Dr. Deena Blanchard, pediatrician and font of knowledge, gives us the tools we need to stay calm and carry on.
What is croup?
Croup is a general name for inflammation for the upper airways, specifically in the area around the vocal chords. If croup is sever their can be swelling around your trachea (wind pipe) as well. Croup is caused by a variety of common viral illnesses. This article is meant to help you better understand the causes of croup, treatment, duration of symptoms and when to seek medical attention. It is NOT a substitute for your pediatrician. If you have any concerns about your child at all you should call your doctor right away.
What are the symptoms of croup?
One of tell tale signs that a child has croup is a distinct barking cough that sounds like a dog or a seal. Other common symptoms are fever, runny nose, sore throart, and decreased appetite. Croup causes inflammation of the upper airway which leads to hoarseness and a barking cough. Adults and older children have larger airways so croup usually presents as a bad cough. In young children, because their airways are smaller to begin with, they can have trouble breathing with croup. This presents itself as a high pitched sound while your child is breathing in, known medically as stridor; that is often worse when cough or crying. The symptoms of croup are often worse at night.
How is Croup Diagnosed?
The diagnosis of croup is made by clinical history. Your doctor will recognize the sound of the barking cough. If your child is making the high pitched noise with cough or crying your doctor will likely prescribe a three day course of oral steroids to help reduce the inflammation in the upper airway. This decreases the airway swelling and allows your child to breathe more comfortably. Your child will continue to cough, but the high pitched noise when breathing in should resolve.
How can I treat croup?
Since croup is caused by a viral illness, there are no magic medicines for croup. However, there are some supportive measures you can take to make your child more comfortable. Steam is your best friend when a child has croup. Go into your bathroom, turn on the shower and get the bathroom as steamy as you can. Then sit in the bathroom (Not in the hot shower) for 15-20 minutes with your child. This should help decrease the barking cough and help your child feel more comfortable. The most important thing is that it helps your child to breathe more comfortably (ie; that the high pitched nose with breathing stops.) You may need to repeat this multiple times during the night. Sometimes, going out into the cold air can help as well. This causes the blood vessels near the vocal cords to clamp down and thereby decreases swelling. Some parents find that alternating between the steam and the cold air (such as the freezer or the window on a cold evening) is helpful. If your child continues to make a high pitched noise when breathing, despite your having used steam and cold air it is time to call your doctor right away.
You can also use medications like acetaminophen or ibuprofen (if your child is over 6 months) to help your child feel more comfortable regardless of whether or not your child has a fever. All dosing is weight based. For the correct dose of either medication for your child click here. It is not recommended to use cough or cold medications in children. If your child is greater than one year old, you may use a teaspoon of honey before bedtime to help soothe the throat and decrease coughing. Encourage your child to drink plenty of fluids.
What is the natural disease course of croup?
In most cases, children will have 2-3 days of barking cough that may or may not be accompanied by fever. Around day 3 of illness children will often develop nasal congestion and then on day 4-5 the cough will transition into a wet mucousy cough that can last about 7-10 days.
When should I call my doctor or seek more emergent medical care?
1. If your child is making a high pitched noise with cough or crying you should see your doctor, if this is over night and the noise resolves with steam, you should see your doctor first thing in the morning.
2. If your child is making a high pitched noise while breathing in at rest (not crying, coughing or running around) you should call 911.
3. If your child’s lips are turning blue call 911
4. If your child is not drinking well and has not urinated in >6-8 hours, is crying with out tears or seems extremely tired call your doctor right away.
5. If your child has excessive drooling and cannot swallow their own saliva.
6. If your child has had fever for > 3 days
7. If your child if persistently irritable despite pain medication or if your child is unusually sleepy
8. If you are unsure of your child’s medical condition, it is always best to contact your pediatrician.
While croup is scary for parents (I know from personal experience), it is often mild and most children recover within a week or so. However, croup can develop into something more serious and it is important closely monitor your child especially during the first few days of illness. If you are unsure of what to do it is always best to talk to your child’s doctor, they can help guide you through what the next best steps are.
Deena Blanchard MD, MPH is a board certified pediatrician working at Premier Pediatrics. Dr. Blanchard has been with Premier since 2009. She completed her residency training at the Morgan Stanley Children’s Hospital of Columbia Presbyterian; where she was awarded Physician of the Year in 2007. There she served as a family advocate as part of the family advisory comity. Prior to attending medical school, she completed her Masters of Public Health at Temple University with a focus on health education. Dr. Blanchard attended Medical School at Albert Einstein College of Medicine where she was awarded Alpha Omega Alpha and The American Women’s Association Glascow Rubin Achievement Award. She currently guest blogs for many child-parent sites.
Premier Pediatrics is an established pediatric practice with locations in both Brooklyn and Manhattan. We have been tending to children for over 30 years with a strong focus on state of the art medical care and family wellness. We offer prenatal visits free of charge which can be scheduled by either calling the office 212-598-0331, 718-369-0817 or via our Prenatal Guide. You can LIKE us on Facebook.