CROUP

What Is Croup? Croup is inflammation of the voice box (laryngitis) and wind-pipe (tracheitis) that causes cough and mild to severe difficulty in breathing, depending on its severity. It is common, generally occurs in infants between about six months and three years of age, is more frequent in the winter months, but can come on at any season. Croup can recur in your child, so be prepared for another attack.

What Causes Croup? It is almost always due to infection by a virus and is spread by airborne infection (e.g. sneezing) or by direct contact.

What Are Its Signs & Symptoms? The hallmarks of croup are cough and noisy and/or difficult breathing. Two types of croup are generally recognized: (1) spasmodic, where your infant may go to bed in apparent good health but wakes up suddenly, breathing noisily and/or with difficulty; (2) viral, in which the onset is more gradual and usually follows an upper respiratory infection (i.e. an infection like a cold, with a runny nose, cough, mild fever, fretfulness, etc). Fever is usually mild but can reach 104^oF. The typical cough of croup sounds like a barking seal.

With What Can Croup Be Confused? Sometimes croup can be confused with other conditions. One of these is acute epiglottitis, a very serious inflammation at the top end of the voice box. It is due to bacteria and progresses much more rapidly than viral croup. An affected child looks sick, may be drooling and have a high fever and prefers to sit up in bed in order to breathe. Rush such a child to the hospital! Another possibility is that your child may have swallowed a foreign body (e.g. a peanut or a small object lying around the house), and it has come to lie in her/his airway. X-rays can help differentiate among these and other possible conditions.

What To Do?

• If you think your child has croup, contact your family doctor or pediatrician immediately.
• If your child is struggling for breath, is exhausted or has a high fever, go to an Emergency Department immediately.
• If the condition is mild, your doctor may recommend the following:
1. turn on the hot water in your bathroom, close the window(s) and door, and sit holding your child while the steam builds up;
2. take your child for a walk in the cool night air;
3. turn on a cool-air moisturizer or humidifier.

Because croup is the result of a viral infection, antibiotics are generally of no use. Your doctor may recommend a decongestant, acetaminophen for fever (NEVER aspirin, because in children it can cause a condition called Reye's syndrome), or a steroid nebulizer. Do NOT use over the counter (OTC) medications that have not been recommended by your infant's physician. If your child is admitted to the hospital he will likely receive oxygen and intravenous fluids, may have a tube passed down to secure her/his airway and will likely be given one or more of the above medications. If treated promptly and properly, full recovery from croup can be expected.