Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilton , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, healthcare and what matters to you. And now here's our host.

Speaker 2: 0:17

Hey everyone. Welcome to Healthy Matters podcast, where we dive into the world of healthcare with experts who live it every day . You've probably figured out by now that I am not Dr. Hilden, he is on a well-deserved vacation. I am Megan McCoy , and I'm a PA in the ear, nose and throat department here at Hennepin Healthcare. I've been on this show before, and so if you go back and listen to episode seven of season two, my voice may sound a little familiar today, we're gonna dive into ear, nose, and throat conditions in children. And we have our guest today, Dr. Krishnan Sub , who's a pediatrician here. He's also the Chief Medical Officer at Hennepin Health. And we're gonna talk about all of the things that go on in kids from snot to strep throat, and we'll dive right into it. So thanks for being here, Dr. Kh . Oh ,

Speaker 3: 1:01

Thanks. Thanks Megan , for having me. Congratulations on your new chair. I plan on subscribing now immediately.

Speaker 2: 1:06

<laugh> . Alright , so let's get into it. Uh, why don't we start with nos . Personally, my favorite. So Dr. K , why do kids have an endless supply of snot? And I have a five-year-old and a two-year-old, and I promise we go through so many tissues. It's really the thing that keeps us at Costco. It's like the number of tissues we go through. So what is up with that? Why? Well,

Speaker 3: 1:30

First, Megan co . Congratulations on your little ones. Second, I, I'm a little nervous. I'm not gonna lie. You know, I deal with noses, ears, and throats a lot, but frankly, you're, you're the expert, right? <laugh> and I , I and I have referred many a patient over the years to, to Megan to get her assistance and her wisdom. So I feel like I'm gonna test here <laugh>. So I'm gonna do my best to , to No , but , but no, I , I hope what , what we can bring today is just some, some practical advice. The things that we're seeing most commonly, things that we're seeing day in, day out, and then hopefully just , uh, some advice that will help calm some nerves. 'cause it's, it's a nerve wracking time for sure. The , the , the winter, the cold season. The viral season. The

Speaker 2: 2:03

Quad demic.

Speaker 3: 2:03

The quad demic. I get, I get questions. It seems like my kids are sick all the time. Right.

Speaker 2: 2:08

And if they're in daycare , they are, they just are. Forget about it . Yeah . Right .

Speaker 3: 2:11

Like , forget about it. You are, they are sick all the time. And, and I think that kind of begins to answer your question, why does it seem like kids have a ton of snot one, it it's because they do , uh, you know, there, there are studies that that show that kids under two years of age in their first year of daycare are getting sick on average about once a month. Yeah. And we'll talk about this a little bit more, but the average sickness is lasting you 10 to 14 days. That means half the time Yep . You are sick. Mm-hmm <affirmative> . And , and most of these sicknesses produce a lot of mucus mm-hmm <affirmative> . You have kids who don't have a really built up immune system. So they're trying to rev up, they're trying to fight these infections. Right. Trying to build a lot of mucus. And then I , I think the other thing that that makes it tough is that, Megan , when you and I get a cold, when we get snot, we have bigger airways, we have bigger noses, we have bigger mouths. And so the mucus, we have more space to put the mucus, whereas when your 2-year-old or my 3-year-old get mucus, it clogs up 50% of their airway. Right.

Speaker 2: 3:04

It's so little.

Speaker 3: 3:05

And it's tough to breathe through a 50% airway. Right. Right . And, and I think that's why it becomes so noticeable to, to families, to parents. And that's why it causes us a lot of grief. Yeah.

Speaker 2: 3:13

Uh, I think you're right. Daycare is just the worst. It's great. We love our daycare providers. I'm so thankful for being able to send my kids to daycare, but it does feel like they're sick all the time. Yeah.

