Archive for the ‘Croup In Children’ Category

Treatment Of Croup

What is the treatment for croup?

Croup can be frightening for both children and parents. Therefore, comforting and reassuring the child is the first step. Breathing difficulties can develop and worsen rapidly. Close monitoring of the child is important during the early phases of the illness.

To help the child breathe more comfortably, a cool or warm mist vaporizer can be placed near the child. The humidified air promotes reduction of vocal cord swelling and thus lessens symptoms. To avoid accidental burns, hot water vaporizers should be out of the reach of infants and toddlers. Also effective is having the child breathe in a bathroom steamed up with hot water from the tub or shower. When cough or stridor worsens at night, 10 or 15 minutes sitting or driving in the cool night air can also help the child breathe.

In infants and children, blockage in the nasal passages from mucus can further impair breathing. Careful instillation of saltwater nose drops (¼ teaspoon of table salt in 1 cup of water) into the nasal openings every few hours, followed by gentle suction using a bulb syringe, can be helpful in opening nasal passages.

The American Academy of Pediatrics recommends avoiding most combination cough and cold medicines. Several studies show that these medicines are ineffective in children. They can potentially cause side effects that could lead to more serious symptoms. Acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) are helpful for pain relief and fever. Acetylsalicylic acid (Aspirin, Ecotrin) is avoided in the treatment of croup and other viral illnesses since aspirin is suspected as being related to Reye’s syndrome in children. Reye’s syndrome is a serious illness causing kidney, liver, and brain damage, which can lead to the rapid onset of coma. Occasionally, cortisone medications are prescribed for more severe cases of croup. Because a virus usually causes croup, antibiotics are reserved for those rare occasions when bacterial infections cause croup or become superimposed on the viral infection.

Even though plenty of fluids are encouraged to avoid dehydration, forcing fluids is generally unnecessary. Popsicles are a popular means of providing fluid. Activity should be restricted to quiet play during the first days of the illness.

Children with croup are most contagious during the first days of fever and illness. Infection spreads easily in a household. Other children in the family will often develop a sore throat or a cough, without necessarily developing the croupy cough and stridor seen in croup. Infants and children may return to school or day care when their temperature is normal and they feel better. A lingering cough can last another two weeks but should not be the reason to keep them at home.

Croup – Treatment Overview:

Home treatment, such as using a humidifier, can help treat mild to moderate croup. Regardless of treatment, symptoms usually improve gradually within 2 to 5 days.

If your child has severe croup or has not responded to home treatment, medicines may be used to reduce airway swelling. These are usually given in a doctor’s office or an emergency room. Medicines usually include:
Recommended Related to Children

Controlling Contagious Infections in Children:

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•      Glucocorticoids, such as dexamethasone or budesonide (for example, Pulmicort).
•      Epinephrine.

If your child needs extra oxygen, it is given through a nasal cannula or delivered through an oxygen mask placed over the nose and mouth.

If breathing improves after one or more of these measures, your child will be observed for a short time and sent home. If symptoms do not improve, your child may need hospitalization and further testing.

What to Think About?

Over-the-counter cough and cold medicines are not helpful for treating croup. These medicines may not be safe for young children. Before you give them to a child, check the label. If you do give these medicines to a child, always follow the directions about how much to give based on the child’s age and weight.

Antibiotics are not effective treatments for croup. These are only used if a secondary bacterial infection, such as a middle ear infection, develops.

Background:

Croup is a common, primarily pediatric viral respiratory tract illness. As its alternative names, laryngotracheitis and laryngotracheobronchitis, indicate, croup generally affects the larynx and trachea, although it may also extend to the bronchi. It is the most common etiology for hoarseness, cough, and onset of acute stridor in febrile children. The vast majority of children with croup recover without consequences or sequelae; however, it may be life-threatening (see the image below). (See Etiology, Epidemiology, Prognosis, Clinical, and Treatment.)
Child with croup. Note the steeple or pencil sign Child with croup. Note the steeple or pencil sign of the proximal trachea evident on this anteroposterior film. Courtesy of Dr. Kelly Marshall, CHOA at Scottish Rite.

Croup manifests as hoarseness, a seal-like barking cough, and a variable degree of respiratory distress. However, morbidity is secondary to narrowing of the larynx and trachea below the level of the glottis (subglottic region), causing the hallmark marked inspiratory stridor. (See Prognosis, Clinical, and Workup.)

Treat the fever. Using Acetaminophen or Ibuprofen. Click on each for dosing help.

Important: Do not give antihistamines or decongestants without your doctor’s advice. These may dry the narrowing air passages that the moisture is trying to open.

The above suggestions usually work well within about twenty minutes (an hour for the fever), and the child is able to settle back to sleep. You should observe your child closely by sleeping in the same room the rest of the night, as another croup attack is likely, and the above treatments will need to be repeated.

When to go to the Emergency Room (or Doctor’s office):

After trying the preceding treatment, assess in which direction your child is going. If indrawing and stridor is lessening, color is returning to child’s pale cheeks, or he initiates some interaction or wants to drift off to sleep (though still breathing noisily), continue with the steam and a watchful eye and ear. If you feel your child is getting worse despite the above treatments go straight to the Emergency Room. Your doctor won’t be able to treat this over the phone, so it may be best to go to the ER instead of paging your doctor and waiting for a call back.