Croup 2022

 

Croup

Croup is making the rounds.  The official name is Laryngotracheitis. For obvious reasons most people simply refer to it as Croup. Much of the time Croup is viral rather than bacterial; antibiotics are not an appropriate treatment. This illness causes inflammation in the upper airway. The air passages in the throat narrow due to the swelling. This often leads to breathing that is noisy and sometimes labored. Croup is so common that it was actually one of the first illnesses that I addressed in a blog post many years ago. It tends to afflict patients between the ages of 6 months - 6 years, but anyone can get it. Many seasonal viruses can lead to infections in the respiratory tract such as Croup. The most familiar ones include RSV and parainfluenza. Now it seems that the Omicron variant of Covid-19, is on that list. Omicron settles higher up in the respiratory tract rather than deep in the lungs, so that makes sense. Having Covid involvement does not impact the treatment. Take comfort in the fact that doctors are quite familiar with this and know what to do! Croup is quite contagious. Usually kids will start showing some symptoms within a day or two after the exposure. Some children who get exposed to this virus will end up with the symptoms of the common cold. Others get the classic croupy cough. (Think Darth Vader) There are actually two distinct presentations. Many patients will start off with a cold, sore throat, hoarse voice and mild fever. This progresses to the deep barky cough. Most kids are sick for 4 - 7 days. It is normal for the cough to linger for a week or so even when they are otherwise on the mend. Others have acute spasmodic croup. With this, it is typical for the symptoms to start without warning in the middle of the night. Your child may have seemed fine when they went to sleep but then they wake up in the wee hours sounding like a seal. This can freak out a lot of even the most hardy parents. Your job is to keep your cool and do your best to keep your child from getting any more agitated. Head into the bathroom and run a hot shower. Sit there in a steamy room (you don't need to be in the actual shower) and sing in a soft voice. See if you can get them calm. It is time to head to the emergency room if your child is excessively drooling and has a tough time swallowing, seems agitated, or breathing is getting more labored or is showing signs of “stridor” at rest (when not agitated or crying). More than half of the time, your child will be dramatically better by the time you get to the ER. Somehow getting out in the night air is quite helpful. The spasmodic type of croup usually lasts about three days. The kids seem to be almost normal during the day but the cough comes back at night. Take a deep breath, the first night is usually the worst. Running a humidifier during the night is often very helpful. If you are nerdy enough to have a hygrometer, 50% humidity is the sweet spot. For mild cases rest, steam and fluids will get you through. For more severe cases your child will likely get a dose of steroids that will calm things down. Dr. Ted’s Tidbits Croup can be really overwhelming for my patients. As soon as they hear a barky cough, they’re sprinting to the doctor’s office.  The barky cough just tells me that there is swelling in the larynx and trachea, which is almost always due to one of a multitude of viruses. That in and of itself, does not always need treatment, but you can call your doctor to ask what they think. I’m the most curious about stridor, the high pitched noise that can be heard when breathing in. I recommend looking up stridor on youtube videos. This happens when the swollen tissue collapses inward during inspiration, and always needs a call to the doctor.