croup

Croup is the term we use to describe a common condition or syndrome of cold symptoms, a hoarse voice, raspy breathing (stridor), and a very characteristic barking cough. While it is usually a mild illness, it can sometimes be severe enough to lead to hospitalization, or very rarely, worse.

The causative organism is usually Parainfluenza virus. Yes, it's one of those pesky viruses we can't do much about.

Mild croup neither requires nor responds to treatment. Measures we commonly recommend (but which may not actually do much) include:

Vaporizers, cool mist preferable (warm mist vaporizers don't work any better and carry a burn risk)
Cough suppressants with dextromethorpham (basically anything that ends is "DM") to prevent coughing fits as much as possible
Plenty of fluids to keep secretions moist (we're big on this for colds)
fever medicine for comfort

Doctors have known for years that antibiotics do not help viral croup. For about the same amount of time we debated whether steroid medications could shrink the swollen tissues in the larynx and windpipe enough to help. At last look in the literature, it was felt that steroids could lower the rate of progression of croup to the point where hospitalization is necessary. Your doctor might prescribe them - don't be alarmed. A single injection of a steroid (dexamethasone) is usually sufficient; sometimes a very short course of oral steroid (usually prednisolone) may be prescribed instead.

There is another, much more dangerous condition called epiglottitis, caused by a bacterial germ, Hemophilus influenzae type B. Luckily this is now very rare, due to widespread immunization with the Hemophilus influenzae vaccine that babies receive at the first three immunizations.

During a croup attack, it is naturally a good idea to keep in touch with your child's doctor. Children who are feverish, coughing and upset will naturally exhibit much more stridor and retractions, and will be naturally agitated and restless. One thing to watch out for is when these symptoms are present even when your child is quiet. If your child is restless and unable to sleep or get comfortable, has significant stridor or has retractions while at quiet rest - call your doctor.

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