What is Croup?
Croup is a swelling in the lower throat (subglottic) caused by a virus. The most common cause is the parainfluenza type 1 virus.
Characteristically a patient with croup is a child between ages 6 months to 6 years old with a barking cough. In all of my years of practice, I have never heard an adult make a croupy sound.
Listen to a croupy cough……
Notice the croup cough sound. Croup is also known by the medical term laryngotracheobronchitis.
Have you ever had to take your child into the ER in the middle of the night like this?
Quickcare or ER?
Red flags that will send you to the ER:
- Respiratory Distress
- Labored breathing (working to breath)
What will your doctor ask?
Symptoms of croup include its characteristic cough which followed an upper respiratory infection. Typically, it gets worse at night. It is not uncommon to have other symptoms such as a runny nose.
What will your doctor look for?
The most important part of the exam is the breathing. A child who is experiencing difficulty breathing has characteristic findings including: nasal flaring, chest wall retractions, and possibly stridor.
What is your doctor thinking?
One diagnosis on the list to consider is foreign body ingestion such as a coin, a nut or a piece of food.
One true emergency that a doctor needs to consider is epiglottitis. This is life-threatening! Children may present with a fever, sore throat, and drooling.
Stridor may develop.
Another possible reason for a sore throat and difficulty swallowing is a retropharyngeal abscess. With this illness, the physical exam may show swelling at the back of the throat. A lateral, soft tissue X-ray of the neck is a diagnostic test.
What is the treatment of Croup?
I treat my patients with a humidified air. So simple and so effective. Depending on the severity, I add on a steroid such as Prelone which is a liquid. In the ER, steroids may be given as a shot.
Another common croup treatment is humidified epinephrine.
So many times, simply the cold night air is curative. A common story is a child, demonstrating a barking cough, is rushed to the hospital. When the parents arrive, they are a bit embarrassed since the cold air cured a croupy cough.
Notice that antibiotics are not helpful with a viral infection such as croup.
How long will you be sick with Croup?
In my experience, children get better within 2-3 days. It is usually self-limiting
If fever and shortness of breath continue, then it has been my practice to do more extensive studies such as X-rays and blood work.
Let me tell you a Story
One night while working a night shift in the ER, I walked into the exam room. I encountered a couple named Felix and Fatima. They were a young couple; Well dressed, Professional looking.
What struck me the most is how much they looked alike.
First, I looked at Fatima then I looked at Felix then back to Fatima. They were both thin, olive skin and straight black hair. Even their respective suits had a pressed, tailored look.
Felix was a male version of Fatima and Fatima was a female version of Felix. I kept staring. I could not help myself.
Even before looking at their child, who was the patient, I asked, “Has anyone ever said that you guys look alike?” Felix answered, “Yeah, we get that all the time.”
“You look like twins. How did you meet?” I asked.
Fatima said smiling, “We met at a family reunion.”
My eyes bugged out and I leaned toward her.
“Got you!… Just kidding…Now can we talk about our daughter?” said Fatima
What a great response! In her polite but strong way, she told me to butt out of their story and focus on Lupe ( their daughter).
Lupe presented with a classic “barking-like-a-seal” croup sound. It almost resolved with the night air exposure. Still, Fatima and Felix wanted her checked out “just to be safe.” She got better with a little saline nebulizer and a dose of Prelone syrup.
I hope this helps
David Reyes MD
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