March 16, 2025 • 26 mins
03/16/25
The Healthy Matters Podcast
S04_E11 - Why Are Kids Always Sick?! Let's Talk About It.
If you have (or know) a kid, you've probably wondered: "How can such a tiny human catch so many illnesses?" And, "How is it humanly possible to create such an endless supply of snot?!" Let's face it, kids are mini germ factories. From coughs to colds to ear infections, kids seem to pick up everything. But which symptoms are just part of growing up, and which ones should actually worry you?
On Episode 11 of the show, we'll be joined by a repeat guest, pediatrician Dr. Krishnan Subrahmanian, to break down the most common childhood illnesses. He'll help us get an understanding of what's normal, what's not, and how to handle those inevitable ailments like a pro. This episode will be guest hosted by Meghan McCoy who will share with us her POV and experiences as an Ear, Nose Throat specialist as well. Kids will always keep us guessing, but you can count on finding at least a few answers here. Join us!
We're open to your comments or ideas for future shows!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Get a preview of upcoming shows on social media and find out more about our show at www.healthymatters.org.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Healthy Matters podcast with
Dr. David Hilton , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host.
Speaker 2 (00:17):
Hey everyone.
Welcome to Healthy Matterspodcast, where we dive into the
world of healthcare withexperts who live it every day .
You've probably figured out bynow that I am not Dr. Hilden,
he is on a well-deservedvacation. I am Megan McCoy ,
and I'm a PA in the ear, noseand throat department here at
Hennepin Healthcare. I've beenon this show before, and so if
(00:37):
you go back and listen toepisode seven of season two, my
voice may sound a littlefamiliar today, we're gonna
dive into ear, nose, and throatconditions in children. And we
have our guest today, Dr.
Krishnan Sub , who's apediatrician here. He's also
the Chief Medical Officer atHennepin Health. And we're
gonna talk about all of thethings that go on in kids from
snot to strep throat, and we'lldive right into it. So thanks
(00:59):
for being here, Dr. Kh . Oh ,
Speaker 3 (01:01):
Thanks. Thanks Megan , for having me.
Congratulations on your newchair. I plan on subscribing
now immediately.
Speaker 2 (01:06):
. 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 endlesssupply of snot? And I have a
five-year-old and atwo-year-old, and I promise we
go through so many tissues.
It's really the thing thatkeeps us at Costco. It's like
the number of tissues we gothrough. So what is up with
(01:29):
that? Why? Well,
Speaker 3 (01:30):
First, Megan co .
Congratulations on your littleones. Second, I, I'm a little
nervous. I'm not gonna lie. Youknow, I deal with noses, ears,
and throats a lot, but frankly,you're, you're the expert,
right? and I , I and Ihave referred many a patient
over the years to, to Megan toget her assistance and her
wisdom. So I feel like I'mgonna test here. So I'm
gonna do my best to , to No ,but , but no, I , I hope what ,
what we can bring today is justsome, some practical advice.
(01:51):
The things that we're seeingmost commonly, things that
we're seeing day in, day out,and then hopefully just , uh,
some advice that will help calmsome nerves. 'cause it's, it's
a nerve wracking time for sure.
The , the , the winter, thecold season. The viral season.
The
Speaker 2 (02:03):
Quad demic.
Speaker 3 (02:03):
The quad demic. I get, I get questions. It seems
like my kids are sick all thetime. Right.
Speaker 2 (02:08):
And if they're in daycare , they are, they just
are. Forget about it . Yeah .
Right .
Speaker 3 (02:11):
Like , forget about it. You are, they are sick all
the time. And, and I think thatkind of begins to answer your
question, why does it seem likekids have a ton of snot one, it
it's because they do , uh, youknow, there, there are studies
that that show that kids undertwo years of age in their first
year of daycare are gettingsick on average about once a
month. Yeah. And we'll talkabout this a little bit more,
but the average sickness islasting you 10 to 14 days. That
(02:33):
means half the time Yep . Youare sick. Mm-hmm
. And , and most of thesesicknesses produce a lot of
mucus mm-hmm .
You have kids who don't have areally built up immune system.
So they're trying to rev up,they're trying to fight these
infections. Right. Trying tobuild a lot of mucus. And then
I , I think the other thingthat that makes it tough is
that, Megan , when you and Iget a cold, when we get snot,
we have bigger airways, we havebigger noses, we have bigger
(02:55):
mouths. And so the mucus, wehave more space to put the
mucus, whereas when your2-year-old or my 3-year-old get
mucus, it clogs up 50% of theirairway. Right.
Speaker 2 (03:04):
It's so little.
Speaker 3 (03:05):
And it's tough to breathe through a 50% airway.
Right. Right . And, and I thinkthat's why it becomes so
noticeable to, to families, toparents. And that's why it
causes us a lot of grief. Yeah.
Speaker 2 (03:13):
Uh, I think you're right. Daycare is just the
worst. It's great. We love ourdaycare providers. I'm so
thankful for being able to sendmy kids to daycare, but it does
feel like they're sick all thetime. Yeah.
Speaker 3 (03:23):
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 . Is a lotof sickness with great
frequency. What you'll noticeover as the patterning goes on
is that as they build upimmunity to these illnesses,
starting about year three orfour, those kids who have been
through daycare have that builtup immune system and they
(03:43):
actually, you know, you may seesickness actually get less. Yep
. And , and so there is a lightat the end of the tunnel for
sure. The , the light comesalong with a lot of good
learning about how to eatcivilly at a table and how to
potty train. Right. Right.
There's so there's positivethings to be learned. Right.
But , uh, yeah, it it's a toughyear and a half and we , we
parents get to share the germstoo, right. Yeah . We get sick
too. Yes . And it , and it's,it's hard.
Speaker 2 (04:04):
Yeah. I feel like I didn't get sick for decades
mm-hmm . Until Ihad kids. And now , uh, it gets
me too . So when you're seeingkids, at what point do you
decide, you know what, this isabnormal snot, this is abnormal
mucus, this is an atypicalnumber of illnesses or
sicknesses, and I think youneed to go see ENT . What ,
what , at what point do yousort of make that decision as a
(04:24):
pediatrician? So
Speaker 3 (04:26):
I I I think first for us to know that there is
this expected 12 to 13illnesses. Yeah . There's that
average of 10 to 14 days mm-hmm . When we start
to get worried is when we startto see a few different
symptoms. If I see a kidhaving, you know, fever for
that whole prolonged period oftime mm-hmm . I'm
like, that's not normal. Sure .
You know, a few days of fever.
Sure. But having that prolongedfever, I , I get a little
(04:46):
concerned. I think if the coldis getting worse, like colds
should have a couple days ofbadness and then get better.
Yeah. Okay . That , that's thegeneral arc of a , of a cold.
