Croup

Alternative Names

Treatment

Most cases of croup can be safely managed at home, but call your health care provider for guidance, even in the middle of the night.

Cool or moist air can bring relief. You might first try bringing the child into a steamy bathroom or outside into the cool night air. If you have a cool air vaporizer, set it up in the child's bedroom and use it for the next few nights.

Acetaminophen can make the child more comfortable and lower a fever, lessening his or her breathing needs. Avoid cough medicines unless you discuss them with your doctor first.

You may want your child to be seen. Steroid medicines can be very effective at promptly relieving the symptoms of croup. Medicated aerosol treatments, if necessary, are also powerful.

Serious illness requires hospitalization. Increasing or persistent breathing difficulty, fatigue, bluish coloration of the skin, or dehydration indicates the need for medical attention or hospitalization.

Medications are used to help reduce upper airway swelling. This may include aerosolized racemic epinephrine, corticosteroids taken by mouth, such as dexamethasone and prednisone, and inhaled or injected forms of other corticosteroids. Oxygen and humidity may be provided in an oxygen tent placed over a crib. A bacterial infection requires antibiotic therapy.

Increasing obstruction of the airway requires intubation (placing a tube through the nose or mouth through the larynx into the main air passage to the lungs). Intravenous fluids are given for dehydration. In some cases, corticosteroids are prescribed.

Outlook (Prognosis)

Viral croup usually goes away in 3 to 7 days. The outlook for bacterial croup is good with prompt treatment.

If an airway obstruction is not treated promptly, respiratory distress (severe difficulty breathing) and respiratory arrest can occur.

Possible Complications

• Respiratory distress
• Respiratory arrest
• Epiglottitis
• Bacterial tracheitis
• Atelectasis (collapse of part of the lung)
• Dehydration

When to Contact a Medical Professional

Most croup can be safely managed at home with telephone support from your health care provider. Call 911 if:

• The croup is possibly being caused by an insect sting or inhaled object
• The child has bluish lips or skin color
• The child is drooling
• The child is having trouble swallowing

Depending on the severity of the symptoms, call 911 or your health care provider for any of the following:

• Stridor (noise when breathing in)
• Retractions (tugging-in between the ribs when breathing in)
• Struggling to breathe
• Agitation or extreme irritability
• Not responding to home treatment

References

Behrman RE. Nelson Textbook of Pediatrics. 17^th ed. St. Louis, Mo: Elsevier; 2004.

Knutson D. Viral croup. Am Fam Physician. 2004; 69(3): 535-40.

Long, SS. Croup (viral laryngotracheobronchitis). In: Principles and Practice of Pediatric Infectious Diseases. 2nd ed. Elsevier, 2003; 210-211.

Murray JF, Nadel JA. Croup. In: Textbook of Respiratory Medicine. 3rd ed.W. B. Saunders Company, 2000; 960-961.

This article uses information by permission from Alan Greene, M.D., © Greene Ink, Inc.