Croup is an inflammation of the upper airways caused by a viral infection. These viruses are all spread via respiratory droplets (think about what happens when you cough or sneeze and you get the picture).
Croup generally begins with several days of cold-like symptoms such as sneezing and a runny nose. However, as the virus causes additional damage to the upper airways, the airways become swollen and the child develops the characteristic “barking” or “seal-like” cough. The cough is often accompanied by hoarseness and relatively low-grade fevers (100o-102o F). The cough tends be worse at night and tends to become progressively worse until the third day of the illness, after which symptoms generally improve. The cough can sometimes be associated with another funny sound called stridor. Stridor is a loud noise made when a child with croup takes in a breath, and it sounds almost like the gasp for air that a person makes when they are in the midst of a choking episode. Most commonly, stridor is only heard when the child is upset and crying. This is known as stridor with agitation and, while indicating that the croup is getting worse, can be safely managed in consultation with your pediatrician. If your child develops stridor while he or she is simply sitting still, this is a relative emergency and you should either go straight to the emergency room or call your pediatrician to find out which ER he/she recommends you visit.
There is no specific treatment for croup. Mild croup tends to respond to the low-tech interventions of either bringing your child into the bathroom and running the shower so they can breathe in the steam or taking them outside into the cool air. Both the steam and the cool air tend to help reduce swelling in the airway, thereby decreasing the cough. If your child has a severe cough that doesn’t seem to respond to the steam, the pediatrician may put your child on oral steroids for several days to reduce this swelling. In more severe cases, your child may actually need an injection of steroids to hasten the body’s response to the steroids. Any child with stridor should be treated with steroids. Finally, if the child has severe stridor he will need to be treated in the emergency room with a medicine known as racemic epinephrine. This medicine, given through a nebulizer, works quickly to reduce the swelling. However, if your child has sufficiently severe symptoms to warrant treatment with racemic epinephrine, she will be observed in the ER for at least four hours after treatment to ensure that the symptoms do not return. If they do, admission to the hospital is warranted for close observation.
There are generally no long-term side effects from croup, and nearly 100 percent of children with croup will be better by the sixth day. There is, unfortunately, no good means of preventing croup. Your best defense, as with most disease, is good hand washing.
By Robert Jawetz, MD, Tenafly Pediatrics
