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Advice: Croup

Croup

Croup basics

  • Croup is caused by a viral infection that leads to swelling and narrowing of the upper airway, including the larynx and trachea.
  • Symptoms include: Barking Cough - distinctive cough that sounds like a seal or barking; Hoarseness - voice may become raspy or strained; Difficulty breathing - rapid, shallow breathing or retractions (visible pulling in of chest or neck muscles); Fever - mild fever may be present; Stridor - high pitched, harsh sound during inhalation, may sounds like gasping for air
  • The presence of stridor indicates a more severe infection. It often worsens when children are crying or more active. If it is persistently present at rest, your child should be seen immediately in the emergency room.
  • Children are most likely to develop croup between 6 months and 3 years of age. It is not as common in older children as their windpipe becomes larger.
  • Severity can range significantly in Croup. Mild cases of croup can be treated at home with the supportive care below, while moderate and severe cases often need evaluation and treatment with a doctor, sometimes in the emergency room

Treatment

  • For mild symptoms, cool night air or a steamy shower may help soothe the airway and calm symptoms. Go into the bathroom, close all the doors and turn the shower all the way hot - sit in the bathroom for 15-20 minutes as steam fills the room.
  • For moderate cases children may require treatment with an oral steroid, like dexamethasone or prednisolone, which helps reduce airway swelling over the course of several hours.
  • In severe cases, children should be treated in the emergency room where they can receive a fast acting nebulized treatment called racemic epinephrine.
  • Your child may return to school when fever free for >24 hours without medication and has improving (though maybe not resolved) symptoms.

When to seek care

  • If your child has a persistent, tight barky cough
  • If your child has intermittent stridor.
  • If you child is breathing harder or faster than normal
  • If you child’s symptoms are worsening from a recent visit
  • If fever continues more than 4-5 days
  • If you are concerned

When to go to the Emergency Departent

  • If your child develops respiratory distress with gasping, difficulty taking a breath, or retractions in the ribs or at the base of the neck
  • If you child has worsening or persistent stridor when calm
  • If you child is drooling or unable to swallow saliva or secretions
  • If your child is showing signs of severe dehydration: lethargy, little/no urine output, dry lips, sunken fontanelle (soft spot)
  • If your child is lethargic or difficult to arouse
  • If you are worried
  • Call 911 if your child seems to be struggling for a breath or cannot speak, seems pale or develops bluish lips

Potomac Pediatrics will always be fully focused on helping your child and you to overcome any healthcare hurdle, with innovative, comprehensive and compassionate care.

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