Croup

Cool mist will help your child’s croup

When babies get croup, they have a terrible, barking cough and can get to a point where they have a lot of trouble breathing. Pediatricians will usually recommend that parents put these babies in a humid place, like the bathroom with the shower running, in order to help with the cough and breathing difficulties. Doctors will also sometimes use special plastic tents with humidified air or humidified breathing treatments when croup sends a baby to the hospital. Parents may even start using humidifiers in order to prevent babies from having these problems. If you ask most doctors, they would say that humidified mist will help your child’s croup. Doctors have used mist like this since the nineteenth century, when physicians felt that the steam from teapots and hot tubs alleviated croup symptoms.

Pediatricians and parents alike may be surprised to learn that there is no evidence to support using humidified air to treat croup. There have only been a few studies looking at this, but none have shown a benefit. A study from 1978 in Britain showed no improvement when using a saline mist (nebulized saline) for children with croup. Another study, done in Australia in 1984, randomized children with croup to either a normal environment or to an enclosed cot where they were surrounded by cool, humid mist. The children were evaluated throughout twelve hours, and there were no differences between the groups in terms of their clinical conditions, vital signs, and the amount of oxygen in their blood. Two subsequent randomized, controlled studies done in Canada showed no evidence that humidity improved croup symptoms of children in the emergency department. A study of dogs showed that airway resistance (which is higher than it should be when a child has croup) actually got better with dry air than with moist air. In fact, both cool dry air and hot dry air created lower airway resistance than cool moist air or hot moist air. A meta-analysis that searched for all of the available studies testing humidified air for croup in children, found that the combined studies did not support using humidified air for croup. It just does not work.

However, we shouldn’t throw out the baby with the bathwater. If sitting with Mom in a bathroom with the shower going makes both Mom and child calmer, then by all means do it. But maybe we should think twice before we advocate holding that mist tube in front of a screaming, thrashing kid in the emergency department, or placing a baby in a croup tent that separates him from loving care.