CROUP

Main Symptoms

  • 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 warm mist.

Cause

  •  Usually a parainfluenza virus

First Aid Advice for Stridor (also use for any difficulty breathing or severe coughing)

  1. 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.
  2. 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 severe stridor)
  • 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 the nose.
  • Difficulty breathing (age > 1 year old) present when not coughing
  • Ribs are pulling in with each breath (retractions)
  • Stridor (harsh noise with breathing in) is present or has occurred today
  • 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 COUGH

  1. Humidifier: If the air is dry, run a humidifier in the bedroom.  (Reason: dry air makes croup worse.)
  2. Coughing Spasms: For coughing spasms, give warm fluids to relax the airway (warm apple juice or caffeine-free tea) (Avoid if < 4 months old)
  3. 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.
  4. Cough Suppressant for Severe Coughs: Use dextromethorphan (DM) which is present in most cough syrups. Do not use under 1 year old.  See dosage chart.
  5. Fever Medicine: For fever > 102° F (39° C), give acetaminophen (e.g. Tylenol) or ibuprofen.
  6. Observation During Sleep: Sleep in the same room with your child for a few nights.  (Reason: croup can suddenly become severe at night.)
  7. Avoid Tobacco Smoke: Active or passive smoking makes coughs much worse.
  8. 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 prevented.
  9. Expected Course: Croup usually lasts 5 to 6 days and becomes worse at night.
  10. Call Your Doctor If:
    • Stridor (harsh raspy sound) occurs
    • The croup lasts > 10 days
    • Your child becomes worse or develops any of the "Call Your Doctor" symptoms.

Disclaimer: 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

Reviewed 8/2004

Revised 8/2003

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