BLOG ENTRY 4
Observe the world around you and reflect on … Habits, ‘truth’ or other phenomenon that have grown from tradition or other source (e.g. family, disciplinary or cultural) and become part of our ‘practice’ that may or not have any evidence base for the practice. 

I have been a mother for 15 years and a Registered Nurse for over 20 years. During this time I have been told by family, friends and colleagues that the use of steam is beneficial in the management of croup. I have implemented this method myself both as a mother
(using a home humidifier and the steam from a shower) and a nurse (using a mist tent). I have also encouraged others to apply this method.

The use of steam to manage croup began in the 19th century and has been a mainstay treatment in hospitals and homes throughout the 20th century and into the 21st century (Defendi, 2011). Despite its widespread use, this method has not been scientifically validated, and therefore has no place in evidence based practice (Johnson, 2009).

It was believed that steam moistened airway secretions, decreased viscosity and soothed inflamed mucosa, thereby relieving the hoarse like cough associated with croup.

Studies including the randomised control trial conducted by Scolnick et al. in 2006, and systematic reviews of the literature such as Moore and Little in 2007, have concluded that there is no difference in the outcome between children who were exposed to steam treatment and and those who were not.

In fact, the use of steam in the management of croup is currently regarded as dangerous due to the potential for scalds and burns in young children in the home environment. In the hospital environment concerns have been raised regarding the risk of fungus and molds being present in the "mist tents", as well as the anxiety and agitation which the child may experience while being separated from parents during treatment (Defendi, 2011).

However, when I have used the steam method myself, I believed it was easing the symptoms associated with croup. Was I imagining this, was it coincidence or something else. Maybe further research needs to be undertaken to prove or disprove this theory.

I welcome your comments on the experiences you may have had with the management of croup with steam.



References

Defendi, G. (2011). Croup treatment and management. Retrieved from
http://emedicine.medscape.com/article/962972-treatment

Johnson, D. (2009). Croup. Retrieved from Online version of  BMJ Clinical Evidence
 http://www.clinicalevidence.com

Moore, M. & Little, P. (2007). Humidified air inhalation for treating croup: a systematic review and meta-analysis. Family Practitioner, 24(4), 295-301.

Scolnik, D., Coates, A., Stephens, D., DaSilva, Z., Lavine, E. & Schuh, S. (2006). Controlled delivery of high vs low humidity vs mist therapy for croup in emergency departments: a randomized controlled trial. JAMA, 295(11), 1274-80.