Totally. If, if I see itgetting actively worse, the
fever's now beginning on daysix and starting to get worse
if, if the mucus production isgetting worse, and then if,
frankly, if a child is in a lotof pain, right? Mm-hmm
. If you'rehaving a lot of pain in your
(05:06):
sinus areas, which, and , andwe go into that, but like the
sinuses are spaces that existbehind your nose, kind of in
your face area. If kids arehaving pain in their face or
around those , the nose areaYeah . That's not usual. Sure.
And so if I , if I see thatprogression, I, I start to
think, Hmm , does this childhave a sinus infection mm-hmm
(05:27):
. Do they havesomething else going on mm-hmm
. And then, youknow, we may do some
conservative management, we maydo some antibiotics, and if
that's still not gettingbetter, then boy, Megan , we're
gonna call you . Yeah.
Speaker 2 (05:36):
Great. You know, the other thing I think we'd be
remiss if we didn't talk aboutwhen it comes to snot and runny
noses is , uh, kids who putstuff in their nose, is
a big part of my practice. And, uh, you know, one of the
telltale signs of somethingstuck in the nose, and, and you
as a pediatrician know this, isif you have a kid with snot
(05:56):
coming at just one side of thenose and it smells gross mm-hmm
. Be supersuspicious of something up
there.
Speaker 3 (06:04):
And , and yeah. That , that, that foreign object
book , kids are really good athiding things. Oh man. And ,
and the nose is a great placeto do that. Mm-hmm
. Mm-hmm . Um, so thanks
for bringing that up. Yeah. Ifyou're smelling that, that foul
smell, sometimes I'll hearparents or or children say,
Hey, I have really bad breath.
Yes. It , it'll come across asas a bad breath type
Speaker 2 (06:22):
Of feeling. Yes .
It's also known as halitosisfor sure.
Speaker 3 (06:24):
And so when that, when that happens and you're
having like a lot of mucusproduction mm-hmm
. And it , and it's new mm-hmm . Then , then
it's something we should, weshould definitely look and, and
then frequently we'll ask ourENT uh , colleagues to, to go
up there with their fancytools, Uhhuh, ,
and , and , and get it out.
Speaker 2 (06:38):
Uh, and that is what we do. Yes. And, you know,
sometimes we're successful andsometimes it takes a little bit
of anesthesia in the operatingroom to get it out, but always
happy to see those kids andthat , and that's something
that if you're worriedsomething that should be done
right away. Absolutely . Wedon't want that thing sitting
in there for a long time. Let'sswitch gears and move on to
ears. If you wanna walk throughear infections, ear canal
(06:58):
infections, middle earinfections, and, and how you
take care of them. And then atwhat point you send 'em to ENT,
Speaker 3 (07:04):
One of the most common complaints we get is my
child's ear is hurting them.
They're in pain, they're indiscomfort, they're
Speaker 2 (07:11):
Pulling at it. Yeah.
Speaker 3 (07:12):
It's really common.
Mm-hmm . Um, youknow , I had the misfortune of
having some sort of ear paininfection , uh, a few years
ago, and they're
Speaker 2 (07:20):
Really painful as an adult. Yeah . You're as an
adult. They're ,
Speaker 3 (07:22):
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 afamily. Yeah. And , and I think
it's really important for usto, to honor that and recognize
that if a child's waking upscreaming mm-hmm
. A few times a night mm-hmm . Due to this
pain. It's, it's awful. It'sreal . Yeah . It's awful for
the whole family. Taking a stepback, what is an ear infection?
(07:43):
I think the classic earinfection we think about is, is
something we call an otusmedia. It's a middle ear
infection. We all have thesetubes in our face, in our, in
our head. They connect ournasal area to our ear and
they're called the eustachiantubes. And they allow mucus and
snot to flow around. They allowfluid to flow. And what happens
(08:05):
in kids is that just the waythe faces are built, those
become a lot flatter as opposedto angled. You don't have
gravity helping you as much.
And , and what that allows ismucus to get stuck, stuck a
little bit more. Yep . Also,what , back to our, our whole
idea, kids have smallpassageways. Yep . And so it's
really easy to get that cloggedup mm-hmm . Or
(08:25):
inflamed. And , and then whathappens 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 themiddle ear is a little chamber
and you start to pack it fullof fluid, you're gonna start
pushing on the one end that's alittle bit flexible and that's
your eardrum. And that is wherekids begin to have a lot of
(08:47):
pain.
Speaker 2 (08:48):
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 (08:53):
And so you see these, these poor children who
are like, it hurts it , it'spainful. When we talk about the
classic ear infection, that'swhat we're treating. And , and
this is the reason why kids,small kids in particular, get
ear infections and get themwith some frequency. It's
Speaker 2 (09:08):
The anatomy. It's
Speaker 3 (09:09):
The anatomy. And so, you know, part of the reason,
Megan , that , that youprobably don't treat a ton of
ear infections, at least atfirst pass , is , is because we
see a lot of kids under the ageof two, right ? Mm-hmm
. And so when westart thinking about when do we
treat an ear infection, one ofthe key guidelines is how old
is the child? Exactly. Ifthey're under two years of age,
we're much more likely to do acourse of antibiotics because,
(09:31):
well, one, the kid can'tcommunicate with us as well to
know when things are gettingworse. Mm-hmm .
But also once they get past two, the likelihood that gravity
size and space will helpimprove its situation on its
own. It is much higher. Yes. Uh, whereas with a under
2-year-old, it may not get aswell as quickly.
Speaker 2 (09:48):
For sure. So let's talk about, you know, the kids
who get a lot of otitis mediaor middle ear infections, at
what point are like, you know,I've treated this kid with four
or five rounds of antibioticsand they're getting better, but
they just keep getting theseear infections. I think maybe
it's time to call it ENT . Sowe ,
Speaker 3 (10:07):
We'll walk down, we'll walk down a stepwise
process with families and, youknow, if it's one day of pain
and, and no fever, we probably,you know, we probably won't
walk down an antibioticpathway, but if we start , uh,
you know, treating your childwith the first line medicine,
which is usually amoxicillinYep . You know, we'll treat the
child and most of the time, 90some plus percent of the time
(10:27):
it gets better. But we have acouple other antibiotics in our
back pocket that if things arenot getting well as quickly, we
may transition to a differentantibiotic. We may try even a
third antibiotic. So we wantkids to start to feel better,
both from a pain perspective,we want that fever to come
down. Frankly, at baseline, wewant families to start to sleep
again. a little bitmore. Yeah. Right . Um, so
(10:50):
that's how we would begin thefirst approach. Now we see
those kids and, and frequentlyit has to do with the anatomy.
Um, there's, there's a geneticcomponent to the anatomy Sure.
