The Croup

Another “C” word is presently putting fear in the hearts of parents and pediatricians alike. It’s called the Croup.

The croup is a not uncommon illness of childhood. Yet this season, it has entered the stage of pediatric health care with a vengeance. Let’s take a moment to discuss the croup and what can be done.

The croup is an infection of the airways. It occurs most often in children between ages 3 months and up to 5 years old; the peak time for croup to occur is at about 2 years of age.

The croup causes a swelling in the upper part in the airway of the neck. The swelling triggers the airway below the vocal cords to narrow. There is also a thickening of the mucus. The combination makes breathing noisy and difficult and, frankly speaking, terrifying for the patient and loved ones. The barking cough is just too terrible. The croup is seen most often late full through the winter seasons.

A virus, usually the parainfluenza virus, is the most common cause of the croup. Some of the viruses include the Parainfluenza virus, the flu (influenza virus), Adenovirus, Enteroviruses, and Respiratory syncytial virus (RSV). Children may contract the virus by breathing infected respiratory droplets coughed or sneezed into the air. Virus particles in these droplets may also survive on toys and surfaces. In other words, croup is contagious.

The croup is more common than people realize. It can last several days. In some cases, medication is required. The sooner a patient with croup is treated, the faster the recovery. Therefore, knowing the signs of croup can help one get medical help.

Here are some of the signs of croup:

1. Fever — Because croup is caused by a virus or an infection, a fever is often present. The fever appears prior to other symptoms and it can be hard to tell if the fever is the result of croup or another condition. Fevers can be mild or severe, and if they get too high, they can be dangerous. Children are more likely to suffer from high fever with croup than adults. Fever medicine can be used to help reduce fever. Further, cool baths can also help lower body temperature. Drinking plenty of fluids when having a fever is important as dehydration is can happen. If a fever lasts for than a couple of days or becomes too high, then quickly seek medical attention. Also, chills often accompany fever; when lowering the temperature. The child may have tremors.

2. A lost voice or hoarseness — The airways become inflamed and swollen, which can press against the voice box. The voice box cannot expand properly, and a person cannot use their voice properly. Throat lozenges may provide some relief, but the hoarseness usually returns within a short time. Coughing and hacking can also make the hoarseness worse. Children with croup often cry which exacerbates losing voices. Rest and lots of liquids can help. If hoarseness persists beyond several days, medical attention must be sought.

3. Cough – As mentioned, the croup cough is a hacking, barking cough, not a normal cough. It’s one of the earliest signs of croup. While cough medicine will help the cough, it will not address the underlying cause. The cough usually worsens at night, possibly because kids tend to lay down at night. Most times, cough medicine is not really of benefit to children.

4. Mucus — Mucus can form in the throat and along the airways of a person who is suffering from croup. This mucus can be thick and can make it hard to breathe, sleep, and eat. When a person coughs, they may expel mucus from the body. Most of the time a cough is the body’s way of trying to remove the mucus. Some medications assist the body in expelling mucus and even thinning it out so it can leave the body more easily. It can also help reduce the amount of mucus that the body produces. Until the underlying cause of the condition is found and treated, the body will continue to produce mucus that gets caught in the airway. Coughing and hacking may help remove some of the mucus from the body. The color of the mucus can be important. Clear mucus is common, but yellow, green mucus can be a sign of an infection.

5. Exhaustion – Sickness strains the body and is fatiguing. Coughing is draining. Rest, rest, rest. Oxygen levels must be monitored. If a person becomes lethargic, he must be monitored. Don’t be shy about reaching out to your pediatrician if symptoms of lethargy linger for too long.

6. Congestion – We’ve discussed coughing. We’ve discussed mucus. A deep, uncontrollable cough is one of the signs of croup. There can also be with croup a rattling sound in the chest as person with croup tries to remove the mucus. Sometimes, people report feeling suffocated. How miserable. No one likes the feeling that their breathing is impaired or negatively impacted. Seek out your pediatrician.

7. Dry lips in infants – Because it can be painful and/or difficult to swallow, infants and children will avoid drink and food. This, in turn, can lead to dehydration. This is why parents need to pay attention to the signs of dehydration, one of which is dry lips. If your baby or child refuses drink or food for 24 hours, then seek medical attention immediately. Dehydration does not have to happen and must be avoided.

8. Kvetchy baby – While babies do not have the power of speech, they can be fabulous communicators. Parents and pediatricians need to learn to listen to the crying and visual cues.

9. Rash and red eyes – A light spotty rash on the eyelids or the whites of the eyes turn red is not uncommon with the croup as the child is not properly oxygenated. When oxygen levels are low, it can lead to the growth and spread of infectious agents. Severe coughing can cuaue burst blood vessels on the face and around the eyes.

The croup tends to emerge as daylight ends and darkness descends. However, croup can worsen during daylight hours. You must seek medical attention.

Your pediatrician can diagnose croup in a child through a history and physical exam. If deemed warranted, the pediatrician may order more tests.

Treating croup depends on the child’s age, symptoms and general health, as well as the severity of the croup itself.

For the most part, milder cases are managed at home. Medications your pediatrician might prescribe include inhaled medicines and/or steroids (injectable and oral, depending on the age and circumstances). Since croup is caused by a virus, antibiotics will not help.

In the most severe cases, children go to the hospital and receive racemic epinephrine via a nebulizer. Rarely, the child may require intubation.

If croup is being treated at home, it helps to prop an older child on some pillows (never use pillows for any child under 12 months old). This can help to ease breathing. Consider a humidifier (not a hot vaporizer) for your child’s bedroom. Put a warm, wet wash cloth over your child’s face when he breathes. Sleep in the same room as your child so you can monitor his breathing. Provide comfort by hugging, cuddling and singing favorite songs. If your child wakes up during the night, consider bundling him up and taking him out into the cool night air.

In all seriousness, the bathroom can be the best tool to help you fight the croup. With the door slightly ajar, steam up the bathroom and sit there with your child for 7-10 minutes. The warm, steamy air will help to relax the vocal chords and to loosen the mucus so it can leave the body more easily. Then stand in front of an open freezer with your child for 1-2 minutes or, as mentioned above, bundle up and go outside in the cold air. The contrast of the two air types can do wonders.

While your child’s may appear mild at first, don’t take them for granted and never underestimate them. The croup has been known to change on a dime. Don’t panic: your panicking will only trigger fear in your child which will then make breathing difficult. It’s been scientifically proven that stridor can lessen and even go away through relaxing.

When should you be in touch with the pediatrician?

Be watchful and attend to the details. And never be bashful about reaching out to your pediatrician for guidance and support.

As always, daven.

The words of this author reflect his/her own opinions and do not necessarily represent the official position of the Orthodox Union.