Speaker 3: 3:23

And, and I think a lot of what we have to do is set expectations for families, including ourselves, right? Yeah. To understand Yeah. That, that first year and a half mm-hmm <affirmative> . Is a lot of sickness with great frequency. What you'll notice over as the patterning goes on is that as they build up immunity to these illnesses, starting about year three or four, those kids who have been through daycare have that built up immune system and they actually, you know, you may see sickness actually get less. Yep . And , and so there is a light at the end of the tunnel for sure. The , the light comes along with a lot of good learning about how to eat civilly at a table and how to potty train. Right. Right. There's so there's positive things to be learned. Right. But , uh, yeah, it it's a tough year and a half and we , we parents get to share the germs too, right. Yeah . We get sick too. Yes . And it , and it's, it's hard.

Speaker 2: 4:04

Yeah. I feel like I didn't get sick for decades mm-hmm <affirmative> . Until I had kids. And now , uh, it gets me too . So when you're seeing kids, at what point do you decide, you know what, this is abnormal snot, this is abnormal mucus, this is an atypical number of illnesses or sicknesses, and I think you need to go see ENT . What , what , at what point do you sort of make that decision as a pediatrician? So

Speaker 3: 4:26

I I I think first for us to know that there is this expected 12 to 13 illnesses. Yeah . There's that average of 10 to 14 days mm-hmm <affirmative> . When we start to get worried is when we start to see a few different symptoms. If I see a kid having, you know, fever for that whole prolonged period of time mm-hmm <affirmative> . I'm like, that's not normal. Sure . You know, a few days of fever. Sure. But having that prolonged fever, I , I get a little concerned. I think if the cold is getting worse, like colds should have a couple days of badness and then get better. Yeah. Okay . That , that's the general arc of a , of a cold. Totally. If, if I see it getting actively worse, the fever's now beginning on day six and starting to get worse if, if the mucus production is getting worse, and then if, frankly, if a child is in a lot of pain, right? Mm-hmm <affirmative> . If you're having a lot of pain in your sinus areas, which, and , and we go into that, but like the sinuses are spaces that exist behind your nose, kind of in your face area. If kids are having pain in their face or around those , the nose area Yeah . That's not usual. Sure. And so if I , if I see that progression, I, I start to think, Hmm , does this child have a sinus infection mm-hmm <affirmative> . Do they have something else going on mm-hmm <affirmative> . And then, you know, we may do some conservative management, we may do some antibiotics, and if that's still not getting better, then boy, Megan , we're gonna call you . Yeah.

Speaker 2: 5:36

Great. You know, the other thing I think we'd be remiss if we didn't talk about when it comes to snot and runny noses is , uh, kids who put stuff in their nose, <laugh> is a big part of my practice. And , uh, you know, one of the telltale signs of something stuck in the nose, and, and you as a pediatrician know this, is if you have a kid with snot coming at just one side of the nose and it smells gross mm-hmm <affirmative> . Be super suspicious of something up there.

Speaker 3: 6:04

And , and yeah. That , that, that foreign object book , kids are really good at hiding things. Oh man. And , and the nose is a great place to do that. Mm-hmm <affirmative> . Mm-hmm <affirmative> . Um, so thanks for bringing that up. Yeah. If you're smelling that, that foul smell, sometimes I'll hear parents or or children say, Hey, I have really bad breath. Yes. It , it'll come across as as a bad breath type

Speaker 2: 6:22

Of feeling. Yes . It's also known as halitosis for sure.

Speaker 3: 6:24

And so when that, when that happens and you're having like a lot of mucus production mm-hmm <affirmative> . And it , and it's new mm-hmm <affirmative> . Then , then it's something we should, we should definitely look and, and then frequently we'll ask our ENT uh , colleagues to, to go up there with their fancy tools, Uhhuh, <affirmative> , and , and , and get it out.

Speaker 2: 6:38

Uh, and that is what we do. Yes. And, you know, sometimes we're successful and sometimes it takes a little bit of anesthesia in the operating room to get it out, but always happy to see those kids and that , and that's something that if you're worried something that should be done right away. Absolutely . We don't want that thing sitting in there for a long time. Let's switch gears and move on to ears. If you wanna walk through ear infections, ear canal infections, middle ear infections, and, and how you take care of them. And then at what point you send 'em to ENT,

Speaker 3: 7:04

One of the most common complaints we get is my child's ear is hurting them. They're in pain, they're in discomfort, they're

Speaker 2: 7:11

Pulling at it. Yeah.

