Croup

Definition

• Viral infection of the voicebox (larynx)
• The croupy cough is tight, low-pitched, and barky (like a barking seal)
• The voice or cry is hoarse (laryngitis)

Cause

• Usually a parainfluenza virus

First Aid Advice For Stridor

• Inhale warm mist in a foggy bathroom with the hot shower running, from a wet washcloth held near the face, or from a humidifier (add warm water) for 20 minutes. (Caution: avoid very hot water or steam which could cause burns or high body temperatures)
• If that fails, inhale cool air from breathing near an open refrigerator or taking outside for a few minutes if the weather is cold.
• Warm mist may also be helpful for difficulty breathing or severe coughing without stridor.

Return to School

• 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.

Stridor: A Complication of Croup

• 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
• See FIRST AID for treatment recommendations

When to Call Your Doctor for Croup

Call Your Doctor Now (night or day) If

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

Call Your Doctor During Weekday Office Hours If

Parent Care at Home If

Home Care Advice for Croupy Cough

1. Reassurance:
   • Most children with croup just have a barky cough.
   • Some develop tight breathing (called stridor).
   • Remember that coughing up mucus is very important for protecting the lungs from pneumonia.
   • We want to encourage a productive cough, not turn it off.
2. Humidifier: If the air is dry, run a humidifier in the bedroom. (Reason: Dry air makes croup worse.)
3. Mild Coughs: For infants, use sweet warm liquids to thin secretions and loosen the cough (avoid fruit juice if less than 4 months old.) Do not use honey in children under 2 years old. Some physicians may recommend the use of honey over 1 year of age; however, its use in the 1-2 year age range has not been well studied. Corn syrup is not recommended as a cough suppressant (no evidence based data or age recommendations available).
   • From 3 months to 1 year of age, only use warm clear fluids (e.g., water or apple juice) to treat the cough. Dosage: 1-3 teaspoons (5-15 ml) four times per day when coughing. Avoid honey.
   • After age 6, use COUGH DROPS to coat the irritated throat. (If not available, can use hard candy.)
4. OTC Cough Medicine (DM): 
   • OTC cough medicines are not recommended. (Reason: no proven benefit for children and not approved by FDA for children under 4 years old)
   • -Evidence-based use of honey for coughing (recommended at bedtime only in the following amounts):
     - 2-5 years: ½ teaspoon
     - 6-11 years: 1 teaspoon
     - 12-18 years: 2 teaspoons
     - Possible side effects of honey are diarrhea or sugar-induced hyperactivity, particularly if honey is given more frequently.
     - For daytime coughing, treat with warm fluids and humidity.
     - Follow up with child’s PCP if cough worsens.
   • -Dextromethorphan (DM) is a cough suppressnat found in most OTC cough medicines.
     - Age under 4 years: never use (AAP recommendation). Reason: risk of side effects and cough is a protective reflex.
     - Age 4-6 years: do not recommend (AAP recommendation). Reason: lack of proven benefit. However, if caller insists, advise them to check the package or their pharmacist. (Avoid multi-ingredient products).
     - Age 6 years or more: Recommend DM for SEVERE COUGHS that interfere with sleep, school or work. Check package insert or pharmacist for dosage.
     - NO ANTIBIOTICS: Antibiotics are not helpful for coughs.
5. Coughing Spasms:  
   • For infants, use sweet warm liquids to thin secretions and loosen the cough (avoid fruit juice if less than 4 months old.) Do not use honey in children under 2 years old. Some physicians may recommend the use of honey over 1 year of age; however its use in the 1-2 year age range has not been well studied. Corn syrup is not recommended as a cough suppressant (no evidence based data or age recommendations available).
6. Fever Medicine: For fever above 102° F (39° C), give acetaminophen (e.g., Tylenol) or ibuprofen.
7. Observation During Sleep: Sleep in the same room with your child for a few nights. (Reason: can suddenly develop stridor at night)
8. Avoid Tobacco Smoke: Active or passive smoking makes coughs much worse.
9. 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.
10. Expected Course: Croup usually lasts 5 to 6 days and becomes worse at night.
11. Call Your Doctor If:
    • Stridor (harsh raspy sound) occurs
    • Croupy cough lasts over 14 days
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "When to 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.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 1/19/2009

Last Revised: 7/1/2008

Copyright 1994-2009 Barton D. Schmitt, M.D.