Is there's a , um, familialcomponent to the anatomy. And
you'll see some kids who justhave , uh, tubes that get
clogged up. Yep . And when thathappens over and over again, if
I see over four in one year,and , and there's other
(11:13):
numbers, like if you see sevenor eight in two years and 10 in
three years. But basically onceI start to see you four times
for an ear infection, I'm gonnasay, you know what, here, I
want you to make an appointmentwith ent . Mm-hmm
. You know, may maybe over thecourse of the next month , uh,
well , you know, you maybe itgets better and everything,
everything is perfect. Great.
Yeah . But at least you havethat appointment. And then when
you go see the ENT doctors, youcan discuss whether there's
(11:35):
benefit to doing somethingfurther. And usually that's
something further is somethingthat you're an expert in again.
Mm-hmm . Andsomething 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 overagain, when we start to see
that look in the eyes ofparents, we're like , we're
done. Yeah. , it'sbeen, 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 youdon'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 ourcolleagues and then you all do
magical work with them and ,uh, and, and really can, can
make a quality of life waybetter 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 takechildren to the operating room.
We do give them generalanesthesia, but it takes about
five minutes. It is so fast.
All we do is make a very smallhole in the eardrum. We go
through the ear canal , uh, sothere's no cuts on the outside
of the ear. There's nostitches. We make a very teeny
(12:34):
tiny hole in the eardrum. Wesuck out all of that fluid
because antibiotics can't getto it. And then we stick a tiny
tube in that hole of theeardrum. It's nothing that you
can see from the outside. Youneed a , what we call an
otoscope to look in the ear andsee 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 thatventilation so it doesn't
(12:58):
prevent the ear infection fromhappening. 'cause like you
said, it's a eustachian tubeproblem. It's anatomical and it
will take time to get better,but when they do get an ear
infection, it doesn't build upthat pressure. So you don't get
the pain, you don't get thefevers. And the best part is it
leaks out of the ear. So momand dad know, oh, this is an
ear infection. I see it. Yep .
(13:19):
The kid is more comfortable,parents are more comfortable.
And the best benefit of all isear drops are 1000% more
effective than oralantibiotics. Yes . They're
tolerated a lot better. And soif your kidneys tubes, I know
we're talking about surgeryhere, but it, it is truly a , a
pretty benign thing and , andcertainly something that helps
these kids. So
Speaker 3 (13:38):
It's remarkable how quick it is. Mm-hmm
. How well thechildren do, how, how, how
nicely they, they come out ofit, and then quality of life
change afterwards. Oh yeah . Oh, if it's needed, you know, I ,
I'd strongly recommend it, youknow, for, for kids who are
having learning challenges orthose speech challenges, you
know, if that's associated withear infections. Yeah. Or if we
start to see every time we seeyour child, there's a big
(13:58):
pocket of fluid, even if it'snot causing 'em discomfort, but
for a long, long time and theirspeech is not quite coming
along, that's also a reallygood reason. We'll send them to
you. Yeah. All to have aconversation. You know, there's
a critical timeframe in whichkids can acquire language
mm-hmm . And ,and acquire the, the signals to
produce language. And , and weneed to get them hearing and
speaking Yeah . At the , at theright times.
Speaker 2 (14:18):
We've covered a lot of ground here. Dr. Krish , I'm
so glad that you're here. We'regonna take a quick break and
when we come back, we're gonnatalk about sore throats and
coughs and other fun things.
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(14:52):
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Speaker 2 (15:07):
Welcome back. Let's talk about sore throats. Dr.
Krish specifically strepthroat. 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 sorethroat? When do you test for
strep? When do you giveantibiotics? 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 afever, you need to get seen.
And I just wanna , I throw thatout all the time because , uh,
if you have a small baby whohas a fever, they , they just
need to get seen. Yeah . Uh ,but , uh, my general rule of
thumb on, on other types offevers for our older kids is if
you're having more than acouple days of fever with a
(15:48):
temperature of 1 0 1 or more,come see us. You know, we'll,
we'll check your ears, we'llcheck your throat, we'll check
your lungs. Those are commonplaces that bacteria like to
hide. And, and we'd like totreat that if , if possible.
And, and so then people come inand they've had these symptoms.
And I'll still say the vastmajority of times you have a
sore throat, it's a virus. Yep. And I know folks don't love
hearing that because there'snot a cure all for that. But
(16:09):
the vast majority of the, thegerms that will cause you to
have a sore throat are viruses.
Mm-hmm . Uh , butsometimes it's a bacteria.
Right . And , and when, when isthat? And what do we look for?
We look to see if you've had afever mm-hmm .
Like a , a legitimate fever ,uh, you know , a hundred 0.4 or
higher. We look to see if yourneck has any swelling, if you
have any, what we call lymphnodes. Right. Places where we
know that we're fighting thatinfection. Third thing , uh,
(16:31):
and this is one that parentscan, can identify on their own.
Ask your if , if you can getyour child to open up their
mouth big and stick theirtongue out, you may be able to
see white spots. And that is,that is what we call, you know,
that's pus . Yep . On thethroat. Uh, and , and you
sometimes can see that. Andthen , um, this is an
interesting one. Strep throatis more likely when you don't
(16:51):
have a cough. Mm-hmm . A lot of
families will come in and say,oh , I have this sore throat
and cough. Most often thatactually is a virus 'cause it's
causing multisystems to beinflamed. But if you have strep
throat, strep throat's prettygood at , uh, not causing a
cough, causing the pain to beright in that throat area and
in that, in those tonsils.
Speaker 2 (17:08):
That's right. Yep .
So when do you send these kidswith strep throat To us? Mm-hmm
. In ENT . Mm-hmm
Speaker 3 (17:13):
. So ,
uh, the , the nice thing is ,
uh, you know, if we see thosesymptoms, we can swab a child
right there. Uh, we can get youan answer very quick . Oh ,
Speaker 2 (17:20):
They love that too, right? . 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, . Uh, but ,um, we can, we can get you an
answer pretty quickly. We canget you the antibiotics if
that's the case. Mm-hmm . Uh , we can
treat you , we can make youfeel better real quick. I will
say Tylenol and ibuprofen inthose settings can do a , a
wonder no matter what the sorethroat is, can make things feel
better. We swab you'repositive, and then three weeks
(17:45):
later you come back again. Andthen a few weeks later, again,
you come back with strepthroat. 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 inanticipation. They're gonna get
one more. Yeah. They're gonnacome see you and , and then you
(18:06):
guys can make an informeddecision about taking out
tonsils, keeping them in. I'llsay, Megan , it seems to me
like when we were younger, theytook out a lot more tonsils.
Yes, they did . They weregetting a lot more conservative
about when we take out tonsils.
Yes. Weighing out the benefitsof, of surgery versus
treatment. And , and I thinkthat's a , that's a really
smart conversation to be had.
There's some other things thatmay cause us to send them to
(18:28):
you. For example, we have somekids who , uh, a family will
say they, they snore likecrazy. 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 worriedabout obstructive sleep apnea.