Speaker 3: 7:12

It's really common. Mm-hmm <affirmative> . Um, you know , I had the misfortune of having some sort of ear pain infection , uh, a few years ago, and they're

Speaker 2: 7:20

Really painful as an adult. Yeah . You're as an adult. They're ,

Speaker 3: 7:22

They're really painful. And I'm like, how do the little kids deal with this? And, and so , uh, they're , there's a reason. It , it , it captures the attention of a family. Yeah. And , and I think it's really important for us to, to honor that and recognize that if a child's waking up screaming mm-hmm <affirmative> . A few times a night mm-hmm <affirmative> . Due to this pain. It's, it's awful. It's real . Yeah . It's awful for the whole family. Taking a step back, what is an ear infection? I think the classic ear infection we think about is, is something we call an otus media. It's a middle ear infection. We all have these tubes in our face, in our, in our head. They connect our nasal area to our ear and they're called the eustachian tubes. And they allow mucus and snot to flow around. They allow fluid to flow. And what happens in kids is that just the way the faces are built, those become a lot flatter as opposed to angled. You don't have gravity helping you as much. And , and what that allows is mucus to get stuck, stuck a little bit more. Yep . Also, what , back to our, our whole idea, kids have small passageways. Yep . And so it's really easy to get that clogged up mm-hmm <affirmative> . Or inflamed. And , and then what happens thereafter is that mucus, puss, white blood cells, snot, all sorts of things can get caught in the middle ear. Yep . If you imagine that the middle ear is a little chamber and you start to pack it full of fluid, you're gonna start pushing on the one end that's a little bit flexible and that's your eardrum. And that is where kids begin to have a lot of pain.

Speaker 2: 8:48

And it's so sensitive that eardrum is so sensitive full of nerves. Yes. And that's why it's so painful. Yeah.

Speaker 3: 8:53

And so you see these, these poor children who are like, it hurts it , it's painful. When we talk about the classic ear infection, that's what we're treating. And , and this is the reason why kids, small kids in particular, get ear infections and get them with some frequency. It's

Speaker 2: 9:08

The anatomy. It's

Speaker 3: 9:09

The anatomy. And so, you know, part of the reason, Megan , that , that you probably don't treat a ton of ear infections, at least at first pass , is , is because we see a lot of kids under the age of two, right ? Mm-hmm <affirmative> . And so when we start thinking about when do we treat an ear infection, one of the key guidelines is how old is the child? Exactly. If they're under two years of age, we're much more likely to do a course of antibiotics because, well, one, the kid can't communicate with us as well to know when things are getting worse. Mm-hmm <affirmative> . But also once they get past two , the likelihood that gravity size and space will help improve its situation on its own. It is much higher. Yes. Uh , whereas with a under 2-year-old, it may not get as well as quickly.

Speaker 2: 9:48

For sure. So let's talk about, you know, the kids who get a lot of otitis media or middle ear infections, at what point are like, you know, I've treated this kid with four or five rounds of antibiotics and they're getting better, but they just keep getting these ear infections. I think maybe it's time to call it ENT . So we ,

