Words With Webb: Croup - What is it and how is it treated?

Every fall and winter we start to see a resurgence of respiratory illnesses in the clinic.  One very common respiratory illness seen in young children and infants is croup.  Croup is a viral illness that causes swelling of the airway and often a cough.  The most common and concerning sign that prompts parents to bring their child in for evaluation is a deep, barky, almost seal-like sound when the child coughs. In some children and infants, there is a high-pitched, almost whistling sound, heard when breathing.  This is called stridor and is a little more concerning. This video example is a child with croup, but without stridor.

So, you may be wondering: what causes croup?

There are several viruses that cause croup including the parainfluenza viruses, respiratory syncytial virus (RSV), adenovirus, and enterovirus, to name a few.  The illness is easily spread through direct contact or fluids from a cough with someone who has croup.  It generally starts in the nose and throat, causing airway inflammation and swelling before moving down to the voice box (larynx) and the windpipe (trachea).  The most common age for croup is two years but can be seen commonly in patients as young as three months. Croup doesn’t just affect infants and children, but the illness has a larger impact on these younger patients due to their smaller airways.  Generally older children and adults have fewer breathing concerns if they contract these croup-causing viruses, mainly due to their larger airways.

Croup tends to cause most trouble for young children during the night.  It is not uncommon for the child to cough and, due to drier air and airway, throw themselves into a coughing fit triggering airway inflammation to worsen.  Stridor is more common during these coughing fits. 

So what can you do and when should you be seen by your pediatrician?

If croup is causing problems at home there are a couple of things you can do to manage the symptoms.  First and foremost, do your absolute best to console and calm your child.  Screaming and crying will only worsen the airway inflammation.  Cold and humid air will help open the airway back up.  It is cold enough this time of year to bundle your child up and step outside for a few minutes.  The cold air will help to decrease that airway inflammation and help your child breathe better.  If you do this, make sure they are wearing proper clothing or wrap them in a warm blanket.  If you are not comfortable taking your child outside, just open the freezer door and get your child very close to the cold air as this can also be effective.  Humid air helps as well.  Go into the bathroom and turn the water on (shower and sink) to the hottest setting and let the bathroom fill with the steam.  Hot, humid air works to lubricate the airway and decrease inflammation.   If at any time you notice your child is struggling to breathe or catch their breath, if they turn blue at all, or you do not feel comfortable with your child at home, call 911 and get help! 

Days 2 and 3

Days 2 and 3 typically cause the most severe symptoms because airway inflammation is at its worst, so at the first sign of a deep, barky cough it is important to be evaluated. Your pediatrician may prescribe a steroid to help decrease inflammation while the body fights the virus.  Dexamethasone is the medication of choice and usually comes in a two dose regimen.  I often recommend my patients take a dose the day they see me and then another in 48 hours.  Prednisone once daily for 3-5 days may also help.  The idea is to keep the airway open while the body fights the virus off.  For fevers and discomfort I recommend ibuprofen for its pain and fever relief and anti-inflammatory properties.  Tylenol is also a good option but will not necessarily help with the inflammation.  With all illness, do your best to keep your child hydrated.  Additionally, I always recommend running a humidifier during the fall and winter months as this will help with cough due to croup, as well.

Finally, keep in mind that croup is easily spread and is very contagious.  If your child contracts croup, try to keep them home from daycare and school if at all possible.  Never hesitate to contact your pediatrician in the clinic with any questions related to croup or other health concerns.  

We are here to keep you and your children healthy and safe!

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