So, so there's a few otherthings, but I would say the
number one reason that we sendthem to you is they keep
getting strep infections overand over again.
Speaker 2 (18:46):
Yeah. Again, seven is not arbitrary. That is what
our academy guidelinesrecommend. Seven sore throats
in one year doesn't actuallyhave to be strep. And so those
viruses may count, but thetonsils have to be big, red,
ugly kids, miserable, missingtons of school. If a parent
comes in, swollen lymph nodes,like you said, a parent comes
(19:07):
in and tells me all of this,it's pretty much a no-brainer.
We should, we should talk abouttaking the tonsils out. I'll
say just a few things abouttonsil surgery. It is also
something we do all the time.
It's very routine. It is alittle bit more risky than
putting in ear tubes. It takesa little bit longer. If you
were to come to see me, wewould have a whole long
conversation about what surgeryentails. If the child has to
(19:29):
stay at night, which if we'reworried about sleep apnea, we
will typically keep themovernight. If they go home the
same day, they are gonna have areally bad sore throat , uh,
can take up to two weeks. Thisis not to be said lightly.
However, kids tend to bounceback really quickly. It's
better to do it when they'reyounger, under 12. And it does
make a difference. It requiresa conversation and , and really
(19:50):
making sure that that's theright thing for the child
because it is a surgery. Sowe'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 andknowing their lived experience,
knowing how frustrating thisprocess is, but, but have a
conversation about the risksand benefits. Yeah . And, and I
think you all do such a nicejob 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 . Older
generation than you and I, theytook out everybody's tonsils.
It was like somebody in theirfifties and sixties doesn't
have their tonsils. Thependulum swung the other way.
Nobody got 'em out. And now wehave these lovely guidelines,
which is super helpful. Solet's switch gears to cough.
(20:26):
We're gonna wrap up with thistopic. And so I, I kind of
wanna focus on two things.
Croup and RSV. Uh, you know, wealready mentioned the quad
demic in the beginning of theshow with RSV, but croup
happens. I mean, both of mykids had croup and it's scary.
And so tell me, let's talkabout the symptoms of croup.
You know, what you guys do forcroup?
Speaker 3 (20:45):
Yeah . Yeah. So, so coughs, coughs are everywhere.
And if you walk through anydaycare or school in America,
you will hear coughs left andright, especially right now.
Mm-hmm . Um, sowe see a lot of patients with
coughs and, and there's a lotof things that can cause coughs
back to this idea that you canhave, some of you can have
viruses, you can haveallergies, you can have
bacteria. And so part of ourconversation that we're gonna
have with you and your familywhen you come in is what could
(21:07):
be causing this? The mostcommon things to cause cough
once again, are viruses. Thingslike RSV and croup . Croup is a
specific type of cough. It's aspecific sound of a cough. We ,
we equate it to a barking coughand we equate it to a barking
seal cough. And when you hearit, you know, you , you , you
will know. I encourage everyonego , go on YouTube right now
and, and, and Google what abarking cough sounds like.
(21:29):
You're gonna hear it. And it's,it's not actually , cru is
actually not a diagnosis of aspecific germ. It's a , it
means that a specific part ofyour airway is infl inflamed.
Yeah . And , and so you couldactually have RSS V cause croup
, you can have, you know ,parainfluenza, which is the
most common one. You can have alot of different germs cause a
croup, but it means that acertain part of your body is,
is inflamed. And that's why youhave this funny sounding cough.
(21:51):
Um, and so it , it gets to be ascary thing because it's a
scary sounding cough. Yeah.
It's harsh. It , it's, it'sdifferent 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 kidswill, will often tell you that
I'm having a , a difficult timebreathing mm-hmm
. And it , it's challenging.
And anytime a child says that,I mean, that's worthy of panic.
Yeah . No way . And, and Iwouldn't say panic, but I would
say , uh, take it seriously.
Yeah. Like, like, let's addressit. 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. ,
Speaker 3 (22:23):
That's, that's exactly right. When if , if
someone says they're havingdifficulty breathing anytime ,
I think it's, it's, it's worthyof our full attention. So the
nice thing about croup thoughis, is like some of these other
things, we know how to treatit. We know how to make kids
feel better. We have specificmedicines, steroids that could
drawn , that will make thingsfeel better. And if we need to
treat it more aggressively thanthat, whether it's in the
(22:43):
hospital or the emergency room,we can, we have other
medicines. There's also somethings families can do at home.
And this is actually somethingthat I would say for, for any
type of cough, I would say ,uh, give your child two warm
steam baths a day. So steam upthe bathroom with a hot shower,
make it nice and steamy, andlet them sit there and breathe
that warm air. Yeah . That canbe very helpful and , and
calming for them. My big advicearound coughs generally
(23:07):
speaking is this one, ifsomeone tells you they're
having difficulty breathing,take it seriously. Two, if you
see ribs when a child isbreathing, yes. You need to get
seen quickly. So , um, I I , Ijust watch a child breathe for
a minute, watch my childrenbreathe for a minute. If you
can see those ribs tuggingmm-hmm . Come in.
If you can see a childbreathing too fast, faster than
(23:28):
they normally breathe for, forprolonged periods of time,
bring 'em in. No one's evergonna fault you for that. We
wanna see them, we wannaevaluate, and we probably have
some intervention that's gonnamake them feel better.
Speaker 2 (23:38):
Yeah. And you mentioned the steroids. I mean,
steroids for this, I think dowonders, and I've seen it in my
own children as well, from anENT perspective on croup. The
only thing that I'll say, and,and you of course know this, is
a kid really shouldn't begetting croup all that much.
Right. That part of that airwayshould not be continually
getting infected and inflamedover and over again. And so,
(23:59):
you know, we always say you'reallowed to have croup once or
twice. Uh, if you're havingcroup more than two times in a
year, it could be an indicationof some anatomical deformity.
And that would be an indicationto come and see ENT. And we
have some nice little camerasand tools that we can do to get
a good look down there, makesure everything looks okay, but
we'll, we'll look for anynarrowing of the airway or
(24:22):
floppy airway or cyst or cleftsor 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'redefinitely calling you all .
Yeah . Uh , I'll just say aboutRSV , it's in the news. It's
everywhere. RSV , um, likegroup will cause you to have a
cough. Uh, it's just reallyprominent in, in little babies.
Mm-hmm . Littlebabies will get it. And , and
if, if little babies under ayear or under six months in
particular get RSV back to ourwhole principle of a lot of
(24:48):
mucus produced by these virusesin small airways Yeah. Can
cause a difficult timebreathing. And so that's when
we see sort of the biggestproblems. That's why it's, it's
really important to wash yourhands and take care and not be
around babies when you're sick,because you don't want them to
get that level of mucus intheir lungs.
Speaker 2 (25:03):
Right. Exactly.
