Croup

Croup

CROUP

Croup is a viral infection of the voicebox (larynx) and surrounding areas. It usually is accompanied by other symptoms of a cold, so the child may have the nasal congestion, runny nose, sore throat, and fever common to any viral respiratory infection. However, because the voicebox is involved, the child may be hoarse, the cough may sound unusual, and he may make another noise when breathing called stridor. The cough of croup is often described as tight, brassy, or like the barking of a seal.
Stridor is a high pitched, harsh, vibrating sound that the child makes when he breathes in. In mild cases, it only occurs when he cries or breathes hard. When croup is more severe, the stridor occurs even when the child is quiet and resting. At this point, he may show other signs of breathing difficulties, such as sucking in of the chest so that the ribs are visible (retractions).
Croup is common in children between one and five years old. Most cases last three to five days. Although it often seems frightening, it is usually not severe. Most children do well and can safely be treated at home. Croup seems to recur often in certain children, but most will have it only once or twice.

TREATMENT:

1. Stay calm. You will be able to comfort your child and help more if you stay relaxed.
2. Run a cold steam vaporizer or humidifier next to the child’s bed while he sleeps.
3. If he awakens at night with a severe coughing spell and stridor, try the “foggy bathroom treatment”. Take him into the bathroom and close the door. Turn on the hot water in the shower and sink. Allow him to rest and breathe the warm foggy air for ten minutes. This will usually relieve his breathing difficulty.
4. If the “foggy bathroom” doesn’t help, take the child outside. Keep his body warm, but allow him to breathe the cold night air. This will usually relieve the swelling in the voicebox and allow him to breathe more comfortably.
5. If these measures do not help, call the advice nurse in the pediatric clinic (or in the emergency room if it is after 11PM) to arrange an emergency appointment.
6. Increase fluid intake. Don’t be surprised if his appetite for solid foods decreases.
7. Acetaminophen (Tylenol, Panadol, etc.) can be given to reduce fever if his temperature is over 101 degrees.
8. As in other viral illnesses, antibiotics do not help croup.
9. Decongestants may help the child’s nasal symptoms, but generally have no effect on the cough or stridor. Cough medicines are usually not helpful either.

Rarely, two other more serious problems may mimic croup:

1. Inhaled foreign body: Let us know if your child may have choked on a toy, button, food etc.
2. Epiglotitis: This is a bacterial infection of the structure that closes over the voicebox during swallowing. It usually becomes severe more quickly than in croup, and is accompanied by a high fever, drooling, difficulty swallowing, and severe breathing difficulty. The child should be seen by a doctor immediately if these symptoms are present.