Springdale Mason Pediatrics

Croup

Definition

  • Croup is an infection of the voicebox (larynx) caused by a virus

Call or Return If

  • Stridor (harsh raspy sound) occurs
  • Croupy cough lasts more than 14 days
  • You think your child needs to be seen
  • Your child becomes worse

About This Topic

Symptoms

  • The croupy cough is tight, low-pitched, and barky (like a barking seal)
  • The voice or cry is hoarse (called laryngitis)
  • Some children with severe croup get a harsh, tight sound while breathing in. This is called stridor.

Stridor: A Complication of Croup

  • Stridor is a harsh, raspy tight sound best heard with breathing in
  • Loud or constant stridor means severe croup
  • All stridor needs to be treated with warm mist
  • Most children with stridor need treatment with a steroid (such as Decadron)
  • For any stridor, see First Aid for stridor (Treatment #2)

Cause

  • Caused by a viral infection of the voicebox (larynx) and windpipe (trachea)
  • Many different viruses can cause croup. Para-influenza is a common one.

Prevention

  • Cover the nose and mouth with a tissue when coughing or sneezing.
  • Wash hands often. After coughing or sneezing are important times.

After Care Advice

Overview:
  • Most children with croup just have a barky cough.
  • Some have tight breathing (called stridor).
  • Coughing up mucus is very important. It helps protect the lungs from pneumonia.
  • We want to help a productive cough, not turn it off.
  • Here is some care advice that should help.

First Aid For Stridor (Harsh sound with breathing in):

  • Breathe warm mist in a closed bathroom with the hot shower running. Do this for 20 minutes. You could also use a wet washcloth held near the face.
  • Caution: Do not use very hot water or steam which could cause burns.
  • If warm mist fails, breathe cool air by standing near an open refrigerator. You can also go outside with your child if the weather is cold. Do this for a few minutes.
Calm Your Child if He or She has Stridor:
  • Crying or fear can make stridor worse.
  • Try to keep your child calm and happy.
  • Hold and comfort your child. Use a soothing, soft voice.
Humidifier:
  • If the air in your home is dry, use a humidifier. Reason: Dry air makes croup worse.
Homemade Cough Medicines:
  • Goal: Decrease the irritation or tickle in the throat that causes a dry cough.
  • AGE 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are warm apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 ml). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old.
  • AGE 1 year and older: Use HONEY ½ teaspoon (2 ml) as needed. It's the best homemade cough medicine. It can thin the secretions and loosen the cough. If you don't have any honey, you can use corn syrup.
  • AGE 6 years and older: Use COUGH DROPS or throat drops to decrease the tickle in the throat. If you don't have any, you can use hard candy.
Drug Store Cough Medicine (DM):
  • Don't give any non-prescription cough medicines to young children. They are not approved by the FDA under 6 years. Reasons: not safe and can cause serious side effects. Also, they are not helpful.
  • Honey has been shown to work better for coughs. (Caution: Do not use honey until 1 year old).
  • Age over 6 years: If you decide to buy a cough medicine, choose one with dextromethorphan (DM). It's present in most non-prescription cough syrups.
  • When to Use DM: Give only for severe coughs that interfere with sleep or school. Give every 6 to 8 hours as needed.
Coughing Fits or Spells:
  • Breathe warm mist (such as with shower running in a closed bathroom).
  • Give warm clear fluids to drink. Examples are apple juice and lemonade.
  • Reason: Both relax the airway and loosen up any phlegm.
Fluids:
  • Try to get your child to drink lots of fluids.
  • Goal: Keep your child well hydrated.
  • It also loosens up any phlegm in the lungs. Then it's easier to cough up.
Fever:
  • For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. See Dose Table. Note: Lower fevers are important for fighting infections.
  • For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.

Sleep Close By to Your Child:

  • Sleep in the same room with your child for a few nights.
  • Reason: Stridor can start all of a sudden at night.
Avoid Tobacco Smoke:
  • Tobacco smoke makes croup much worse.
What to Expect:
  • Most often, croup lasts 5 to 6 days and becomes worse at night.
  • The croupy cough can last up to 2 weeks.

Return to School:

  • Your child can go back to school after the fever is gone.
  • Your child should also feel well enough to join in normal activities.

Author: Barton Schmitt MD, FAAP
Copyright 2000-2020 Schmitt Pediatric Guidelines LLC
Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it.
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