Dr. Hive - Baby with bronchitis

[carriede]

Just got back from the pediatrician for my 6 month old. He's been stuffy and sneezy all week with a mild fever and woke up with a cough this morning.

 

The doctor identified the croup cough and diagnosed him with bronchitis. Tested negative for strep, no other infections.

 

My question is about treatment. No bacteria was confirmed, but she wrote a script for antibiotics - I will not fill this unless he does not get better. She also wrote a script for a decongestant, which is what I was hoping for.

 

She ALSO wrote a script for prednisone, which I am completely unfamiliar with despite this being my 4th kid. DS is breathing fine (minus the stuffy nose), so I'm hesitatant give a 6 month old a steroid for a mild symptom - especially since I expect the decongestant to help clear things up.

 

So, my question: is prednisone needed to treat the bronchitis? Like I said, he has no trouble breathing, but he does have a mild, infrequent croup cough.

 

What's y'alls experience with steroids and babies and bronchitis? Given that doctor prescribed antibiotics in this instance makes me question the other treatment methods.

 

Thanks!

[prairiewindmomma]

My experience has been the whole range of mild cold to hospitalized on oxygen with RSV-like virus.  

 

My thoughts:

1. I'm not super wild about the idea of antibiotics being given without evidence of a bacterial infection---high fever & chills, ear infection that's not resolving, etc.

2. Decongestants typically don't work well with babies. Saline spray & suctioning in the nose, yes.  Decongestant, no.

3. If dr. hears a crackle or there's evidence of wheezing or other breathing difficulty, albuterol through a nebulizer is usually the first step. If baby is not resolving issues with just albuterol, THEN prednisone is given.

 

I'm not a MD or other health care professional.  I'm not sure what your dr. saw and heard today. S/he may have detected a secondary upper respiratory infection happening after several days of the primary virus.  Honestly, the abx rx freaks me out more than the prednisone one.

[wapiti]

I assume the prednisone would be in case stridor develops, as that might happen in the middle of the night.  Alternatively, prednisone would be helpful for wheezing.  It does not sound like that is involved here though.  Personally, I am reluctant to give steroids unless the inflammatory response is impacting breathing, such as with wheezing or stridor, as prednisone may impact the immune system's response to the germ.  (We've done many rounds of steroids here and four of my six kids have had hospitalizations for breathing issues needing oxygen, two of them while babies.)  ETA, what prairiewindmomma said - albuterol via nebulizer would be the first line therapy for a baby wheezing.

 

AFAIK, typically croup is viral, so I'm not sure I understand the antibiotic prescription unless there were more of a bronchiolitis/wheezing/pneumonia type of concern though that isn't what you've described.  I agree w/prairiewindmomma that I would not give antibiotics lightly as the immune system in the gut is still in rapid development at that age.  (I did have a kiddo on antibiotics for his entire first year of life.  He has other health complications and now, at 13, also an immune deficiency.)

 

ETA, that's a lot of prescriptions.  Maybe the doc's concerns weren't well-communicated?

 

We were always told that water is the best decongestant, though with a baby that young, I guess I'd just encourage lots of feeding rather than water.

Edited September 9, 2016 by wapiti

[DesertBlossom]

My 3 yo had bronchitis when she was about 4-6 months old. What concerned me is that it would not go away. She is #5 and illnesses don't worry me like they used to. But I was concerned about how long it lasted. I hate to use abx if I don't have to, but they gave her a rx for one and she got better very quickly afterwards.

 

A couple months ago my baby was really croupy and having a hard time breathing one night. I took him to urgent care rhe next day to get prednisone because my experience was that nights are always the worst and even though we made through one bad night, I didn't want another bad night. I only gave him one dose of the steroids that night just in case and he was fine.

 

I don't know that prednisone would be helpful for bronchitis. But I could be mistaken about that.

Edited September 9, 2016 by DesertBlossom

[DesertBlossom]

The first thing I usually do it use some kind of "breathe" essential oil blend. Right now I have Eden's Garden brand Breathe Easy. I mix it with coconut oil and rub it on chest and feet.

[carriede]

My experience has been the whole range of mild cold to hospitalized on oxygen with RSV-like virus.