Speaker 3: 10:07

We'll walk down, we'll walk down a stepwise process with families and, you know, if it's one day of pain and, and no fever, we probably, you know, we probably won't walk down an antibiotic pathway, but if we start , uh, you know, treating your child with the first line medicine, which is usually amoxicillin Yep . You know, we'll treat the child and most of the time, 90 some plus percent of the time it gets better. But we have a couple other antibiotics in our back pocket that if things are not getting well as quickly, we may transition to a different antibiotic. We may try even a third antibiotic. So we want kids to start to feel better, both from a pain perspective, we want that fever to come down. Frankly, at baseline, we want families to start to sleep again. <laugh> a little bit more. Yeah. Right . Um, so that's how we would begin the first approach. Now we see those kids and, and frequently it has to do with the anatomy. Um, there's, there's a genetic component to the anatomy Sure. Is there's a , um, familial component to the anatomy. And you'll see some kids who just have , uh, tubes that get clogged up. Yep . And when that happens over and over again, if I see over four in one year, and , and there's other numbers, like if you see seven or eight in two years and 10 in three years. But basically once I start to see you four times for an ear infection, I'm gonna say, you know what, here, I want you to make an appointment with ent . Mm-hmm <affirmative> . You know, may maybe over the course of the next month , uh, well , you know, you maybe it gets better and everything, everything is perfect. Great. Yeah . But at least you have that appointment. And then when you go see the ENT doctors, you can discuss whether there's benefit to doing something further. And usually that's something further is something that you're an expert in again. Mm-hmm <affirmative> . And something we're really grateful to have around for, which is , uh, placing some tubes so that you have a release valve Yes . For all this pus. Exactly. And , and so when we start to see you coming back over and over again, when we start to see that look in the eyes of parents, we're like , we're done. Yeah. <laugh> , it's been, this is since

Speaker 2: 11:55

Please do something else besides an antibiotic.

Speaker 3: 11:57

Dr. K , we like you, we don't like you this much. Yeah, exactly. Right . And you don't, you don't want any, you know , we wanna make sure , uh, families are okay. Yeah. Uh , and so we'll send 'em to our colleagues and then you all do magical work with them and , uh, and, and really can, can make a quality of life way better for

Speaker 2: 12:13

Families. I will say tubes are a wonderful thing that we have the ability to do. Just real quick, we take children to the operating room. We do give them general anesthesia, but it takes about five minutes. It is so fast. All we do is make a very small hole in the eardrum. We go through the ear canal , uh, so there's no cuts on the outside of the ear. There's no stitches. We make a very teeny tiny hole in the eardrum. We suck out all of that fluid because antibiotics can't get to it. And then we stick a tiny tube in that hole of the eardrum. It's nothing that you can see from the outside. You need a , what we call an otoscope to look in the ear and see it. And they're temporary. They last about a year. Sometimes they come out sooner, sometimes they last a little bit longer. But it allows that ventilation so it doesn't prevent the ear infection from happening. 'cause like you said, it's a eustachian tube problem. It's anatomical and it will take time to get better, but when they do get an ear infection, it doesn't build up that pressure. So you don't get the pain, you don't get the fevers. And the best part is it leaks out of the ear. So mom and dad know, oh, this is an ear infection. I see it. Yep . The kid is more comfortable, parents are more comfortable. And the best benefit of all is ear drops are 1000% more effective than oral antibiotics. Yes . They're tolerated a lot better. And so if your kidneys tubes, I know we're talking about surgery here, but it, it is truly a , a pretty benign thing and , and certainly something that helps these kids. So

Speaker 3: 13:38

It's remarkable how quick it is. Mm-hmm <affirmative> . How well the children do, how, how, how nicely they, they come out of it, and then quality of life change afterwards. Oh yeah . Oh , if it's needed, you know, I , I'd strongly recommend it, you know, for, for kids who are having learning challenges or those speech challenges, you know, if that's associated with ear infections. Yeah. Or if we start to see every time we see your child, there's a big pocket of fluid, even if it's not causing 'em discomfort, but for a long, long time and their speech is not quite coming along, that's also a really good reason. We'll send them to you. Yeah. All to have a conversation. You know, there's a critical timeframe in which kids can acquire language mm-hmm <affirmative> . And , and acquire the, the signals to produce language. And , and we need to get them hearing and speaking Yeah . At the , at the right times.

Speaker 2: 14:18

We've covered a lot of ground here. Dr. Krish , I'm so glad that you're here. We're gonna take a quick break and when we come back, we're gonna talk about sore throats and coughs and other fun things.

