Croup

When To Call

Call 911 Now

• Severe trouble breathing (struggling for each breath, constant severe stridor)
• Passed out or stopped breathing
• Lips or face are bluish when not coughing
• Croup started suddenly after bee sting, taking a new medicine or allergic food
• Drooling, spitting or having great trouble swallowing. Exception: drooling due to teething.
• You think your child has a life-threatening emergency

Go to ER Now

• Choked on a small object that could be caught in the throat
• Ribs are pulling in with each breath (called retractions)
• Age less than 1 year old with stridor (harsh sound with breathing in)

Call Doctor or Seek Care Now

• Stridor (harsh sound with breathing in) is heard now
• Trouble breathing, but not severe
• Lips or face have turned bluish during coughing
• Breathing is much faster than normal
• Can't bend the neck forward
• Severe chest pain
• Had croup before that needed Decadron
• Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
• Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
• High-risk child (such as cystic fibrosis or other chronic lung disease)
• Fever higher than 104° F (40° C)
• Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Stridor (harsh sound with breathing in) occurred but not present now
• Nonstop coughing
• Age less than 1 year old with a croupy cough
• Earache or ear drainage
• Fever lasts more than 3 days
• Fever returns after being gone more than 24 hours
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Coughing causes vomiting 3 or more times
• Croup is a frequent problem (3 or more times)
• Barky cough lasts more than 14 days
• You have other questions or concerns

Self Care at Home

• Mild croup (barky cough) with no stridor

Care Advice

What You Should Know About Croup:

• Most children with croup just have a barky cough.
• Some have tight breathing (called stridor). Stridor is a loud, harsh sound when breathing in. It comes from the area of the voicebox.
• Coughing up mucus is very important. It helps protect the lungs from pneumonia.
• We want to help a productive cough, not turn it off.
• Here is some care advice that should help.

First Aid for Stridor (Harsh sound with breathing in):

• Breathe warm mist in a closed bathroom with the hot shower running. Do this for 20 minutes.
• You could also use a wet washcloth held near the face.
• Caution: do not use very hot water or steam which could cause burns.
• If warm mist fails, breathe cool air by standing near an open refrigerator. You can also go outside with your child if the weather is cold. Do this for a few minutes.

Calm Your Child if He or She has Stridor:

• Crying or fear can make stridor worse.
• Try to keep your child calm and happy.
• Hold and comfort your child.
• Use a soothing, soft voice.

Humidifier:

• If the air in your home is dry, use a humidifier.
• Reason: dry air makes croup worse.

Homemade Cough Medicine:

• Goal: decrease the irritation or tickle in the throat that causes a dry cough.
• Age 6 months to 1 year: give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: use a dose of 1-2 teaspoons (5-10 mL). Give 4 times per day when coughing. Caution: do not use honey until 1 year old.
• Age 1 year and older: use Honey ½ to 1 teaspoon (2-5 mL) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough. If you don't have any honey, you can use corn syrup.
• Age 6 years and older: use cough drops to decrease the tickle in the throat. If you don't have any, you can use hard candy. Avoid cough drops before 6 years. Reason: risk of choking.

Non-Prescription Cough Medicine (DM):

• Non-prescription cough medicines are not advised. Reason: no proven benefit for children and not approved under 6 years old (FDA).
• Honey has been shown to work better for coughs. Caution: do not use honey until 1 year old.
• If age 6 years or older, you might decide to use a cough medicine. Choose one with dextromethorphan (DM) which is present in most non-prescription cough syrups. Follow the instructions on the package.
• When to Use: give only for severe coughs that interfere with sleep or school.

Coughing Fits or Spells - Warm Mist and Fluids:

• Breathe warm mist, such as with shower running in a closed bathroom.
• Give warm clear fluids to drink. Examples are apple juice and lemonade.
• Age less than 6 months. Only give breast milk or formula
• Age 6 - 12 months. Give 1-2 teaspoons (5-10 mL) each time. Limit to 4 times per day.
• Age over 1 year. Give as much warm fluids as needed.
• Reason: both relax the airway and loosen up any phlegm.

Fluids - Offer More:

• Try to get your child to drink lots of fluids.
• Goal: keep your child well hydrated.
• It also loosens up any phlegm in the lungs. Then it's easier to cough up.

Fever Medicine:

• For fevers higher than 102° F (39° C), give an acetaminophen product (such as Tylenol).
• Another choice is an ibuprofen product (such as Advil).
• Note: fevers less than 102° F (39° C) are important for fighting infections.
• For all fevers: keep your child well hydrated. Give lots of cold fluids.

Sleep Close by to Your Child:

• Sleep in the same room with your child for a few nights.
• Reason: stridor can start all of a sudden at night.

Avoid Tobacco Smoke:

• Tobacco smoke makes croup much worse.

Return to School:

• Your child can go back to school after the fever is gone.
• Your child should also feel well enough to join in normal activities.
• For practical purposes, the spread of croup and colds cannot be prevented.

What to Expect:

• Most often, croup lasts 5 to 6 days and becomes worse at night.
• The croupy cough can last up to 2 weeks.

Call Your Doctor If:

• Trouble breathing occurs
• Stridor (harsh raspy sound) occurs
• Croupy cough lasts more than 14 days
• You think your child needs to be seen
• Your child becomes worse

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FIRST AID Advice - Croup with Stridor

• Stridor is a harsh, tight sound with breathing in. Stridor means the croup is severe.
• Breathe warm mist in a closed bathroom with the hot shower running. Do this for 20 minutes.
• Other Option: Use a wet washcloth held near the face. You can also use a humidifier containing warm water.
• Caution: do not use very hot water or steam. These can cause burns. Hot steam can also cause high body temperatures.
• If warm mist doesn't work, breathe cool air by standing near an open refrigerator. You can also go outside with your child if the weather is cold. Do this for a few minutes.

Source: Self Care Decisions, LLC
Used with Permission from Schmitt Pediatric Guidelines LLC.