear. On examination, there was a huge plug of wax in the ear and it took me quite a long time to extract all of it. What I managed to extract will give you goose bumps. It was a piece of waxy, mouldy cotton bud tip which had been lying in the ear for who knows how long!

So please be advised not to put anything smaller than your elbow in your ear!

What you can do:
  • Use ear drops to soften the wax
  • Avoid using cotton buds
  • When using a hair dryer, avoid blowing the warm air into the ear as it may cause the wax to harden
  • Do not try to use a pair of tweezers or any instruments to dig out the wax as you may accidentally perforate the ear drum
  • Do not try to syringe out the ear wax yourself, as it there might be a middle ear infection so you might accidentally cause a perforation of the ear drum.
  • Visit your doctor if you suspect that there is a lot of wax built up in the ear
The ear has a self cleaning mechanism by which the wax that is produced is removed naturally. So you don't really need to do anything to remove the wax yourself. However, sometimes, it does build up due to various reasons. When that happens, you are advised to visit your doctor.

A Word on Ear Candling

This is quite popular nowadays and I guess it can be quite soothing to undergo the procedure. There has been a few reported cases of injuries caused by ear candling that you should be aware of. To read more about Ear Candling, please click here.