Speaker 4: 14:30

When Hennepin Healthcare says, we are here for life, they mean here for you, your life and all that it brings. He up in healthcare has a hospital HCMC, and a network of clinics both downtown and across the west metro. They provide all the primary care and specialty care you would expect to find, but did you know they also have services like acupuncture and chiropractic care available at many of their primary care clinics and at their integrative health clinic in downtown Minneapolis? Learn more@hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 2: 15:07

Welcome back. Let's talk about sore throats. Dr. Krish specifically strep throat. Something you see a lot of, I see a lot of, tell me, you know, when should a parent bring their child in for a sore throat? When do you test for strep? When do you give antibiotics? What should people know about this? Yeah,

Speaker 3: 15:25

Thanks Megan . And yeah, we, we see a lot, a lot of sore throats. Um, I'll say , uh, first of all, any child under three months who has a fever, you need to get seen. And I just wanna , I throw that out all the time because , uh, if you have a small baby who has a fever, they , they just need to get seen. Yeah . Uh , but , uh, my general rule of thumb on, on other types of fevers for our older kids is if you're having more than a couple days of fever with a temperature of 1 0 1 or more, come see us. You know, we'll, we'll check your ears, we'll check your throat, we'll check your lungs. Those are common places that bacteria like to hide. And, and we'd like to treat that if , if possible. And, and so then people come in and they've had these symptoms. And I'll still say the vast majority of times you have a sore throat, it's a virus. Yep . And I know folks don't love hearing that because there's not a cure all for that. But the vast majority of the, the germs that will cause you to have a sore throat are viruses. Mm-hmm <affirmative> . Uh , but sometimes it's a bacteria. Right . And , and when, when is that? And what do we look for? We look to see if you've had a fever mm-hmm <affirmative> . Like a , a legitimate fever , uh, you know , a hundred 0.4 or higher. We look to see if your neck has any swelling, if you have any, what we call lymph nodes. Right. Places where we know that we're fighting that infection. Third thing , uh, and this is one that parents can, can identify on their own. Ask your if , if you can get your child to open up their mouth big and stick their tongue out, you may be able to see white spots. And that is, that is what we call, you know, that's pus . Yep . On the throat. Uh, and , and you sometimes can see that. And then , um, this is an interesting one. Strep throat is more likely when you don't have a cough. Mm-hmm <affirmative> . A lot of families will come in and say, oh , I have this sore throat and cough. Most often that actually is a virus 'cause it's causing multisystems to be inflamed. But if you have strep throat, strep throat's pretty good at , uh, not causing a cough, causing the pain to be right in that throat area and in that, in those tonsils.

Speaker 2: 17:08

That's right. Yep . So when do you send these kids with strep throat To us? Mm-hmm <affirmative> . In ENT . Mm-hmm

Speaker 3: 17:13

<affirmative> . So , uh, the , the nice thing is , uh, you know, if we see those symptoms, we can swab a child right there. Uh, we can get you an answer very quick . Oh ,

Speaker 2: 17:20

They love that too, right? <laugh> . They love it.

Speaker 3: 17:22

It's their

Speaker 2: 17:22

Favorite thing. They're lining up at the door.

Speaker 3: 17:24

Yes. Yes. Um, they're very happy with me afterwards, <laugh> . Uh, but , um, we can, we can get you an answer pretty quickly. We can get you the antibiotics if that's the case. Mm-hmm <affirmative> . Uh , we can treat you , we can make you feel better real quick. I will say Tylenol and ibuprofen in those settings can do a , a wonder no matter what the sore throat is, can make things feel better. We swab you're positive, and then three weeks later you come back again. And then a few weeks later, again, you come back with strep throat. Once we start to see that recurrent pattern, and , and the number is, is, is fairly high, technically, it's , uh, you know, seven infections in a year. But , uh, once I start to see that pattern over and over again, Megan , I'm asking them to call you. Yeah. Um, yeah . Almost in anticipation. They're gonna get one more. Yeah. They're gonna come see you and , and then you guys can make an informed decision about taking out tonsils, keeping them in. I'll say, Megan , it seems to me like when we were younger, they took out a lot more tonsils. Yes, they did . They were getting a lot more conservative about when we take out tonsils. Yes. Weighing out the benefits of, of surgery versus treatment. And , and I think that's a , that's a really smart conversation to be had. There's some other things that may cause us to send them to you. For example, we have some kids who , uh, a family will say they, they snore like crazy. In fact, they, they pause breathing for 10 seconds. Yeah . If we see that pattern, we may have them come see you for sure. 'cause we're worried about obstructive sleep apnea. So, so there's a few other things, but I would say the number one reason that we send them to you is they keep getting strep infections over and over again.

