Croup Chasing off a Scary Cough
CROUP Chasing Off a Scary Cough
Your child has had the sniffles for a few days when suddenly he wakes up in the middle of the night with a strange cough that sounds like a seal barking. His voice is hoarse, and he's running a slight fever. He's also having trouble breathing.
After a panicky call to the doctor you learn that these are the symptoms of croup, a common viral infection of the vocal cords that strikes babies and preschoolers mainly during the fall and spring.
Though it's often thought of as a single ailment, croup is more accurately a symptom of many different viruses, says Marjorie Hogan, M.D., an instructor of pediatrics at the University of Minnesota and a pediatrician at the Hennepin County Medical Center in Minneapolis. ''It can be very frightening--to both parents and children--because the swelling in the throat that causes the barking cough can also make breathing difficult,'' she says. Some children with croup also experience what is called stridor, a vibrating sound that occurs when they breathe in. It's especially noticeable when they cry.
| |
| When to See the Doctor ''Most of the time croup is a benign disease that parents can readily deal with at home,'' says Marjorie Hogan, M.D., an instructor of pediatrics at the University of Minnesota and a pediatrician at the Hennepin County Medical Center in Minneapolis. But a severe case can cause breathing problems that may require a visit to a hospital emergency room. ''If the child's symptoms are really frightening you, call the doctor or go to the emergency room right away,'' says Dr. Hogan. There are two other diseases that resemble croup, and both of them are life-threatening. One is epiglottitis, a sudden swelling of the cartilage flap at the top of the throat that can close a child's windpipe. The other is infectious tracheitis, an inflammation of the windpipe caused by a staph infection, which calls for antibiotics and often respiratory support. In both cases, says Loraine Stern, M.D., associate clinical professor of pediatrics at the University of California, Los Angeles, and author of When Do I Call the Doctor?, you may need to call local paramedics ''if the emergency room is far away and the child is in real distress.'' Here are some warning signs that indicate a medical emergency. * Home remedies are not working * High fever (103° to 105°) * Crouplike symptoms that progress rapidly * Unusual amount of drooling * Inability to bend the neck forward * The child is leaning forward and gasping for air * Poor color (the child appears gray, blue or pale) * Breathing becomes more and more labored, and the child's ribs are clearly visible at each breath * Nostrils are flaring and the child is making a crowing sound with each breath * The child cannot talk or cry * The child looks frantic If you suspect epiglottitis, it is imperative that you do not open the child's mouth to peer inside. ''If you do that, the whole throat can close up and the child can go into respiratory arrest,'' says Dr. Hogan. |
In most cases, croup can be treated successfully at home with very simple measures. However, croup can sometimes be serious, and there are two life-threatening conditions that resemble it. So read ''Medical Alert'' on the opposite page before trying any of these home remedies.
Stay calm. The reason you need to stay calm is that you want your child to stay calm. ''The symptoms of croup get worse when the child gets agitated,'' says Dr. Hogan. ''As he's gasping for more breath, he breathes faster. If you can calm him, he'll breathe slower and more air can get in and out.''
Turn on the hot water. If your child is having breathing difficulties, take him into the bathroom and turn on a hot shower to get the room really steamy, suggests Dr. Hogan. ''The child will be able to breathe more easily in the steam. No one is really sure why this works, but it may decrease the inflammation so the swelling goes down.''
Hit the cold air. One of the curious things about croup is what happens when panicky parents bundle their child into the car for the drive to the hospital. ''Suddenly, the problem stops,'' says Dr. Hogan. ''For some reason, cold air--like steamy air--can be really beneficial.'' So you may be able to help your child just by opening the window (if it's a cool night) or by taking him into an air-conditioned room.
Use a humidifier. ''Turn your cool-mist vaporizer up full blast,'' says Shirley Menard, R.N., a certified pediatric nurse practitioner and assistant professor at the University of Texas Health Science Center at San Antonio School of Nursing. '' You can either let the vaporizer douse the entire room or direct it toward the child.'' You need to get a lot of moisture into the air before this will be effective, she says.
Some experts recommend a warm-mist vaporizer, ''but I always recommend the cool mist because if the child gets out of bed and falls on it, he won't burn himself,'' says Loraine Stern, M.D., associate clinical professor of pediatrics at the University of California, Los Angeles, and author of When Do I Call the Doctor? ''Just be sure to use a vaporizer with a filter that's designed to filter out impurities, because those can aggravate breathing difficulties in an allergic child.'' Clean the vaporizer often, following the manufacturer's instructions.
Control the fever. ''Children who have a fever tend to breathe faster to cool off their bodies, and that makes their breathing more difficult,'' says Dr. Stern. You can give your child acetaminophen (Children's Tylenol) to bring the fever down. Check the package directions for the correct dosage for your child's age and weight. If your child is under age two, consult a physician.
Give plenty of fluids. '' We all lose some fluid from the body with each breath. But for the child breathing harder and faster with croup, this can become a real problem,'' says Menard. '' You can give the child frequent, small sips of an over-the-counter electrolyte replacement fluid such as Pedialyte--or even Gatorade.'' But any clear liquid--like broth or apple juice--will help restore fluids to the child's body.
Sleep with the child. Croup is scary. For your own peace of mind, it might be best to sleep in the same room as your child, says Dr. Stern. That way you'll be right there if he experiences breathing difficulties. For some reason croup tends to get worse at night. ''It may be because the body produces less of the hormone cortisone at night. There's some evidence that cortisone can help a little bit with croup,'' says Dr. Stern. If you can't sleep in the same room as the child, use a monitoring device that will alert you if there's any problem.
