Croup

Croup is a common viral infection whose season is typically between October/November and April and results in the usual stuffy nose, low-moderate grade fever, hoarse voice and a sore throat. The distinguishing symptom that caracterizes croup is the cough.  The cough is described as seal-like or bark-like (sharp, medium-pitched cough in short bursts). The cough generally occurs between 7PM-7AM. Occasionally, the cough can show up during the day after some screaming, crying, or hearty laughing.

Treatment for the cough is to have the child sleep sitting somewhat upright in a cool humidified environment. Should the child have a coughing episode, the parent should take the child into the bathroom and run the shower such that the child can breathe in a more humidified air. If there is a cool mist humidifier, the child can sit approximately 1-2 feet in front of the humidifier.  The child should breathe this air for approximately 10-15 minutes, the face and exposed skin wiped down (so as to stop the child from cooling down too much from the exposure to the cold air), then the child should be brought outside into the cold air. By breathing in the cold air, the humidity that was recently inhaled that is still within the throat and vocal chords gets cold and decreases the swelling of the thraot and vocal chords and relieves the cough. Cough treatment is designed to help relieve the irritation to the throat and the vocal chords which is where the problematic component of the swelling is located.  This may have to be repeated several times per night. Like most upper respiratory viral infections, the symptoms worsen for the first 3-4 days, stay the same for another day and then start to improve.

For most children it is more annoying than anything else, however, concern arises when the child’s cough occurs during the day with minimal (if any) provocation, shortness of breath, rapid, shallow breathing causing lethargy, and decreased drinking of fluids. Children with any these difficulties or a fever of greater than 4-5 days should be seen and evaluated to make sure that they are still appropriately hydrated and maintaining high enough blood oxygen levels. Treatment may be oral or inhaled steroids, IV fluids, and possibly even supplemental oxygen.