Croup

Croup is a common respiratory illness in children aged six months to six years, primarily caused by a viral infection, often parainfluenza, leading to swelling in the upper airway (larynx and trachea). The hallmark symptom of croup is a distinctive barking cough, similar to a seal's bark, accompanied by a hoarse voice. Children may also experience stridor, a high-pitched sound when inhaling. Symptoms often worsen at night, causing parental concern, and may include a low-grade fever.

Most mild croup cases can be managed at home with supportive care. Keeping the child calm is needed, as crying and distress can exacerbate symptoms. Moisturizing the air with a humidifier or steam from a bathroom can soothe the airways. Exposing the child to cool night air or seating them near an open freezer may also help. Ensuring they stay hydrated by drinking plenty of fluids is also beneficial.

In certain situations, medical attention may be necessary. Seek urgent care if the child shows signs of respiratory distress, such as retractions (skin pulling in around the throat, ribs, or collarbones), continued stridor even when relaxed, or if the child appears very unwell, extremely agitated, or unusually tired. In these cases, visit our office immediately or go to Arkansas Children's Hospital ER. 

Treatment of Croup:

1. Give the child plenty of clear liquids and use a vaporizer to keep the secretions moist (we recommend cool mist).
2. You may treat the fever with acetaminophen (Tylenol, see Dosing Guide for dose on page 235) for comfort’s sake. Please see the section on fever for a description of the benefits of fever in fighting off a viral infection.
3. During an attack of breathing difficulty, place the child in the bathroom, turn the shower on hot and fill the room with steam. Fifteen to 20 minutes in this environment will often relieve the attack. If this does not work, wrap the child up warmly and take her out into the cool night air for a few minutes. Also, hold your child upright. This moves the swollen voice box above the heart minimizing swelling.
4. If these measures fail to help and she continues to have breathing difficulty, she will need to be taken to our office or to the emergency room. Effective treatment with a cortisone type steroid medication is available. We do not call in steroids for croup. These medications require an office visit for a prescription. Nebulized epinephrine might be used to provide quick, although temporary, relief of airway obstruction. If your child receives nebulized epinephrine and then goes home, watch for the symptoms recurring. If they do, return for additional treatment immediately.
5. If your child develops an inability to swallow manifested by constant drooling and has the above symptoms of barky cough, fever (usually high), hoarse voice and breathing difficulty, she may have a more serious bacterial infection of the throat called epiglottitis. This requires an immediate trip to the emergency room.