Really great advice. Well, Dr.
Krish , I can't thank youenough for being here and
sharing your wisdom. You are awealth of knowledge and I am so
happy to have you here atHennepin, taking care of my
kids and all of our kids in thecommunity. Uh, the pediatrics
department here , uh, is justunbelievable. Just a pool of
amazing, amazing practitioners.
(25:24):
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, tosupport our children.
Speaker 2 (25:29):
Thank you everyone.
Thanks for listening. Uh, ifDr. Hilton isn't here in two
weeks, it's 'cause he lost hisjob. We'll be back in two weeks
no matter what. And in themeantime, be healthy and be
well.
Speaker 1 (25:41):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(26:03):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At Highball Executiveproducers are Jonathan, CTO and
Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(26:25):
time, be healthy and be well.
Welcome to the Healthy Matters podcast with
Dr. David Hilton , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare
and what matters to you. Andnow here's our host.
Speaker 2 (00:17):
Hey everyone.
Welcome to Healthy Matterspodcast, where we dive into the
world of healthcare withexperts who live it every day .
You've probably figured out bynow that I am not Dr. Hilden,
he is on a well-deservedvacation. I am Megan McCoy ,
and I'm a PA in the ear, noseand throat department here at
Hennepin Healthcare. I've beenon this show before, and so if
(00:37):
you go back and listen toepisode seven of season two, my
voice may sound a littlefamiliar today, we're gonna
dive into ear, nose, and throatconditions in children. And we
have our guest today, Dr.
Krishnan Sub , who's apediatrician here. He's also
the Chief Medical Officer atHennepin Health. And we're
gonna talk about all of thethings that go on in kids from
snot to strep throat, and we'lldive right into it. So thanks
(00:59):
for being here, Dr. Kh . Oh ,
Speaker 3 (01:01):
Thanks. Thanks Megan , for having me.
Congratulations on your newchair. I plan on subscribing
now immediately.
Speaker 2 (01:06):
don't we start with nos .
Personally, my favorite. So Dr.
K , why do kids have an endlesssupply of snot? And I have a
five-year-old and atwo-year-old, and I promise we
go through so many tissues.
It's really the thing thatkeeps us at Costco. It's like
the number of tissues we gothrough. So what is up with
(01:29):
that? Why? Well,
Speaker 3 (01:30):
First, Megan co .
Congratulations on your littleones. Second, I, I'm a little
nervous. I'm not gonna lie. Youknow, I deal with noses, ears,
and throats a lot, but frankly,you're, you're the expert,
right?
over the years to, to Megan toget her assistance and her
wisdom. So I feel like I'mgonna test here
gonna do my best to , to No ,but , but no, I , I hope what ,
what we can bring today is justsome, some practical advice.
(01:51):
The things that we're seeingmost commonly, things that
we're seeing day in, day out,and then hopefully just , uh,
some advice that will help calmsome nerves. 'cause it's, it's
a nerve wracking time for sure.
The , the , the winter, thecold season. The viral season.
The
Speaker 2 (02:03):
Quad demic.
Speaker 3 (02:03):
The quad demic. I get, I get questions. It seems
like my kids are sick all thetime. Right.
Speaker 2 (02:08):
And if they're in daycare , they are, they just
are. Forget about it . Yeah .
Right .
Speaker 3 (02:11):
Like , forget about it. You are, they are sick all
the time. And, and I think thatkind of begins to answer your
question, why does it seem likekids have a ton of snot one, it
it's because they do , uh, youknow, there, there are studies
that that show that kids undertwo years of age in their first
year of daycare are gettingsick on average about once a
month. Yeah. And we'll talkabout this a little bit more,
but the average sickness islasting you 10 to 14 days. That
(02:33):
means half the time Yep . Youare sick. Mm-hmm
. And , and most of thesesicknesses produce a lot of
mucus mm-hmm
You have kids who don't have areally built up immune system.
So they're trying to rev up,they're trying to fight these
infections. Right. Trying tobuild a lot of mucus. And then
I , I think the other thingthat that makes it tough is
that, Megan , when you and Iget a cold, when we get snot,
we have bigger airways, we havebigger noses, we have bigger
(02:55):
mouths. And so the mucus, wehave more space to put the
mucus, whereas when your2-year-old or my 3-year-old get
mucus, it clogs up 50% of theirairway. Right.
Speaker 2 (03:04):
It's so little.
Speaker 3 (03:05):
And it's tough to breathe through a 50% airway.
Right. Right . And, and I thinkthat's why it becomes so
noticeable to, to families, toparents. And that's why it
causes us a lot of grief. Yeah.
Speaker 2 (03:13):
Uh, I think you're right. Daycare is just the
worst. It's great. We love ourdaycare providers. I'm so
thankful for being able to sendmy kids to daycare, but it does
feel like they're sick all thetime. Yeah.
Speaker 3 (03:23):
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
frequency. What you'll noticeover as the patterning goes on
is that as they build upimmunity to these illnesses,
starting about year three orfour, those kids who have been
through daycare have that builtup immune system and they
(03:43):
actually, you know, you may seesickness actually get less. Yep
. And , and so there is a lightat the end of the tunnel for
sure. The , the light comesalong with a lot of good
learning about how to eatcivilly at a table and how to
potty train. Right. Right.
There's so there's positivethings to be learned. Right.
But , uh, yeah, it it's a toughyear and a half and we , we
parents get to share the germstoo, right. Yeah . We get sick
too. Yes . And it , and it's,it's hard.
Speaker 2 (04:04):
Yeah. I feel like I didn't get sick for decades
mm-hmm
me too . So when you're seeingkids, at what point do you
decide, you know what, this isabnormal snot, this is abnormal
mucus, this is an atypicalnumber of illnesses or
sicknesses, and I think youneed to go see ENT . What ,
what , at what point do yousort of make that decision as a
(04:24):
pediatrician? So
Speaker 3 (04:26):
I I I think first for us to know that there is
this expected 12 to 13illnesses. Yeah . There's that
average of 10 to 14 days mm-hmm
to get worried is when we startto see a few different
symptoms. If I see a kidhaving, you know, fever for
that whole prolonged period oftime mm-hmm
like, that's not normal. Sure .
You know, a few days of fever.
Sure. But having that prolongedfever, I , I get a little
(04:46):
concerned. I think if the coldis getting worse, like colds
should have a couple days ofbadness and then get better.
Yeah. Okay . That , that's thegeneral arc of a , of a cold.
Totally. If, if I see itgetting actively worse, the
fever's now beginning on daysix and starting to get worse
if, if the mucus production isgetting worse, and then if,
frankly, if a child is in a lotof pain, right? Mm-hmm
(05:06):
sinus areas, which, and , andwe go into that, but like the
sinuses are spaces that existbehind your nose, kind of in
your face area. If kids arehaving pain in their face or
around those , the nose areaYeah . That's not usual. Sure.
