The croupy cough is tight, low-pitched,
and barky (like a barking seal).
The voice or cry is hoarse (laryngitis).
Stridor is a harsh, raspy sound heard with breathing in. Loud
or continuous stridor means severe croup. All stridor needs to be treated with
Usually a parainfluenza virus
First Aid Advice for Stridor (also use for any
difficulty breathing or severe coughing)
Inhale warm mist in a foggy bathroom with the shower
running, from a wet washcloth held near the face, or from a humidifier
(add warm water) for 20 minutes.
If that fails, inhale cool air from breathing
near an open refrigerator or taking outside for a few minutes.
See More Appropriate Topic (instead of this one) If
- It doesn't sound like croup, see COUGH
- Tight purring sound when breathing out, see WHEEZING
WHEN TO CALL YOUR DOCTOR FOR CROUP
Call 911 Now (your child may
need an ambulance) If:
Severe difficulty breathing (struggling
for each breath, unable to speak or cry because of difficulty breathing, continuous
Child has passed out or has bluish lips
Croup started suddenly after taking a medicine or allergic food
Child is drooling, spitting or having great difficulty swallowing
(EXCEPTION: drooling due to teething)
Call Your Doctor Now (night or day) If:
Your child looks or acts very sick
Child choked on a small object that could be caught in the throat
Difficulty breathing (age < 1 year old) not relieved by cleaning
Difficulty breathing (age > 1 year old) present when not
Ribs are pulling in with each breath (retractions)
Stridor (harsh noise with breathing in) is present or has occurred
Child can't bend the neck forward
Fever > 104°F (40° C) at any age
Age < 12 weeks with fever > 100.4°F (38° C) rectally
Severe chest pain
Call Your Doctor
Within 24 Hours (between 9am and 4pm) If
You think your child needs to be seen
Continuous (nonstop) cough
Age less than 1 month (EXCEPTION: coughs a few times)
Age 1 to 3 months with a cough for > 3 days
Earache is also present
Fever present > 3 days
Call Your Doctor During Weekday Office Hours If
You have other questions or concerns
Croup is a recurrent problem
Barky cough present > 10 days
Parent Care at Home If
Mild croup with no complications and
you don't think your child needs to be seen
HOME CARE ADVICE FOR CROUPY
If the air is dry, run a humidifier in the bedroom. (Reason: dry air makes
Coughing Spasms: For coughing spasms, give warm fluids to relax the
airway (warm apple juice or caffeine-free tea) (Avoid if < 4 months old)
Cough Medicine for Mild Coughs: These are less helpful than warm mist.
After age 1, use corn syrup 2 to 5 ml whenever needed as a homemade cough medicine.
It can thin the secretions and loosen the cough. After age 4, use cough drops
or hard candy. Remember, coughing up mucus is very important for protecting
the lungs from pneumonia.
Cough Suppressant for Severe Coughs: Use dextromethorphan (DM) which
is present in most cough syrups. Do not use under 1 year old. See dosage
Fever Medicine: For fever > 102° F (39° C), give acetaminophen
(e.g. Tylenol) or ibuprofen.
Observation During Sleep: Sleep in the same room with your child for
a few nights. (Reason: croup can suddenly become severe at night.)
Avoid Tobacco Smoke: Active or passive smoking makes coughs much worse.
Contagiousness: Your child can return to day care or school after
the fever is gone and your child feels well enough to participate in normal
activities. For practical purposes, the spread of croup and colds cannot be
Expected Course: Croup usually lasts 5 to 6 days and becomes worse
- Call Your Doctor If:
(harsh raspy sound) occurs
croup lasts > 10 days
child becomes worse or develops any of the "Call Your Doctor" symptoms.
This information is not intended be a substitute for professional medical advice.
It is provided for educational purposes only. You assume full responsibility
for how you choose to use this information.
Pediatric HouseCalls Online. Copyright © 2000-2004
Barton Schmitt, M.D. FAAP
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