Croup

     Spring and Fall are times when children get croup. Croup is an infection of the upper airway near the voice box that is most often caused by a virus. It is common in children 6 months to 36 months of age. As with most viral upper respiratory infections, it begins with runny nose, congestion and night fever. In the evening of the second or third day, the child begins to get hoarse and develops a barking, seal-like cough. This comes along with a noise called “stridor” which is a high-pitched noise made when the child breaths in (a “wheeze”, the sign of asthma, is a noise made when the child breathes out). Croup is worse between10 pm to 4 am. The symptoms improve during the day but return at night for about the next three nights.

     Mild viral croup will give the child a barking cough at night and some stridor after a coughing episode, but the child will be alert, responsive and having no other problems. This can be treated with humidified, cool air or a walk in the cool, moist night air common in Spring and Fall. Another common treatment is warm, moist air – sitting in the bathroom with the hot water running in the shower. Encourage the child to keep drinking fluids, don’t allow any smoking around the child and, if the child has fever, you can give fever medication to make the child more comfortable (not to lower the fever).  Avoid decongestants or cold and cough medications.

     If the child is breathing rapidly, seems to be working harder at breathing, has stridor continuously, is agitated or acting more ill, he needs to be seen. Even though antibiotics aren’t helpful for viral infections, there are medications your child’s caregiver can give to help relieve the croup symptoms. Respiratory distress, severe throat pain, and difficulty swallowing can all be signs that a more severe infection may be present and the child needs to be seen immediately.

     There are children who seem to get croup frequently. Doctors argue about what causes this “recurring croup” but it happens more often in families with a history of allergies and asthma. In my practice, I found that if I treated these children more like asthmatics and gave them inhaled medications when they first got cold symptoms, they did not get croup as often.