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  • Croup

    Definition

    • Infection of the voicebox (larynx) caused by a virus
    • The croupy cough is tight, low-pitched, and barky (like a barking seal)
    • The voice or cry is hoarse (called laryngitis)
    • Some children with severe croup get a harsh, tight sound while breathing in. This is called stridor.

    First Aid Advice For Stridor (Harsh sound with breathing in) or for Nonstop Coughing:

    • Breathe warm mist in a closed bathroom with the hot shower running. Do this for 20 minutes. You could also use a wet washcloth held near the face. Another option is to use a humidifier containing warm water.
    • Caution: Do not use very hot water or steam which could cause burns. Hot steam can also cause high body temperatures.
    • If warm mist fails, breathe cool air by standing near an open refrigerator. You can also go outside with your child if the weather is cold. Do this for a few minutes.

    Stridor: A Complication of Croup

    • Stridor is a harsh, raspy tight sound best heard with breathing in
    • Loud or constant stridor means severe croup
    • All stridor needs to be treated with warm mist
    • Most children with stridor need treatment with a steroid (Decadron)
    • For any stridor, see FIRST AID for treatment

    Causes

    • Most often, caused by a virus
    • Croup symptoms can also be caused by a food allergy. This can be life-threatening.

    Return to School

    • Your child can go back to school after the fever is gone. Your child should also feel well enough to join in normal activities. For practical purposes, the spread of croup and colds can’t be prevented.

    When to Call Us for Croup

    Call 911 Now (your child may need an ambulance) If:

    • Severe trouble breathing (struggling for each breath, constant severe stridor)
    • Passed out or stopped breathing
    • Lips or face are bluish when not coughing
    • Croup started suddenly after bee sting, taking a medicine or allergic food
    • Drooling, spitting or having great trouble swallowing (Exception: drooling due to teething)
    • You think your child has a life-threatening emergency

    Call Us Now (night or day) If:

    • Caution: For any stridor or trouble breathing, see FIRST AID
    • Stridor (harsh sound with breathing in) is heard now
    • Your child looks or acts very sick
    • Choked on a small object that could be caught in the throat
    • Trouble breathing (Exception: present only when coughing)
    • Lips or face have turned bluish during coughing
    • Ribs are pulling in with each breath (retractions)
    • Can’t bend the neck forward
    • Severe chest pain
    • Age less than 1 year old with stridor
    • Weak immune system. (Such as sickle cell disease, HIV, cancer, organ transplant, taking oral steroids)
    • Fever over 104° F (40° C)
    • Age under 12 weeks old with fever. (Caution: Do NOT give your baby any fever medicine before being seen.)
    • You think your child needs to be seen urgently

    Call Us Within 24 Hours (between 9 am and 4 pm) If:

    • You think your child needs to be seen, but not urgently
    • Had croup before that needed Decadron
    • Stridor (harsh sound with breathing in) occurred but not present now
    • Nonstop coughing
    • Age less than 1 year old with a croupy cough
    • Earache OR ear drainage
    • Fever lasts more than 3 days
    • Fever returns after gone for more than 24 hours

    Call Us During Weekday Office Hours If:

    • You have other questions or concerns
    • Coughing causes vomiting 3 or more times
    • Croup is a frequent problem (3 or more times)
    • Barky cough lasts more than 14 days

    Parent Care at Home If:

    • Mild croup with no complications

    Care Advice for Croup

    What You Should Know:

    • Most children with croup just have a barky cough.
    • Some have tight breathing (called stridor).
    • Coughing up mucus is very important. It helps protect the lungs from pneumonia.
    • We want to help a productive cough, not turn it off.
    • Here is some care advice that should help.

    Humidifier:

    • If the air in your home is dry, use a humidifier.
    • Reason: Dry air makes croup worse.

    Homemade Cough Medicine:

    • Goal: Decrease the irritation or tickle in the throat that causes a dry cough.
    • AGE 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 ml). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old.
    • AGE 1 year and older: Use HONEY ½ to 1 teaspoon (2-5 ml) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough. If you don’t have any honey, you can use corn syrup.
    • AGE 6 years and older: Use COUGH DROPS to coat the sore throat. If you don’t have any, you can use hard candy.

    Non-Prescription Cough Medicine (DM):

    • Non-prescription cough medicines are not advised. Reason: No proven benefit for children and not approved under 4 years old. (FDA 2008.)
    • Honey has been shown to work better for coughs. (Caution: Do not use honey until 1 year old).
    • If age over 4 years old, you might decide to use a cough medicine. Choose one with dextromethorphan (DM). It’s present in most non-prescription cough syrups.
    • When to Use: Give only for severe coughs that interfere with sleep or school.
    • DM Dose: See Dose Table. Give every 6 to 8 hours as needed.

    Coughing Fits or Spells:

    • Breathe warm mist (such as with shower running in a closed bathroom).
    • Give warm clear fluids to drink. Examples are apple juice and lemonade. Don’t use before 3 months of age.
    • Amount. If 3 – 12 months of age, give 1 ounce (30 ml) each time. Limit to 4 times per day. If over 1 year of age, give as much as needed.
    • Reason: Both relax the airway and loosen up any phlegm.

    Fluids:

    • Try to get your child to drink lots of fluids.
    • Goal: Keep your child well hydrated.
    • It also will thin out the mucus discharge from the nose.
    • It also loosens up any phlegm in the lungs. Then it’s easier to cough up.

    Fever:

    • For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. See Dose Table. Note: Lower fevers are important for fighting infections.
    • For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.
    • For babies, dress lightly. Don’t wrap in too many blankets. Reason: Can make the fever higher.

    Sleep Close By to Your Child:

    • Sleep in the same room with your child for a few nights.
    • Reason: Stridor can start all of a sudden at night.

    Calm Your Child if He or She has Stridor:

    • Crying or fear can make stridor worse.
    • Try to keep your child calm and happy.
    • Hold and comfort your child.
    • Use a soothing, soft voice.
    • For a few days, give in more than usual to his or her demands.

    Avoid Tobacco Smoke:

    • Tobacco smoke makes croup much worse.

    Return to School:

    • Your child can go back to school after the fever is gone.
    • Your child should also feel well enough to join in normal activities.
    • For practical purposes, the spread of croup and colds cannot be prevented.

    What to Expect:

    • Most often, croup lasts 5 to 6 days and becomes worse at night.
    • The croupy cough can last up to 2 weeks.

    Call Your Doctor If:

    • Stridor (harsh raspy sound) occurs
    • Croupy cough lasts more than 14 days
    • Your child becomes worse

    Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

    Author and Senior Reviewer: Barton D. Schmitt, M.D.
    Copyright 1994-2013 Barton D. Schmitt, M.D.

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