Sunday, April 25, 2010

All about croup

I've been away for a few days.. did anyone miss me? :)

Croup is a condition that usually seen in the winter but can be seen anytime. It can be terrifying and it can also be serious at times.

What is croup?
Croup is a viral illness that affects the upper airway. These are the smaller areas such as the trachea and vocal cords. The airway becomes inflamed and swells, which makes it more difficult for the child to breathe.

What are the symptoms of croup?
The cardinal symptom is a harsh barking cough. Anyone who has heard this cough will recognize it when they hear it again. A child usually has a fever and difficulty breathing. You will hear upper airway noises called stridor. These are harsh sounds that are heard with each breath and sound like the child has difficulty breathing. It can be very scary to hear. Kids may also have bluish tinge to their lips or fingernails and may be very anxious.

How long do symptoms last?
Symptoms can last 4-5 days. It usually gets worse before it gets better. Often symptoms start late at night and then are better in the morning then get worse again in the evening. Most emergency room visits to for croup are at night.

How is croup treated?
The best thing to do at home is steam up the bathroom and sit in there with your child. You can take your child outside on a cold night. If these do not work and your child is having severe breathing difficulty then you will need to take them to be seen in the emergency department.

Once they are in the emergency department we will give them oxygen if needed and monitor them closely. Some kids may have swelling so bad that they have difficulty getting any air in. Other kids may have more mild disease. Sometimes we use albuterol nebulizers but this usually has limited success because albuterol works better on problems in the lower airway. We may also try a nebulizer of racemic epinephrine in severe cases to help the symptoms.

Kids who are getting enough oxygen and are able to eat and drink at home can be discharged. We almost always give kids a dose of Dexamethasone, which is a steroid. It works by decreasing the swelling of the airway which allows the kids to be able to breathe better. It takes about 4 hours to work but the best part is it lasts 48 hours and by the time it wears off, most kids are better from their croup.

When should you worry that your child is getting worse?
If your child is breathing fast (how fast depends on your child's age)
If your child is sucking in her chest with each breath
If your child has a bluish tinge to her lips
If your child is unable to talk to you or is very sleepy

then you should call your health care provider or go to the emergency department.

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