And so if I , if I see thatprogression, I, I start to
think, Hmm , does this childhave a sinus infection mm-hmm
(05:27):
conservative management, we maydo some antibiotics, and if
that's still not gettingbetter, then boy, Megan , we're
gonna call you . Yeah.
Speaker 2 (05:36):
Great. You know, the other thing I think we'd be
remiss if we didn't talk aboutwhen it comes to snot and runny
noses is , uh, kids who putstuff in their nose,
a big part of my practice. And, uh, you know, one of the
telltale signs of somethingstuck in the nose, and, and you
as a pediatrician know this, isif you have a kid with snot
(05:56):
coming at just one side of thenose and it smells gross mm-hmm
there.
Speaker 3 (06:04):
And , and yeah. That , that, that foreign object
book , kids are really good athiding things. Oh man. And ,
and the nose is a great placeto do that. Mm-hmm
for bringing that up. Yeah. Ifyou're smelling that, that foul
smell, sometimes I'll hearparents or or children say,
Hey, I have really bad breath.
Yes. It , it'll come across asas a bad breath type
Speaker 2 (06:22):
Of feeling. Yes .
It's also known as halitosisfor sure.
Speaker 3 (06:24):
And so when that, when that happens and you're
having like a lot of mucusproduction mm-hmm
. And it , and it's new mm-hmm
it's something we should, weshould definitely look and, and
then frequently we'll ask ourENT uh , colleagues to, to go
up there with their fancytools, Uhhuh,
and , and , and get it out.
Speaker 2 (06:38):
Uh, and that is what we do. Yes. And, you know,
sometimes we're successful andsometimes it takes a little bit
of anesthesia in the operatingroom to get it out, but always
happy to see those kids andthat , and that's something
that if you're worriedsomething that should be done
right away. Absolutely . Wedon't want that thing sitting
in there for a long time. Let'sswitch gears and move on to
ears. If you wanna walk throughear infections, ear canal
(06:58):
infections, middle earinfections, and, and how you
take care of them. And then atwhat point you send 'em to ENT,
Speaker 3 (07:04):
One of the most common complaints we get is my
child's ear is hurting them.
They're in pain, they're indiscomfort, they're
Speaker 2 (07:11):
Pulling at it. Yeah.
Speaker 3 (07:12):
It's really common.
Mm-hmm
having some sort of ear paininfection , uh, a few years
ago, and they're
Speaker 2 (07:20):
Really painful as an adult. Yeah . You're as an
adult. They're ,
Speaker 3 (07:22):
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 afamily. Yeah. And , and I think
it's really important for usto, to honor that and recognize
that if a child's waking upscreaming mm-hmm
. A few times a night mm-hmm
pain. It's, it's awful. It'sreal . Yeah . It's awful for
the whole family. Taking a stepback, what is an ear infection?
(07:43):
I think the classic earinfection we think about is, is
something we call an otusmedia. It's a middle ear
infection. We all have thesetubes in our face, in our, in
our head. They connect ournasal area to our ear and
they're called the eustachiantubes. And they allow mucus and
snot to flow around. They allowfluid to flow. And what happens
(08:05):
in kids is that just the waythe faces are built, those
become a lot flatter as opposedto angled. You don't have
gravity helping you as much.
And , and what that allows ismucus to get stuck, stuck a
little bit more. Yep . Also,what , back to our, our whole
idea, kids have smallpassageways. Yep . And so it's
really easy to get that cloggedup mm-hmm
(08:25):
inflamed. And , and then whathappens 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 themiddle ear is a little chamber
and you start to pack it fullof fluid, you're gonna start
pushing on the one end that's alittle bit flexible and that's
your eardrum. And that is wherekids begin to have a lot of
(08:47):
pain.
Speaker 2 (08:48):
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 (08:53):
And so you see these, these poor children who
are like, it hurts it , it'spainful. When we talk about the
classic ear infection, that'swhat we're treating. And , and
this is the reason why kids,small kids in particular, get
ear infections and get themwith some frequency. It's
Speaker 2 (09:08):
The anatomy. It's
Speaker 3 (09:09):
The anatomy. And so, you know, part of the reason,
Megan , that , that youprobably don't treat a ton of
ear infections, at least atfirst pass , is , is because we
see a lot of kids under the ageof two, right ? Mm-hmm
treat an ear infection, one ofthe key guidelines is how old
is the child? Exactly. Ifthey're under two years of age,
we're much more likely to do acourse of antibiotics because,
(09:31):
well, one, the kid can'tcommunicate with us as well to
know when things are gettingworse. Mm-hmm
But also once they get past two, the likelihood that gravity
size and space will helpimprove its situation on its
own. It is much higher. Yes. Uh, whereas with a under
2-year-old, it may not get aswell as quickly.
Speaker 2 (09:48):
For sure. So let's talk about, you know, the kids
who get a lot of otitis mediaor middle ear infections, at
what point are like, you know,I've treated this kid with four
or five rounds of antibioticsand they're getting better, but
they just keep getting theseear infections. I think maybe
it's time to call it ENT . Sowe ,
Speaker 3 (10:07):
We'll walk down, we'll walk down a stepwise
process with families and, youknow, if it's one day of pain
and, and no fever, we probably,you know, we probably won't
walk down an antibioticpathway, but if we start , uh,
you know, treating your childwith the first line medicine,
which is usually amoxicillinYep . You know, we'll treat the
child and most of the time, 90some plus percent of the time
(10:27):
it gets better. But we have acouple other antibiotics in our
back pocket that if things arenot getting well as quickly, we
may transition to a differentantibiotic. We may try even a
third antibiotic. So we wantkids to start to feel better,
both from a pain perspective,we want that fever to come
down. Frankly, at baseline, wewant families to start to sleep
again.
(10:50):
that's how we would begin thefirst approach. Now we see
those kids and, and frequentlyit has to do with the anatomy.
Um, there's, there's a geneticcomponent to the anatomy Sure.
Is there's a , um, familialcomponent to the anatomy. And
you'll see some kids who justhave , uh, tubes that get
clogged up. Yep . And when thathappens over and over again, if
I see over four in one year,and , and there's other
(11:13):
numbers, like if you see sevenor eight in two years and 10 in
three years. But basically onceI start to see you four times
for an ear infection, I'm gonnasay, you know what, here, I
want you to make an appointmentwith ent . Mm-hmm
. You know, may maybe over thecourse of the next month , uh,
well , you know, you maybe itgets better and everything,
everything is perfect. Great.
Yeah . But at least you havethat appointment. And then when
you go see the ENT doctors, youcan discuss whether there's
(11:35):
benefit to doing somethingfurther. And usually that's
something further is somethingthat you're an expert in again.
Mm-hmm
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 overagain, when we start to see
that look in the eyes ofparents, we're like , we're
done. Yeah.
