Caring for a child with croup

The Pediatric Insider

© 2014 Roy Benaroch, MD

Last time, we talked about croup—what it is, and what it isn’t. It’s a viral infection of the upper airway, usually caused by parainfluenza virus, that causes a peculiar, bark-like cough in infants and young children. Usually there’s a hoarse voice, some fever, and other minor viral symptoms like a runny nose. More-severe cases of croup include a high-pitched inhaling noise called “stridor.”

Though most children with croup do fine with home care, some kids can really get sick with this. Red flags to look out for:

  • Frequent or persistent squeaky upper-airway noise.
  • A sense that the child is really scared or upset.
  • A child who is excessively sleepy.
  • Blue color to the lips.
  • A parent who’s really worried.

If your child has one or more of these red flags, go see a doctor right away. Do not hesitate to go to the Emergency Department. Breathing is really important. If you’re worried, your child needs to be seen immediately.

Most kids, though, do not have severe disease and can be managed at home. The best “first aid” trick for croup is cold air. If it’s cool out, go outside or open a window. If it’s not cool out, put your child’s face in the freezer. I know this sounds weird, but it works. Croup is caused by swelling in the upper airway, and cold air quickly reduces that swelling.

If you don’t like the idea of cold air: try warm steam. I don’t think it works quite as well as cold air, but sitting in a steamy bathroom seems to help at least some.

Also, try to keep your child calm and content. Worrying and crying makes croup worse. Kids can pick up on worries from parents, and when any of us get anxious we can have some tightening of the throat. Keep things calm, or even pop in a favorite video as a distraction.

If your child has asthma, it may be worthwhile to at least try a breathing treatment with asthma rescue medications. Asthma and croup aren’t the same thing, but children with asthma will sometimes get a barky cough that sounds like croup. An asthma treatment isn’t going to hurt. Talk with your child’s doctor about when you ought to be using asthma medications so you’re all on the same page.

Children with croup that doesn’t respond to home care ought to go see their pediatrician or family doc. Pro tip: bring a video so we can hear what the cough really sounds like. (The cough is always better during the day when out offices are open.) We can help confirm the diagnosis, and sometimes treatment with a steroid can help shrink the upper airway and relieve the barky cough and tightness. Typical steroids used include prednisolone orally (tastes bad, but easy to find at pharmacies and cheap); dexamethosone orally (tastes fine, but you have to crush tablets—there isn’t a good practical liquid version); or dexamethasone injected (Ow! But it works!) Steroids will take the “croup” out of the croup, but will not knock out the cough completely. It’s still a viral infection, and a bit of cough and fever and runny nose are going to persist for a week or so no matter what you do.

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