Croup (patient information)
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What are the symptoms of Croup?
Croup features a cough that sounds like a seal barking. Most children have what appears to be a mild cold for several days before the barking cough becomes evident. As the cough gets more frequent, the child may have labored breathing or stridor (a harsh, crowing noise made during inspiration).
Croup is typically much worse at night. It often lasts 5 or 6 nights, but the first night or two are usually the most severe. Rarely, croup can last for weeks. Croup that lasts longer than a week or recurs frequently should be discussed with your doctor to determine the cause.
What causes Croup?
Before the era of immunizations and antibiotics, croup was a dreaded and deadly disease, usually caused by the diphtheria bacteria. Today, most cases of croup are mild. Nevertheless, it can still be dangerous.
In the Northern hemisphere, it is most common between October and March, but can occur at any time of the year.
In severe cases of croup, there may also be a bacterial super-infection of the upper airway. This condition is called bacterial tracheitis and requires hospitalization and intravenous antibiotics. If the epiglottis becomes infected, the entire windpipe can swell shut, a potentially fatal condition called epiglottitis.
When to seek urgent medical care?
- The croup is possibly being caused by an insect sting or inhaled object
- The child has bluish lips or skin color
- The child is drooling
- The child is having trouble swallowing
Depending on the severity of the symptoms, call 911 or your health care provider for any of the following:
- Stridor (noise when breathing in)
- Retractions (tugging-in between the ribs when breathing in)
- Struggling to breathe
- Agitation or extreme irritability
- Not responding to home treatment
Do NOT wait until morning to address the problem.
Children with croup are usually diagnosed based on the parent's description of the symptoms and a physical exam. Sometimes a doctor will even identify croup by listening to a child cough over the phone. Occasionally other studies, such as x-rays, are needed.
Cool or moist air can bring relief. You might first try bringing the child into a steamy bathroom or outside into the cool night air. If you have a cool air vaporizer, set it up in the child's bedroom and use it for the next few nights.
Serious illness requires hospitalization. Increasing or persistent breathing difficulty, fatigue, bluish coloration of the skin, or dehydration indicates the need for medical attention or hospitalization.
Medications are used to help reduce upper airway swelling. This may include aerosolized racemic epinephrine, corticosteroids taken by mouth, such as dexamethasone and prednisone, and inhaled or injected forms of other corticosteroids. Oxygen and humidity may be provided in an oxygen tent placed over a crib. A bacterial infection requires antibiotic therapy.
Increasing obstruction of the airway requires intubation (placing a tube through the nose or mouth through the larynx into the main air passage to the lungs). Intravenous fluids are given for dehydration. In some cases, corticosteroids are prescribed.
Where to find medical care for Croup?
What to expect (Outlook/Prognosis)?
- Atelectasis (collapse of part of the lung)
- Bacterial tracheitis
- Respiratory arrest
- Respiratory distress
Wash your hands frequently and avoid close contact with those who have a respiratory infection.
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