 

My thoughts:

1. I'm not super wild about the idea of antibiotics being given without evidence of a bacterial infection---high fever & chills, ear infection that's not resolving, etc.

2. Decongestants typically don't work well with babies. Saline spray & suctioning in the nose, yes. Decongestant, no.

3. If dr. hears a crackle or there's evidence of wheezing or other breathing difficulty, albuterol through a nebulizer is usually the first step. If baby is not resolving issues with just albuterol, THEN prednisone is given.

 

I'm not a MD or other health care professional. I'm not sure what your dr. saw and heard today. S/he may have detected a secondary upper respiratory infection happening after several days of the primary virus. Honestly, the abx rx freaks me out more than the prednisone one.

Pretty sure she didn't mention albterol - I wish I had known more to ask now. :/ She did say she heard a cackle on the stethoscope, but I can't hear it with just ears, so no audible wheezing. Knowing there's a "first step" to try be for prednisone makes me more weary to use it.

 

She sent in scripts directly to the pharmacy, so I'm not sure exactly what's there. I'll call to double check.

 

I am not planning on giving the antibiotics unless something changes.

Edited September 9, 2016 by carriede

[wapiti]

It's hard to know without talking to the doc, but to me a reference to a cackle (might she have said crackle?) sounds more like a concern about pneumonia than a concern about wheezing.  If that was the doc's concern, then I wouldn't hesitate to give the antibiotic.

[carriede]

I assume the prednisone would be in case stridor develops, as that might happen in the middle of the night. Alternatively, prednisone would be helpful for wheezing. It does not sound like that is involved here though. Personally, I am reluctant to give steroids unless the inflammatory response is impacting breathing, such as with wheezing or stridor, as prednisone may impact the immune system's response to the germ. (We've done many rounds of steroids here and four of my six kids have had hospitalizations for breathing issues needing oxygen, two of them while babies.) ETA, what prairiewindmomma said - albuterol via nebulizer would be the first line therapy for a baby wheezing.

 

AFAIK, typically croup is viral, so I'm not sure I understand the antibiotic prescription unless there were more of a bronchiolitis/wheezing/pneumonia type of concern though that isn't what you've described. I agree w/prairiewindmomma that I would not give antibiotics lightly as the immune system in the gut is still in rapid development at that age. (I did have a kiddo on antibiotics for his entire first year of life. He has other health complications and now, at 13, also an immune deficiency.)

 

ETA, that's a lot of prescriptions. Maybe the doc's concerns weren't well-communicated?

 

We were always told that water is the best decongestant, though with a baby that young, I guess I'd just encourage lots of feeding rather than water.

Your thinking is similar to mine on all counts. Wish I had know more to ask about the albuterol...

[carriede]

My 3 yo had bronchitis when she was about 4-6 months old. What concerned me is that it would not go away. She is #5 and illnesses don't worry me like they used to. But I was concerned about how long it lasted. I hate to use abx if I don't have to, but they gave her a rx for one and she got better very quickly afterwards.

 

A couple months ago my baby was really croupy and having a hard time breathing one night. I took him to urgent care rhe next day to get prednisone because my experience was that nights are always the worst and even though we made through one bad night, I didn't want another bad night. I only gave him one dose of the steroids that night just in case and he was fine.

 

I don't know that prednisone would be helpful for bronchitis. But I could be mistaken about that.

So one can just take prednisone as needed? I'm so used to dealing with antibiotics that that hadn't occurred to me.

[carriede]

It's hard to know without talking to the doc, but to me a reference to a cackle (might she have said crackle?) sounds more like a concern about pneumonia than a concern about wheezing. If that was the doc's concern, then I wouldn't hesitate to give the antibiotic.

She made no mention of pneumonia at all.

[wapiti]

Your thinking is similar to mine on all counts. Wish I had know more to ask about the albuterol...

 

I wouldn't second-guess your doc on this.  Typically, if there is wheezing enough for albuterol to be prescribed, the ped's office will do a first treatment right then and there, before you leave, so they can listen afterward to see if it helped.  That's why I'm kind of assuming your doc did not hear wheezing.  The cackle reference makes me think the doc was concerned about the baby having/developing pneumonia.  (Though our ped would usually order a chest x-ray, I'm not sure all docs do if they're planning to go ahead and rx regardless of what an x-ray might show.  Be thankful; a chest x-ray in a baby that small can be unpleasant.)

