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What is croup?
Croup is an acute viral infection which causes
narrowing of the airway below the vocal cords and the trachea. In
its early stages, the virus can produce an inspiratory sound called
stridor or a tight, low pitched barking cough (like a seal or a
goose). After a few days the tight cough is often replaced by a more
productive loose cough. For little known reason, children’s symptoms
are worse at night. Sometimes, the first indication of the illness
is the child awakening at night with a very harsh loud cough. The
cough is usually accompanied by crying which may exacerbate the
symptoms. Croup can be frightening for parents but it is usually a
mild illness lasting from 1-5 nights and the cold symptoms that
follow may last as long as 10 days. Symptoms may also be severe
enough to require emergent evaluation. Other symptoms that may
accompany the diagnosis of croup include a hoarse voice, nasal
congestion, fever (usually 104° or lower) and a sore throat.
What causes croup?
Croup may be caused by many viral agents. The
parainfluenza viruses are quite common, as well as respiratory
syncytial virus (RSV), and influenza viruses (both A and B).
What
are the peak ages of croup?
Croup occurs primarily in children between the
ages of 3 months and 3 years of age with the peak incidence in the 2nd
year of life. Older children and adults usually present with just a
raspy hoarse voice or laryngitis with sore throat.
How
is croup spread from person to person?
Infection with croup usually occurs with
contact from respiratory fluids (mucus or saliva) and spreads from
fingers to mouth to respiratory tract. From there, the virus
multiplies and spreads to the large airways and causes inflammation
or swelling of the larynx and trachea. Because smaller children
have smaller (the width of your pinky finger) and typically more
pliable airways, this population is usually more at risk of having
more severe symptoms.
How do the symptoms
start and when will they go away?
The child will awaken on the first night with a
spasmodic cough and respiratory distress. The child’s symptoms are
most noticeable at each inspiration or air coming in. There may be
some retracting (sucking in) of the muscles around the rib cage so
that the edge of the ribs and the clavicles are more prominent. This
occurs because the child is experiencing a harder time getting air
into the lungs. You may notice that your child looks like he/she is
running a race. Sometimes the symptoms may stop for awhile- (like
all next day) and then restart again (possibly after a nap or later
in the evening). This respiratory distress cycle may repeat over 1-3
days and possibly be accompanied by fever and then “turn into” a
regular cold over 7-10 days.
How do I treat croup?
Treatments for croup are directed at decreasing
the swelling of the airway. Appropriate dosing of ibuprofen
(Motrin/Advil) may help decrease the swelling and help lower fever
if present. Please see the
dosing chart. Turn on the hot water in the shower and sink
and make a “steam shower”. Sit in there with your child to relieve
the inflammation which is causing the cough. Try to calm your child
as best as possible- singing, reading, any other distraction.
Crying makes the symptoms worse. Bundling your child up and going
outside to breathe cold night air may also help relieve the stridor.
If after the steam shower and the trip outside your child is still
very noisy with every inspiration and still working hard to breathe,
you may need to go to the emergency room for immediate care.
Therapies in the ER include a breathing treatment with racemic
epinephrine and/or the administration of steroids. Steroids can also
be prescribed in the office by the doctor or nurse practitioner.
Some children may be more susceptible to recurrent episodes of
croup. If steroids are prescribed for your child once, they may be
recommended if croup recurs. Please call your doctor.
Call the office if:
the coughing spasms are getting worse
the attacks of stridor are occurring with more
frequency
your child is not drinking much and has not had
urine output in 8 hours
you have other concerns or questions
Please call the
doctor immediately if:
The stridor or raspy
breathing at rest is occurring during the day
Your child develops retractions (tugging or
sucking in around the ribs)
The warm mist in the steam shower or a trip out
in the cold night air does not help
You feel your child is getting worse.
Call 911 or go to
the ER immediately if:
Breathing is very difficult
Your child is drooling excessively and can’t or
won’t swallow easily
The lips turn blue or your child is dusky
around the mouth
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