Blue Fish Pediatrics

Health Topics : Croup

Croup is a common respiratory problem characterized by a harsh, barking cough. Croup most often affects young children. It causes inflammation, swelling, and narrowing in the voice box (larynx), windpipe (trachea), and breathing (bronchial) tubes leading to the lungs.

Croup symptoms often develop a few days after the start of what appears to be an upper respiratory infection (URI), such as a cold. Most cases are caused by human parainfluenza viruses types I and II. However, other viruses, such as influenza viruses types A and B, respiratory syncytial virus (RSV), and measles, can also cause croup. As children grow older and structures in the throat and breathing tubes mature, they are less susceptible to croup.

Symptoms of croup are caused by a narrowed airway and include a barking cough, a raspy, hoarse voice, and a harsh crowing noise when breathing in. Croup usually develops after a day or two of coldlike symptoms, such as a runny nose and congestion. Symptoms of croup often improve during the day and become worse at night; sometimes children have episodes, or attacks, of intense symptoms that wake them up in the middle of the night. Usually symptoms gradually improve within 2 to 5 days.

Even though croup is usually a minor illness, your child’s coughing and troubled breathing can seem severe and frightening, especially during an episode or attack of intense symptoms. However, even intense symptoms usually improve with home treatment, such as staying calm, soothing your child, and humidifying the air.

Home treatment usually is all that is needed to treat croup. You can help prevent major episodes, or attacks, as well as use techniques to manage attacks if they occur.

• Use a cool air humidifier in your child’s room. Do not use a hot vaporizer, and make sure to put only plain water in the humidifier. Although research has not consistently shown that croup symptoms improve with humidifier use, using one poses very little risk and may benefit your child. Be sure to empty, clean, and completely dry out the humidifier between each use to prevent mold growth.
• Offer plenty of fluids to drink. Always have water available and try offering other beverages, frozen ice treats (such as Popsicles), or crushed ice drinks several times each hour.
• Do not smoke, especially in the house.

• Do not use medications designed for the common cold, which may include antihistamines (such as chlorpheniramine [for example, Chlor-Trimeton] or diphenhydramine [for example, Benadryl]) and decongestants (such as pseudoephedrine [for example, Sudafed or Triaminic] or oxymetazoline [for example, Afrin or Neo-Synephrin]).

It is important for you and your child to keep calm during an attack of croup, even though it can be frightening. If your child is upset, crying, and anxious, the swelling and narrowing of the airway can become worse. Usually, symptoms sound worse than they are.

Taking measures to manage an episode of croup, such as adding moisture to the air and keeping your child calm and comfortable, can help keep symptoms under control. If coughing and difficulty breathing do not improve within about 30 minutes despite your efforts, please call our office (or page operator after hours).

Revised 3.23.09

Disclaimer: These guidelines are to help the caretaker with treatment at home. However, if you are ever concerned about your child’s health, you should see a physician in person.