A single dose of a steroid can quiet the barking cough of croup and let children and parents get some sleep, Canadian doctors report.
One dose was known to help children with moderate to serious croup, but doctors did not know if it would be worth using the drug for mild symptoms that would go away in three days anyway.
"We're recommending, basically, that all kids with croup are treated,'' said Dr. David W. Johnson, the University of Calgary pediatrician who led the study for the Pediatric Emergency Research Canada Network.
That is a bit strong, said Dr. Bob Frenck, a professor of pediatrics at UCLA and a member of the American Academy of Pediatrics' national committee on infectious disease.
Emphasizing that he was not speaking for the academy, he said the study shows the drug is worth considering because it is simple, inexpensive and effective - but it does not show it should always be used.
About 275,000 U.S. children under 6 get croup each year. Inflammation, usually caused by a virus, swells the windpipe, sometimes so much that breathing is difficult.
But as many as 89 percent of all patients - and at least 60 percent of those taken to emergency rooms - have mild symptoms. Many are sent home without treatment.
Johnson's study, published in Thursday's New England Journal of Medicine, found that the steroid cut repeat doctor's visits in half, more than offsetting its cost.
In addition, parents averaged almost two hours more sleep on the first and worst night of croup.
Dr. Perri Klass, an associate professor of pediatrics at Boston University School of Medicine, said doctors tend to talk about mild croup as if it were nothing to worry about.
"But speaking as a pediatrician who's been on the phone with a lot of parents late at night and as a parent of three children, these `minor childhood illnesses' can be devastating for the whole family,'' she said.
Until now, she said, she has been able to suggest only that parents take their child to the ER if they hear the whistling breaths that mean danger, and otherwise take the youngster into a steamy bathroom.
Now, she said, she can tell them that if they want to go to the emergency room, there is something that could make a difference.