Get the Scoop on Croup

Anne Steigerwald

Many parents can recognize the hoarse, rough-sounding cough of croup. But what they often don't know are the other indications that their child has croup. Parents need to be able to decipher if croup is serious. Here is some information to help you become familiar with the causes, symptoms and treatments of croup.

What is Croup?
Croup is an inflammatory condition of the lining of the upper airway, especially around the vocal cords and upper windpipe (trachea). If you could see the lining of an airway affected by croup, it would appear swollen and red. Croup leads to a distinctive barking cough, and in younger children with smaller airways, it can cause trouble breathing. Croup usually occurs in children three months to three years old. Most children outgrow croup after age five because their windpipes are larger. Your child may get croup more than once.

What Causes Croup?
Anything that causes inflammation to the lining of the upper airway can cause croup symptoms. Overwhelmingly, the most common cause is infection with a respiratory virus. The same viruses often cause laryngitis, cough illnesses in older children and adults. The viruses most commonly involved in croup are parainfluenza virus, adenovirus, repiratory syncytial virus (RSV), influenza and measles. Because croup is usually caused by a virus, it cannot be treated with antibiotics. Croup is most likely to occur October through March but can happen at any time.

What are the Symptoms of Croup?
Your child can have a painful, bark-like cough (like a seal's bark). If there is enough swelling, your child will have difficulty breathing, especially breathing in, with a distinctive noisy "catch" called stridor. When the child is having trouble breathing, you can sometimes see his skin between his ribs or in the front of his neck move in and out with respirations. If there is trouble breathing, your child may be anxious and/or restless. Your child may have a high fever, low fever or no fever. Your child may also have a sore throat or a previous runny nose a few days prior to croup onset. He or she may be breathing quickly. Blueness around the lips or the rest of the skin is only present in severe croup when a child is not getting enough oxygen. Your child may drool or have trouble swallowing. Sometimes your child may be too tired from the difficulty of breathing to eat or drink. Symptoms of croup become worse when your child is anxious or agitated.

Your child will usually have his worst symptoms in the evening. There are several theories as to why croup is worse at night. The most probable ones have to do with the cycle of steroids in the body (it is lowest during the night) and also the blood flow in the respiratory tract changes when you are lying down. Croup can have a sudden onset. Your child can wake up in the middle of the night with a croup cough having had no other symptoms during the daytime.

What are the Treatments for Croup?
Home Treatments
Breathing in cool or moist air can sometimes help to lessen the symptoms of a croup attack. Try turning on the shower in the bathroom with the door closed for ten or fifteen minutes. This will produce a lot of moist air. Remember to keep your child calm during this period. Keep the child sitting up, which allows her to breathe more easily.

Cool air outside shrinks inflamed tissues lining the airway. During the winter months, try taking your bundled-up child outside for a few minutes. Or you can drive around in the car with the windows down and heat off to bring in cool air.

If your child is fast-breathing, breathing with stridor or appears blue around the mouth, call your child's doctor or seek medical attention as soon as possible.

Hospital Treatments
Steroids are used to reduce swelling of the airways. These can be given orally, by an intravenous route (IV) or with a shot into the muscle. If the swelling needs to be reduced immediately, aerosolized racemic epinephrine is very helpful. Cool mist is also used, and extra oxygen if needed. A neck x-ray may be taken to determine if there is another cause of airway obstruction, such as a foreign body or bacterial infection. A bacterial infection of the upper airway, called bacterial tracheitis, requires hospitalization and intravenous antibiotics. If the x-ray shows no bacterial infection or other airway obstruction, but the swelling is severe, the airway can be kept open with a tube through the vocal cords and trachea, or in the worst - and rare - case a tracheotomy can be performed. Increasing or persistent breathing difficulty accompanied by fatigue, bluish coloration of the skin, or dehydration could indicate your child has serious croup and should be hospitalized.

How Long Does Croup Last?
Croup usually is at its worst the 2nd or 3rd night. If it is a viral croup, it usually lasts less than a week. Sometimes as the croup symptoms lessen, the child is left with a cold and cough that can last 1-2 weeks.

Prevention
Croup is contagious. While there is no way to prevent croup or other viruses, adults, children, healthcare workers and childcare provider should frequently hand wash to thwart an onset of croup Avoiding people who have respiratory infections also reduces chances of spreading or catching viruses that cause croup.

The distinctive hoarse barking cough of croup is a common sound in pediatricians' offices from the fall through the spring. When first heard and seen by parents at home, croup can be a frightening experience. But most of these children have a mild disease that can be managed at home, often after checking in with their medical care provider. A short treatment with steroids has led to a significant decrease in the hospitalization rate of croup with few serious side effects. However, if a child has difficulty breathing that does not improve with home treatments, then parents should seek medical care. As children frequently wake in the middle of the night with their worst symptoms, this can mean a visit to your local emergency department.

Anne Steigerwald is a mother of two girls under four and a free-lance writer. She lives with her husband and daughters in the Pacific Northwest. She frequently writes about family, emotional and health subject matters.

Anne Steigerwald is a mother of two girls under four and a free-lance writer. She lives with her husband and daughters in the Pacific Northwest. She frequently writes about family, emotional and health subject matters.


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