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260 Elm Street #105
Somerville, MA 02144
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Davis Square Family Practice
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Deborah Bershel, MD
Michelle Clark, NP
Carmen Phillips, NP
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Barbara Kaplan, LICSW
Christopher Mulvey, NP
Croup is a spasm (tightening of the muscles) around the larynx (voice box). This spasm causes frightening sounds. Your child will have a cough that sounds like a seal barking. When your child breathes in you will hear a high-pitched rasping sound. The voice may be hoarse.
Croup may come on suddenly in the night and is usually caused by a virus. Usually croup causes breathing problems in children 3 months to 6 years old. A child that has it once often will have it again.
Usually croup is a relatively mild illness and may require almost no intervention on the part of the parent or clinician but occasionally it can be serious and even life-threatening.
What You Will See
• The hollow in the child 's neck may "pull in."
• His chest may "pull in" when he breathes in.
• His face will be pale.
• He will look "frightened
This happens because your child cannot move air in and out of his lungs easily.
Croup is frightening to the child. A crying, upset child tends to make the croup worse. Parents can help to relieve croup by being calm themselves, which helps to quiet the child. This relieves the tightness of the voice box and allows the child to breathe easier.
What You Should Do
As a parent your job is mainly to decide if this is a minor or major emergency situation. If your child may have a foreign body in her airway you would want to sweep the mouth with a finger to attempt to dislodge it followed by taking her on you knee and with her head pointing slightly down give a few blows to her back. Sweep the mouth again and follow by the back blows if you have not gotten the foreign body out.
If the difficulty breathing is severe with chest wall retractions and stridor (harsh wheeze with each breath in) then go immediately to the nearest ER. Another sign of an emergency situation would be cyanosis (purple lips).
If you do not feel there is an emergency situation:
1) Take your child to the bathroom and shut the door. Turn on the shower and hot water faucets to make steam.
Be careful to keep away from the hot water. Sit with the child and let him breathe in the steam.
This MAY help the symptoms
2) Alternatively, you may bundle up your child and take her into to cool night air. This too MAY help the symptoms
3)Do not leave the child alone.
After a Visit to the Emergency Department
Your child may have had a breathing treatment with a medicine that reduces the swelling in his throat. After you get him home he may have the same breathing problem he had when you brought him in. If this happens, take him into a steamy bathroom as explained above.
You can treat his fever (if temperature is above 102° rectally) with ibuprofen or acetaminaphen: teaspoons or droppers, or with baby aspirin.
When to Call the Doctor
Call the on-call physician :
• If child does not improve after being in a steamy bathroom for 10-15 minutes.
• If child's breathing becomes more difficult (chest continues to "pull in")
• If child begins to drool
• If child has difficulty swallowing
Often we will give oral prednisone (a steroid) for croup. It has been shown to be beneficial. Epinephrine (usually given in the ER) may help but its effects tend to be short-lived.