CROUP

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WHAT IS CROUP? Croup is a viral infection that looks just like and average cold except that the child will have a bark like cough. The barky cough always seems to get worse between 1 and 3 am in the morning.

MAKE SURE IT IS NOTHING WORSE: Notify physician immediately for any of the following:

• Labored breathing not relieved by the treatment below (fast , hard, difficulty taking a breath not due to congestion)

• Blue color to the lips (or nose, ears, body) not just around the lips.

• Alteration of consciousness (difficult or unable to arouse)

• Temp above 104 F

• Difficulty swallowing

• Patient very anxious or scared looking

• Patient is drooling (not due to teething)

NORMAL COURSE OF THE ILLNESS

• Croup is a viral infection that causes a narrowing of the airway just below the vocal cords.

• This tends to be worse at night, when the child is excited and when the child lays down.

• The croupy cough sounds like a dog or seal barking (it is not congested).

• The cough tends to get worse the first two nights and then resolves over the next 1 to 2 weeks.

• The fever, if present, only goes up to 102 and rarely lasts more than 2 days.

• The remaining symptoms will resolve over the next 10 to 14 days.

• The incubation period is 2 to 6 days and the child is contagious from 4 to 21 days or until they are improved.

 TREATMENT

• Run a cool mist humidifier in the child’s room.

• Close the door to the room so that the humidity builds up and aim the mist from overhead into the child’s crib.

• You may line the crib with blankets on the sides to hold the mist in.

• Cool mist is better that warm mist for croup, but the warm mist is still better than nothing.

• If your child has a attack of labored breathing try:

• Calm him / her down as increased excitement level worsens the problem. The importance of calming cannot be overemphasized.

• If there is a nebulizer available, then give the child a treatment with only saline. This is the same, but better, than the following two treatments.

• Take your child into the bathroom and make it very misty by running the shower full hot and closing the door.

• Take your child out on the porch to breathe the cool night air.

• You may repeat these treatments as often as necessary.

• If your child still has labored breathing after the above treatments:

• If your child has asthma, then give a nebulizer with the usual medicine and follow your physician’s usual plan for asthma.

• Try the other treatment above (porch vs bathroom).

• If your child is still breathing hard, call the physician on call and let the operator know that your child is having difficulty breathing. You should get a call back within 10 minutes, if not call again.

• If your child’s breathing is very labored and you cannot wait for the call back, drive your child to the emergency room with the car windows down, but wrap your child in blankets to keep him / her warm. Most of the time the cool air rushing by their face calms the child and resolved the labored breathing. If your child improves, then return home and if not, then go ahead to the ER.

• If your child has a particularly bad night, such as you and the child are up all night due to the cough:

• We should see you in the office the next morning. The croup symptoms will be better by the time we see you, but the nature of croup will make the next night much worse.

• We can give you breathing treatments in the office with steroids (Pulmicort) to reduce the swelling below the vocal cords. The steroid nebulizer treatment consists of tiny doses of a steroid delivered via a nebulizer to the airways. This breathing treatment will be most effective 8-16 hours after the dose is given. To give you an example of how low / safe the dose of inhaled steroid is: emergency room doctors often give a shot of steroids to reduce the swelling below the vocal cords. That injected dose is 40 times the dose given in the nebulizer and only a tiny fraction of the inhaled steroid is absorbed in the blood.

• We can also prescribe a nebulizer machine for you to use at home (they can be rented, not just purchase and most insurances cover this rental).

Medicines: In general there are no over the counter medicines that will help croup. It is a viral infection and will not respond to antibiotics either. As you read above, if your child is upset or excited, then that makes the croup worse. Therefore, if the medicine makes your child irritable, then the medicine will make your child worse. If the medicine calms your child down, then it actually may help the situation.