[carriede]

Called the pharmacy, this is what they have ready:

 

Azithromycin

Again, never heard of this antibiotic - he's only 6 mo, what happened to Ammoxocillian first?

 

Prelone

 

NoHist DM

 

Thoughts? Do decongestants just "not work" or is there a negative to trying it?

 

Thanks for all the help, I'm not usually so uppity about meds. Then again I don't usually give my babies unknown antibiotics for bronchitis either...

[Momto6inIN]

I've had kids with croup lots of times, some kids have airways shaped such that they get it frequently and some don't. 4 of mine have been susceptible to it and had it frequently, the other 1 has never had it even once. I'd much rather give them prednisone than have an emergency trip to the ER in the middle of the night because they can't breathe. Like literally gasping for air and you're freaking out. That's happened twice to us, and I wouldn't wish it on anyone. It almost always gets worse at night, even if they seem like it's a minor cold during the day. Prednisone is not fun, don't get me wrong ... the side effects make them cranky and unable to sleep well. But a gasping baby is worse, IMO.

[AmandaVT]

Called the pharmacy, this is what they have ready:

 

Azithromycin

Again, never heard of this antibiotic - he's only 6 mo, what happened to Ammoxocillian first?

 

Prelone

 

NoHist DM

 

Thoughts? Do decongestants just "not work" or is there a negative to trying it?

 

Thanks for all the help, I'm not usually so uppity about meds. Then again I don't usually give my babies unknown antibiotics for bronchitis either...

 

Can you call the office back? Our pedi is really good about taking our calls or calling us back if we have any questions after a visit. Now that you've had time to think about it, ask your follow up questions so you can get a handle on his thought process. 

 

I hope the baby feels better soon!!

[ktgrok]

Steroids are a typical treatment for croup. It sounds like that's what it was prescribed for. If the cough sounds croupy that means there is inflammation in the larynx area, and if that gets worse it can stop breathing. And it happens FAST. You can always call the doctor and ask for clarification as to why those choices of medications. 

 

 

[ktgrok]

This article may help, it shows that steroids in mild croup keep it from progressing to more serious illness. And because steroids can suppress the immune system and let bacteria flourish, that may be why the antibiotics: http://www.webmd.com/children/news/20040922/steroid-calms-kids-with-mild-croup#1

Edited September 9, 2016 by ktgrok

[carriede]

This article may help, it shows that steroids in mild croup keep it from progressing to more serious illness. And because steroids can suppress the immune system and let bacteria flourish, that may be why the antibiotics: http://www.webmd.com/children/news/20040922/steroid-calms-kids-with-mild-croup#1

That makes sense! Thanks so much.

[Rebecca]

Azithromycin is what was prescribed to my kids last year for pneumonia. We had multiple bouts. Prelone is the steroid. I would call back and get clarification on why things were prescribed.

[trulycrabby]

If you are familiar with this doc and trust her competence, then I would take the meds as prescribed.

 

I hope your precious little one gets better very soon!

[Catalytic]

Azithromycin is Zithromax, and while a tough antibiotic, I prefer it to anything else for littles because it's only 5 doses.  I personally don't play around when it comes to breathing (and I despise over-using antibiotics and antibacterials because of the superbugs we have created), so I would use the meds as directed, EXCEPT the decongestant.  As said upthread, they don't work well for young kids/babies, and you can usually get better results with saline.

[Jann in TX]

About the wheezing/crackling...

 

My middle dd had RSV when she was 8 weeks old-- when she was 6 months old she had symptoms like the OP's baby.  The Dr diagnosed bronchitis due to wheezing/crackling-- ('I' could hear nothing with my ears BTW).  Later a nurse friend told me that without x-rays the Dr could not dx pneumonia.

 

In very young children (under 2 yrs), if you can hear wheezing with your ears things are BAD.  Like another poster said-- things can get worse very quickly (and often late at night).

 

 

[TranquilMind]

I had it when I gave birth and my baby became ill right away. She got some liquid drops. I let her sleep propped in the baby seat and it passed in a few days.