Since I’ve seen several cases of croup this week, I thought it would be a good time to say a word about that condition.
Croup occurs mostly in children aged 6 mo-3 years. The problem localizes in the subglottic airway(below the vocal cords). Some but not all children have fever. The most common symptom is stridor–a harsh cough sometimes described as “barky”, “brassy,” or “seal-like.” Stridor often worsens when the child is upset and crying. Some children will also develop bronchospasm–wheezing–at the same time, but, again, not invariably. So, what can be done?
What you can do:
- Acetaminophen or ibuprofen for fever or discomfort
- Lots of fluids
- Cool mist humidifier or vaporizer by head of your child’s bed
- For attacks of breathing difficulty, bring your child into the bathroom, close the doors and windows, and run the shower good and hot to fill the room with steam; stay in there for 15-30 minutes to loosen the tight cough
- Often 10-15 minutes of breathing cool air after the above will finish the job and bring relief. Bundle your child up and walk outside for a few minutes after the shower routine above if she is still symptomatic
- Cough treatments as I’ve discussed previously
What I do:
- Steroids–usually one dose only is enough and most studies indicate that oral administration is just as effective as injections
- Inhaled epinephrine
- Bronchodilators like albuterol may help with wheezing but not stridor.
Croup is usually a mild, if uncomfortable, illness. Infrequently, a child’s difficulties may necessitate hospital admission for serial breathing treatments, IV fluids, or supplemental oxygen. However, please note that even in these cases, croup will usually resolve on its own in 3-4 days. Croup is almost always caused by viruses so antibiotics are of no use. Some children have spasmodic croup–recurring episodes of abrupt onset of stridorous coughing. This is more allergic in nature. The treatment is the same as above and the symptoms are usually very responsive to these interventions.
You should call promptly if you notice:
- Cyanosis (blue lips or tongue)
- Retractions (skin sucks in outlining the ribcage while inhaling)
- Excessive drooling
- Rapid breathing–1 breath per second that does not improve within one hour
Please forward questions or comments, and thanks for following.