Croup

Croup is a common disease in childhood, caused by one of the common cold viruses. If an adult catches this virus he will experience sore throat and especially laryngitis. It is pretty benign in grown-ups. However, when small children get this virus, they may become fairly ill with it. Rarely, a child might need to be hospitalised for respiratory treatments and oxygen.

Croup is characterised by stridor, which is a coarse, harsh whistling or wheezing sound coming from the throat area. The child usually has some cold symptoms including fever in the early stages, becomes progressively more hoarse, and then develops the characteristic barking cough.

Treatment of viral croup is generally supportive, which means

Keep the child quiet and comfortable - the less struggling, the less crouping.
Steam or vapor is sort of standard treatment - perhaps it does help. Run a cool mist vaporizer (just as effective as the warm steam vaporizer and a lot safer to use) by the crib. If the child awakens and is distressed, coughing and struggling, take her into the bathroom and steam it up with the shower. Let her breathe the mist while you hold her upright and calm and soothe her. The raspiness and barking cough will usually subside quickly and the child will fall back asleep in your arms.
Cough suppression, preferably with dextromethorpham over the counter. Delsym® is the best medicine for this - pure dextromethorpham without the usual horrible taste of "DM" medicines. The average kid with croup is about 25 pounds - the dose of Delsym® for that weight is 1/2 teaspoon (2.5 ml) every twelve hours.
Fever control. We prefer ibuprofen (Childrens Motrin® or Advil®) if the temperature is running above 102F; otherwise use acetaminophen (Tylenol® and all the others) for the lower fevers. Temperature under 101F is probably not worth treating at all unless it has been spiking much higher. Ask us for your child's fever medication doses if you are't sure. Remember not to panic about the fever - fever in itself cannot hurt a child.
Encourage fluids and don't worry about the solid foods for now. If your child will eat, fine, but as usual for these viral infections, appetite can be expected to be poor for several days. Don't worry -your child will bounce back just fine when the illness is over.
Call us if you are concerned that your child is getting worse or is having trouble breathing while at rest and not struggling or crying. It is usual for the child with croup to sound pretty frightening when she is upset, crying and coughing. It is another thing when she is calm and quiet and still sounds very raspy. Watch for signs of retractions (where the chest wall sinks in between the ribs or above the collarbone) when your child is at rest, or if your child seems restless and agitated even when asleep or when not coughing - this could be a sign of a significant respiratory deterioration.

There is one other form of croup you should be aware of - that is spasmodic croup, which is an allergic croup. It usually affects elementary school age kids. A child with spasmodic croup awakens in the middle of the night with loud barking cough and stridor, which is a coarse, harsh whistling or wheezing sound coming from the throat area. These children usually respond to steam treatment or walking outside in the cool night air. Some oral Benadryl® in a dose of one teaspoon per 25 pounds of body weight as a one time dose would perhaps be helpful.

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