Speaker 2: 18:46

Yeah. Again, seven is not arbitrary. That is what our academy guidelines recommend. Seven sore throats in one year doesn't actually have to be strep. And so those viruses may count, but the tonsils have to be big, red, ugly kids, miserable, missing tons of school. If a parent comes in, swollen lymph nodes, like you said, a parent comes in and tells me all of this, it's pretty much a no-brainer. We should, we should talk about taking the tonsils out. I'll say just a few things about tonsil surgery. It is also something we do all the time. It's very routine. It is a little bit more risky than putting in ear tubes. It takes a little bit longer. If you were to come to see me, we would have a whole long conversation about what surgery entails. If the child has to stay at night, which if we're worried about sleep apnea, we will typically keep them overnight. If they go home the same day, they are gonna have a really bad sore throat , uh, can take up to two weeks. This is not to be said lightly. However, kids tend to bounce back really quickly. It's better to do it when they're younger, under 12. And it does make a difference. It requires a conversation and , and really making sure that that's the right thing for the child because it is a surgery. So we're always happy to see those kids. You know,

Speaker 3: 19:55

I think it's, it's, it's really great when they can, they can come in and knowing their lived experience, knowing how frustrating this process is, but, but have a conversation about the risks and benefits. Yeah . And, and I think you all do such a nice job of , of laying those out for families. Yeah.

Speaker 2: 20:06

If you wanna keep 'em, by all means. Yeah . You can, you can keep your tonsils. Years and years ago mm-hmm <affirmative> . Older generation than you and I, they took out everybody's tonsils. It was like somebody in their fifties and sixties doesn't have their tonsils. The pendulum swung the other way. Nobody got 'em out. And now we have these lovely guidelines, which is super helpful. So let's switch gears to cough. We're gonna wrap up with this topic. And so I, I kind of wanna focus on two things. Croup and RSV. Uh, you know, we already mentioned the quad demic in the beginning of the show with RSV, but croup happens. I mean, both of my kids had croup and it's scary. And so tell me, let's talk about the symptoms of croup. You know, what you guys do for croup?

Speaker 3: 20:45

Yeah . Yeah. So, so coughs, coughs are everywhere. And if you walk through any daycare or school in America, you will hear coughs left and right, especially right now. Mm-hmm <affirmative> . Um, so we see a lot of patients with coughs and, and there's a lot of things that can cause coughs back to this idea that you can have, some of you can have viruses, you can have allergies, you can have bacteria. And so part of our conversation that we're gonna have with you and your family when you come in is what could be causing this? The most common things to cause cough once again, are viruses. Things like RSV and croup . Croup is a specific type of cough. It's a specific sound of a cough. We , we equate it to a barking cough and we equate it to a barking seal cough. And when you hear it, you know, you , you , you will know. I encourage everyone go , go on YouTube right now and, and, and Google what a barking cough sounds like. You're gonna hear it. And it's, it's not actually , cru is actually not a diagnosis of a specific germ. It's a , it means that a specific part of your airway is infl inflamed. Yeah . And , and so you could actually have RSS V cause croup , you can have, you know , parainfluenza, which is the most common one. You can have a lot of different germs cause a croup, but it means that a certain part of your body is, is inflamed. And that's why you have this funny sounding cough. Um, and so it , it gets to be a scary thing because it's a scary sounding cough. Yeah. It's harsh. It , it's, it's different sounding. They can

