Croup

• Barky cough and hoarse voice caused by a virus
• Croup is a viral infection of the voicebox (larynx)
• 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: Another Health Problem of Croup

• Stridor is a harsh, raspy tight sound best heard with breathing in
• Loud or constant stridor means severe croup. So does stridor at rest (when not crying or coughing).
• 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 treatment

Causes of a Croupy Cough

• Viral Croup. Viruses are the most common cause of croup symptoms. Many respiratory viruses can infect the vocal cord area and cause narrowing. Even influenza (the flu) can do this. A fever is often present with the barky cough.
• Allergic Croup. A croupy cough can occur with exposure to pollens or allergens in a barn. A runny nose, itchy eyes and sneezing are also often present.
• Inhaled Powder. Breathing in any fine substance can trigger 10 minutes of severe coughing. Examples are powdered sugar, flour dust or peanut dust. They can float into the lungs. This is not an allergic reaction.
• Airway Foreign Object (Serious). Suspect when there is a sudden onset of coughing and choking. Common examples are peanut and seeds. Peak age is 1 to 4 years.
• Food Allergy (Serious). Croup symptoms can also be caused by a food allergy. This can be life-threatening (anaphylaxis). Examples are nuts or fish.

Call 911 Now

• Severe trouble breathing (struggling for each breath, constant severe stridor)
• Passed out or stopped breathing
• Lips or face are bluish when not coughing
• Croup started suddenly after bee sting, taking a new medicine or allergic food
• Drooling, spitting or having great trouble swallowing. Exception: drooling due to teething.
• You think your child has a life-threatening emergency

Go to ER Now

• Choked on a small object that could be caught in the throat
• Ribs are pulling in with each breath (called retractions)
• Age less than 1 year old with stridor (harsh sound with breathing in)

Call Doctor or Seek Care Now

• Stridor (harsh sound with breathing in) is heard now
• Trouble breathing, but not severe
• Lips or face have turned bluish during coughing
• Breathing is much faster than normal
• Can't bend the neck forward
• Severe chest pain
• Had croup before that needed Decadron
• Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
• Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
• High-risk child (such as cystic fibrosis or other chronic lung disease)
• Fever higher than 104° F (40° C)
• Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Stridor (harsh sound with breathing in) occurred but not present now
• Nonstop coughing
• Age less than 1 year old with a croupy cough
• Earache or ear drainage
• Fever lasts more than 3 days
• Fever returns after being gone more than 24 hours
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Coughing causes vomiting 3 or more times
• Croup is a frequent problem (3 or more times)
• Barky cough lasts more than 14 days
• You have other questions or concerns

Self Care at Home

• Mild croup (barky cough) with no stridor

Care Advice for Croup

What You Should Know About Croup:

• Most children with croup just have a barky cough.
• Some have tight breathing (called stridor). Stridor is a loud, harsh sound when breathing in. It comes from the area of the voicebox.
• 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, cold air may help. If the weather is cold, stand by an open window or take your child outside for a few minutes. If the weather is not cold, stand near an open freezer or refrigerator.

Calm Your Child if They Have 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.

Cough Treatment:

• Age less than 1 year: give extra breastmilk or formula. Avoid honey in this age group.
• Age 1 year and older: use Honey ½ to 1 teaspoon (2 to 5 mL) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough.
• Age 6 years and older: use cough drops to decrease the tickle in the throat. Avoid cough drops before 6 years. Reason: risk of choking. Note: also continue honey.
• Mild coughing is helpful and doesn't need any treatment except staying well hydrated.

Cough Medicine from Drugstore: Not Advised

• OTC cough medicines are not approved by the FDA until 6 years of age.
• Reasons: not safe and can cause serious side effects. Also, no proven benefit for children.
• Honey has been shown to work better for coughs. Caution: do not use honey until 1 year old.
• Age 6 years or older. If you might decide to buy a cough medicine, use it for severe coughs that interfere with sleep, school or work. See dosage on package label.
• No Antibiotics. Antibiotics are not helpful for coughs. Antibiotics may be used if your child gets a bacterial ear or sinus infection

Coughing Attack Treatment - Warm Mist and Fluids:

• Any age: breathe warm mist, such as with warm shower running in a closed bathroom.
• Age 1 year and older: drink some warm fluids, such as apple juice or herbal tea.
• Reason: both relax the airway and loosen up any phlegm.

Fluids - Offer More:

• 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 Treatment:

• For fevers higher than 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen.
• For lower fevers, meds are not needed. Reason: fever helps the body fight the infection.
• For all fevers: keep your child well hydrated. Offer extra 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.

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.
• For practical purposes, the spread of croup and colds cannot be prevented.

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.

Call Your Doctor If:

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

Care Advice for Croup

• Stridor is a harsh, tight sound with breathing in. Stridor means the croup is severe.
• Breathe warm mist in a closed bathroom with the hot shower running. Do this for 20 minutes.
• Other Option: Use a wet washcloth held near the face. You can also use a humidifier containing warm water.
• Caution: do not use very hot water or steam. These can cause burns. Hot steam can also cause high body temperatures.
• If warm mist doesn't work, 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.