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 youdon'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 ourcolleagues and then you all do
magical work with them and ,uh, and, and really can, can
make a quality of life waybetter 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 takechildren to the operating room.
We do give them generalanesthesia, but it takes about
five minutes. It is so fast.
All we do is make a very smallhole in the eardrum. We go
through the ear canal , uh, sothere's no cuts on the outside
of the ear. There's nostitches. We make a very teeny
(12:34):
tiny hole in the eardrum. Wesuck out all of that fluid
because antibiotics can't getto it. And then we stick a tiny
tube in that hole of theeardrum. It's nothing that you
can see from the outside. Youneed a , what we call an
otoscope to look in the ear andsee 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 thatventilation so it doesn't
(12:58):
prevent the ear infection fromhappening. 'cause like you
said, it's a eustachian tubeproblem. It's anatomical and it
will take time to get better,but when they do get an ear
infection, it doesn't build upthat pressure. So you don't get
the pain, you don't get thefevers. And the best part is it
leaks out of the ear. So momand dad know, oh, this is an
ear infection. I see it. Yep .
(13:19):
The kid is more comfortable,parents are more comfortable.
And the best benefit of all isear drops are 1000% more
effective than oralantibiotics. Yes . They're
tolerated a lot better. And soif your kidneys tubes, I know
we're talking about surgeryhere, but it, it is truly a , a
pretty benign thing and , andcertainly something that helps
these kids. So
Speaker 3 (13:38):
It's remarkable how quick it is. Mm-hmm
nicely they, they come out ofit, and then quality of life
change afterwards. Oh yeah . Oh, if it's needed, you know, I ,
I'd strongly recommend it, youknow, for, for kids who are
having learning challenges orthose speech challenges, you
know, if that's associated withear infections. Yeah. Or if we
start to see every time we seeyour child, there's a big
(13:58):
pocket of fluid, even if it'snot causing 'em discomfort, but
for a long, long time and theirspeech is not quite coming
along, that's also a reallygood reason. We'll send them to
you. Yeah. All to have aconversation. You know, there's
a critical timeframe in whichkids can acquire language
mm-hmm
produce language. And , and weneed to get them hearing and
speaking Yeah . At the , at theright times.
Speaker 2 (14:18):
We've covered a lot of ground here. Dr. Krish , I'm
so glad that you're here. We'regonna take a quick break and
when we come back, we're gonnatalk 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 foryou, your life and all that it
brings. He up in healthcare hasa hospital HCMC, and a network
of clinics both downtown andacross the west metro. They
provide all the primary careand specialty care you would
expect to find, but did youknow they also have services
like acupuncture andchiropractic care available at
(14:52):
many of their primary careclinics and at their
integrative health clinic indowntown Minneapolis? Learn
more@hennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Speaker 2 (15:07):
Welcome back. Let's talk about sore throats. Dr.
Krish specifically strepthroat. 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 sorethroat? When do you test for
strep? When do you giveantibiotics? 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 afever, you need to get seen.
And I just wanna , I throw thatout all the time because , uh,
if you have a small baby whohas a fever, they , they just
need to get seen. Yeah . Uh ,but , uh, my general rule of
thumb on, on other types offevers for our older kids is if
you're having more than acouple days of fever with a
(15:48):
temperature of 1 0 1 or more,come see us. You know, we'll,
we'll check your ears, we'llcheck your throat, we'll check
your lungs. Those are commonplaces that bacteria like to
hide. And, and we'd like totreat that if , if possible.
And, and so then people come inand they've had these symptoms.
And I'll still say the vastmajority of times you have a
sore throat, it's a virus. Yep. And I know folks don't love
hearing that because there'snot a cure all for that. But
(16:09):
the vast majority of the, thegerms that will cause you to
have a sore throat are viruses.
Mm-hmm
Right . And , and when, when isthat? And what do we look for?
We look to see if you've had afever mm-hmm
Like a , a legitimate fever ,uh, you know , a hundred 0.4 or
higher. We look to see if yourneck has any swelling, if you
have any, what we call lymphnodes. Right. Places where we
know that we're fighting thatinfection. Third thing , uh,
(16:31):
and this is one that parentscan, can identify on their own.
Ask your if , if you can getyour child to open up their
mouth big and stick theirtongue out, you may be able to
see white spots. And that is,that is what we call, you know,
that's pus . Yep . On thethroat. Uh, and , and you
sometimes can see that. Andthen , um, this is an
interesting one. Strep throatis more likely when you don't
(16:51):
have a cough. Mm-hmm
families will come in and say,oh , I have this sore throat
and cough. Most often thatactually is a virus 'cause it's
causing multisystems to beinflamed. But if you have strep
throat, strep throat's prettygood at , uh, not causing a
cough, causing the pain to beright in that throat area and
in that, in those tonsils.
Speaker 2 (17:08):
That's right. Yep .
So when do you send these kidswith strep throat To us? Mm-hmm
Speaker 3 (17:13):
uh, you know, if we see thosesymptoms, we can swab a child
right there. Uh, we can get youan answer very quick . Oh ,
Speaker 2 (17:20):
They love that too, right?
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,
answer pretty quickly. We canget you the antibiotics if
that's the case. Mm-hmm
treat you , we can make youfeel better real quick. I will
say Tylenol and ibuprofen inthose settings can do a , a
wonder no matter what the sorethroat is, can make things feel
better. We swab you'repositive, and then three weeks
(17:45):
later you come back again. Andthen a few weeks later, again,
you come back with strepthroat. 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 inanticipation. They're gonna get
one more. Yeah. They're gonnacome see you and , and then you
(18:06):
guys can make an informeddecision about taking out
tonsils, keeping them in. I'llsay, Megan , it seems to me
like when we were younger, theytook out a lot more tonsils.
Yes, they did . They weregetting a lot more conservative
about when we take out tonsils.
Yes. Weighing out the benefitsof, of surgery versus
treatment. And , and I thinkthat's a , that's a really
smart conversation to be had.
There's some other things thatmay cause us to send them to
(18:28):
you. For example, we have somekids who , uh, a family will
say they, they snore likecrazy. 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 worriedabout obstructive sleep apnea.
So, so there's a few otherthings, but I would say the
number one reason that we sendthem to you is they keep
getting strep infections overand over again.
Speaker 2 (18:46):
Yeah. Again, seven is not arbitrary. That is what
our academy guidelinesrecommend. Seven sore throats
in one year doesn't actuallyhave to be strep. And so those
viruses may count, but thetonsils have to be big, red,
ugly kids, miserable, missingtons of school. If a parent
comes in, swollen lymph nodes,like you said, a parent comes
(19:07):
in and tells me all of this,it's pretty much a no-brainer.
We should, we should talk abouttaking the tonsils out. I'll
say just a few things abouttonsil surgery. It is also
something we do all the time.
