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Croup

Intro

Call your doctor if the following conditions develop:

  • Your child has a temperature of 102°F or higher.
  • The child's cough continues despite cough medications and cool-mist treatments at home.
  • The child is breathing faster than normal or has noisy respirations.
  • The child has signs of dehydration, including increased sleepiness, dry mouth, or decreased urination.

If there is any doubt regarding severity of symptoms, then call 911 for an ambulance immediately. Your child should be taken for urgent evaluation in a hospital's Emergency Department if these conditions develop:

  • The child starts having loud, high-pitched wheezing while breathing.
  • The child begins to struggle to breathe or speaks in short sentences because of lack of breath.
  • The child has difficulty swallowing.
  • The child is having signs of restlessness or sluggishness either from respiratory distress or dehydration.
  • The child has signs of respiratory distress including retractions of skin around the ribs from deep breathing, nostril flaring, or rapid breathing.
  • Cyanosis, which is a bluish color to the skin, lips, or nail bed, indicates severe lack of oxygen in the body and should be considered an emergency.
Self-Care at Home

Breathing moist air from steamed water, a hot shower, or a cool-mist humidifier is helpful in the majority of cases. Coughing and stridor should improve within 20-30 minutes.

Taking the child outside while dressed warmly on a cold day for a few minutes may be helpful as well. The cool moist air that the child breathes on the way to the doctor's office or Emergency Department often helps resolve the symptoms prior to arrival.

Substitute juices for milk products. Frequent sips of clear liquids can loosen mucus and prevent dehydration, which often occurs with croup.

Crying can trigger spasmodic coughing. Attempt to comfort your child to prevent agitation.

acetaminophen (Children's Tylenol) may be given for fever. Consult your doctor before using Aspirin or related products such as children's ibuprofen (Advil).

Some children will benefit from sitting up straight for ease of breathing. An infant car seat can be used for small babies.

Avoid exposure to respiratory irritants such as smoking .

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Follow-up

Have the child rest as much as possible.
Give him or her plenty of fluids to drink.
Continue cool mist from a vaporizer or steam from a hot shower. Do not leave your child alone in the bathroom with hot water. Keep your child calm, because breathing symptoms can worsen with crying and agitation.
Make certain your child takes his or her medications for the length of time prescribed, even if the child has improved.
If symptoms return or worsen, then notify your doctor or return to the Emergency Department.

Prevention

Croup is a contagious disease. If possible, avoid contact with others who have colds or cough symptoms.
Have children wash their hands often to reduce the chance of spreading the infection.
Get prompt treatment with symptoms of respiratory infection.
Increase the amount of fluids children drink.
Avoid exposure to respiratory irritants such as smoke.

Outlook

Croup usually gets better over 5-6 days. Although most children respond to humidified air from a shower or vaporizer, studies have reported that 7% of cases will require admission to the hospital. Of these admitted, only 1-2% will be severe enough to require a breathing tube with mechanical ventilation or pediatric intensive care.

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