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Entries in Croup (1)


FYI: Croup is here! 

This past week in clinic I saw several young children with Croup.  Their stories are all very similar - a day or two of runny nose, maybe a fever, and then they come to clinic after a long night of helping their child who is struggling with a barky cough and trouble breathing.  

Croup is a viral illness causing swelling of the voice box (larynx) and windpipe (trachea)  Parainfluenza virus is the most common cause of croup, but other viruses can cause it as well. The classic barky (or seal like bark) cough and trouble breathing comes from that welling in the back of the throat.  Many children also have hoarseness and, in severe cases, some kids develop a high pitched sound when they breathe in which we call "stridor".

What are the symptoms of Croup?

  • The first symptoms of croup are similar to that of a common cold such as stuffy nose and fever.
  • The fever is usually between 100.4-104
  • After 1-2 days of cold symptoms, the classic barky cough develops (heard at the beginning of this video clip, also you hear the "stridor" around 50 seconds into this clip and the child shows signs of trouble breathing - sucking in between the ribs and flaring out nostrils, etc).
  • The cough is usually worse at night and peaks on night 2 or 3 (then improves gradually)
  • Many children also have a hoarse voice because of the inflammation of the larynx and vocal cords
  • Stridor is a harsh and raspy sound when the child breathes in and signals increased swelling in the back of the throat - which requires prompt attention! (See below)  

How can I treat Croup?

  • Since croup is a viral infection, antibiotics are of no help.
  • If your child wakes up at night with this barking cough and if you hear stridor (see video clip) moisture is key to decreasing the swelling.  The temperature doesn't matter so either taking your child outside (thankfully nights in North Carolina are humid) or sit with your child in a warm steamy bathroom (while running a hot shower) After about 10-15 minutes of exposure to steam/humidity, your child’s airway should become less inflamed and more clear.  If they aren't improving - seek emergency treatment at WFBH Brenner Children's Hospital (your child may need a special treatment of aerosolized epinephrine that is only available in the Emergency Department).
  • A cool mist humidifier in your child’s room will also help her breathe easier at night.
  • Be sure to treat your child’s fever with a fever reducer. This will make her a lot more comfortable and ease their breathing some as well.
  • Keep your child as calm and comfortable as possible. Crying makes this barking cough sound worse.
  • Continue to offer clear liquids throughout the day to avoid dehydration
  • Do not use cough syrups or antihistamines. They do not help children with croup.

When to call the Doctor

  • Your child has stridor (the harsh and raspy sound made by taking a breath).
  • Your child is having difficulty breathing (sucking in between their ribs or above their collar bone with each breath or flaring out the nostrils)
  • Your child cannot talk because she cannot catch her breath
  • Your child appears very ill and sleepy
  • Your child has a pale or bluish discoloration around her mouth
  • Your child’s croupy cough does not seem to be getting better after the 3rd day
  • Whenever in doubt, call your child’s doctor.

Most cases of croup are mild. Your child may return to school or daycare once the fever has resolved and your child is ready to participate in his daily activities. The best prevention for croup is diligent hand washing since croup is spread just like the common cold: droplet transmission (coughing and sneezing near others) and person to person contact (dirty hands).