It's very routine. It is alittle bit more risky than
putting in ear tubes. It takesa little bit longer. If you
were to come to see me, wewould have a whole long
conversation about what surgeryentails. If the child has to
(19:29):
stay at night, which if we'reworried about sleep apnea, we
will typically keep themovernight. If they go home the
same day, they are gonna have areally bad sore throat , uh,
can take up to two weeks. Thisis not to be said lightly.
However, kids tend to bounceback really quickly. It's
better to do it when they'reyounger, under 12. And it does
make a difference. It requiresa conversation and , and really
(19:50):
making sure that that's theright thing for the child
because it is a surgery. Sowe'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 andknowing their lived experience,
knowing how frustrating thisprocess is, but, but have a
conversation about the risksand benefits. Yeah . And, and I
think you all do such a nicejob 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
generation than you and I, theytook out everybody's tonsils.
It was like somebody in theirfifties and sixties doesn't
have their tonsils. Thependulum swung the other way.
Nobody got 'em out. And now wehave these lovely guidelines,
which is super helpful. Solet's switch gears to cough.
(20:26):
We're gonna wrap up with thistopic. And so I, I kind of
wanna focus on two things.
Croup and RSV. Uh, you know, wealready mentioned the quad
demic in the beginning of theshow with RSV, but croup
happens. I mean, both of mykids had croup and it's scary.
And so tell me, let's talkabout the symptoms of croup.
You know, what you guys do forcroup?
Speaker 3 (20:45):
Yeah . Yeah. So, so coughs, coughs are everywhere.
And if you walk through anydaycare or school in America,
you will hear coughs left andright, especially right now.
Mm-hmm
coughs and, and there's a lotof things that can cause coughs
back to this idea that you canhave, some of you can have
viruses, you can haveallergies, you can have
bacteria. And so part of ourconversation that we're gonna
have with you and your familywhen you come in is what could
(21:07):
be causing this? The mostcommon things to cause cough
once again, are viruses. Thingslike RSV and croup . Croup is a
specific type of cough. It's aspecific sound of a cough. We ,
we equate it to a barking coughand we equate it to a barking
seal cough. And when you hearit, you know, you , you , you
will know. I encourage everyonego , go on YouTube right now
and, and, and Google what abarking cough sounds like.
(21:29):
You're gonna hear it. And it's,it's not actually , cru is
actually not a diagnosis of aspecific germ. It's a , it
means that a specific part ofyour airway is infl inflamed.
Yeah . And , and so you couldactually have RSS V cause croup
, you can have, you know ,parainfluenza, which is the
most common one. You can have alot of different germs cause a
croup, but it means that acertain part of your body is,
is inflamed. And that's why youhave this funny sounding cough.
(21:51):
Um, and so it , it gets to be ascary thing because it's a
scary sounding cough. Yeah.
It's harsh. It , it's, it'sdifferent 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 kidswill, will often tell you that
I'm having a , a difficult timebreathing mm-hmm
. And it , it's challenging.
And anytime a child says that,I mean, that's worthy of panic.
Yeah . No way . And, and Iwouldn't say panic, but I would
say , uh, take it seriously.
Yeah. Like, like, let's addressit. 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.
Speaker 3 (22:23):
That's, that's exactly right. When if , if
someone says they're havingdifficulty breathing anytime ,
I think it's, it's, it's worthyof our full attention. So the
nice thing about croup thoughis, is like some of these other
things, we know how to treatit. We know how to make kids
feel better. We have specificmedicines, steroids that could
drawn , that will make thingsfeel better. And if we need to
treat it more aggressively thanthat, whether it's in the
(22:43):
hospital or the emergency room,we can, we have other
medicines. There's also somethings families can do at home.
And this is actually somethingthat I would say for, for any
type of cough, I would say ,uh, give your child two warm
steam baths a day. So steam upthe bathroom with a hot shower,
make it nice and steamy, andlet them sit there and breathe
that warm air. Yeah . That canbe very helpful and , and
calming for them. My big advicearound coughs generally
(23:07):
speaking is this one, ifsomeone tells you they're
having difficulty breathing,take it seriously. Two, if you
see ribs when a child isbreathing, yes. You need to get
seen quickly. So , um, I I , Ijust watch a child breathe for
a minute, watch my childrenbreathe for a minute. If you
can see those ribs tuggingmm-hmm
If you can see a childbreathing too fast, faster than
(23:28):
they normally breathe for, forprolonged periods of time,
bring 'em in. No one's evergonna fault you for that. We
wanna see them, we wannaevaluate, and we probably have
some intervention that's gonnamake them feel better.
Speaker 2 (23:38):
Yeah. And you mentioned the steroids. I mean,
steroids for this, I think dowonders, and I've seen it in my
own children as well, from anENT perspective on croup. The
only thing that I'll say, and,and you of course know this, is
a kid really shouldn't begetting croup all that much.
Right. That part of that airwayshould not be continually
getting infected and inflamedover and over again. And so,
(23:59):
you know, we always say you'reallowed to have croup once or
twice. Uh, if you're havingcroup more than two times in a
year, it could be an indicationof some anatomical deformity.
And that would be an indicationto come and see ENT. And we
have some nice little camerasand tools that we can do to get
a good look down there, makesure everything looks okay, but
we'll, we'll look for anynarrowing of the airway or
(24:22):
floppy airway or cyst or cleftsor 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'redefinitely calling you all .
Yeah . Uh , I'll just say aboutRSV , it's in the news. It's
everywhere. RSV , um, likegroup will cause you to have a
cough. Uh, it's just reallyprominent in, in little babies.
Mm-hmm
if, if little babies under ayear or under six months in
particular get RSV back to ourwhole principle of a lot of
(24:48):
mucus produced by these virusesin small airways Yeah. Can
cause a difficult timebreathing. And so that's when
we see sort of the biggestproblems. That's why it's, it's
really important to wash yourhands and take care and not be
around babies when you're sick,because you don't want them to
get that level of mucus intheir lungs.
Speaker 2 (25:03):
Right. Exactly.
Really great advice. Well, Dr.
Krish , I can't thank youenough for being here and
sharing your wisdom. You are awealth of knowledge and I am so
happy to have you here atHennepin, taking care of my
kids and all of our kids in thecommunity. Uh, the pediatrics
department here , uh, is justunbelievable. Just a pool of
amazing, amazing practitioners.
(25:24):
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, tosupport our children.
Speaker 2 (25:29):
Thank you everyone.
Thanks for listening. Uh, ifDr. Hilton isn't here in two
weeks, it's 'cause he lost hisjob. We'll be back in two weeks
no matter what. And in themeantime, be healthy and be
well.
Speaker 1 (25:41):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(26:03):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At Highball Executiveproducers are Jonathan, CTO and
Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(26:25):
time, be healthy and be well.
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