Speaker 2: 21:59

Whe Right. You can

Speaker 3: 22:01

Hear all sorts of sounds. Yeah . Yeah . And , and I , so kids will have this, this cough, and then I, I think it also gets scary because kids will, will often tell you that I'm having a , a difficult time breathing mm-hmm <affirmative> . And it , it's challenging. And anytime a child says that, I mean, that's worthy of panic. Yeah . No way . And, and I wouldn't say panic, but I would say , uh, take it seriously. Yeah. Like, like, let's address it. This is the time to, to do something about it. This

Speaker 2: 22:20

Isn't , oh mom, my tummy hurts and I don't wanna go to school today. <laugh> ,

Speaker 3: 22:23

That's, that's exactly right. When if , if someone says they're having difficulty breathing anytime , I think it's, it's, it's worthy of our full attention. So the nice thing about croup though is, is like some of these other things, we know how to treat it. We know how to make kids feel better. We have specific medicines, steroids that could drawn , that will make things feel better. And if we need to treat it more aggressively than that, whether it's in the hospital or the emergency room, we can, we have other medicines. There's also some things families can do at home. And this is actually something that I would say for, for any type of cough, I would say , uh, give your child two warm steam baths a day. So steam up the bathroom with a hot shower, make it nice and steamy, and let them sit there and breathe that warm air. Yeah . That can be very helpful and , and calming for them. My big advice around coughs generally speaking is this one, if someone tells you they're having difficulty breathing, take it seriously. Two, if you see ribs when a child is breathing, yes. You need to get seen quickly. So , um, I I , I just watch a child breathe for a minute, watch my children breathe for a minute. If you can see those ribs tugging mm-hmm <affirmative> . Come in. If you can see a child breathing too fast, faster than they normally breathe for, for prolonged periods of time, bring 'em in. No one's ever gonna fault you for that. We wanna see them, we wanna evaluate, and we probably have some intervention that's gonna make them feel better.

Speaker 2: 23:38

Yeah. And you mentioned the steroids. I mean, steroids for this, I think do wonders, and I've seen it in my own children as well, from an ENT perspective on croup. The only thing that I'll say, and, and you of course know this, is a kid really shouldn't be getting croup all that much. Right. That part of that airway should not be continually getting infected and inflamed over and over again. And so, you know, we always say you're allowed to have croup once or twice. Uh, if you're having croup more than two times in a year, it could be an indication of some anatomical deformity. And that would be an indication to come and see ENT. And we have some nice little cameras and tools that we can do to get a good look down there, make sure everything looks okay, but we'll, we'll look for any narrowing of the airway or floppy airway or cyst or clefts or any of those other rare but important things to know about. So,

Speaker 3: 24:28

Absolutely. And yeah, if we see that pattern over and over again, we're definitely calling you all . Yeah . Uh , I'll just say about RSV , it's in the news. It's everywhere. RSV , um, like group will cause you to have a cough. Uh, it's just really prominent in, in little babies. Mm-hmm <affirmative> . Little babies will get it. And , and if, if little babies under a year or under six months in particular get RSV back to our whole principle of a lot of mucus produced by these viruses in small airways Yeah. Can cause a difficult time breathing. And so that's when we see sort of the biggest problems. That's why it's, it's really important to wash your hands and take care and not be around babies when you're sick, because you don't want them to get that level of mucus in their lungs.

Speaker 2: 25:03

Right. Exactly. Really great advice. Well, Dr. Krish , I can't thank you enough for being here and sharing your wisdom. You are a wealth of knowledge and I am so happy to have you here at Hennepin, taking care of my kids and all of our kids in the community. Uh, the pediatrics department here , uh, is just unbelievable. Just a pool of amazing, amazing practitioners. So thank you so much.

Speaker 3: 25:25

Uh , thank you Megan . And we we're super grateful that to have you there to, to support our children.

Speaker 2: 25:29

Thank you everyone. Thanks for listening. Uh, if Dr. Hilton isn't here in two weeks, it's 'cause he lost his job. We'll be back in two weeks no matter what. And in the meantime, be healthy and be well.

Speaker 1: 25:41

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show, email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At Highball Executive producers are Jonathan, CTO and Christine Hill . Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.