Healthy Living: November 19, 2019 – WABI

BANGOR, Maine (WABI) - Fall and Winter are typically the worst times for "cold and flu" season, when lots of respiratory illness circulates among the population. Most of these illnesses are mild and have similar symptoms that may including congestion, sore throat, cough, and fever.

Viral Croup is one such illness in small children that starts like any other "cold" with congestion, but the symptoms quickly become quite specific. Croup mostly affects children less than 5 years old and tends to occur mostly in the Fall. In croup, the windpipe/trachea and voice box /vocal cords become swollen and this causes its distinctive symptoms. The cough from croup is classically described as "barking" or "seal-like". The voice becomes raspy and there can be a high-pitched squeaking sound when breathing IN; this is known as stridor. All these symptoms become worse with agitation or crying.

The reason these noises are so specific is that air is harder to pull into the lungs because the swelling makes the size of the windpipe smaller. Its much harder to breath through a drinking straw, than say, a snorkel. Croup targets young children because their breathing tubes are small to begin with because they are small people. A little bit of swelling makes a much bigger difference to them than older children or adults who have the same amount of swelling but are starting with much larger breathing tubes.

Happily, most cases of croup are mild and don't need any special treatment. Keeping your child calm and comfortable while encouraging fluids and rest as you normally would with any minor illness is often all that is required. Tylenol and ibuprofen can be used for any fever or other pain. A cool mist humidifier or steam filled bathroom may improve the barking cough, sometimes dramatically. If its cool and moist outside, taking the child outside may provide some relief.If a child with croup is still eating, drinking and sleeping well they should be fine to stay home. The illness usually runs it course in a week or less. Sometimes, however, it needs more medical attention. If the stridor is worsening quickly, or breathing becoming fast and labored, seek care right away. With more serious croup you can see the notch at the base of the neck suck in during each breath and maybe the chest as well. If your child has trouble talking, swallowing or is drooling a lot you should go to an emergency room right away. Same thing if they become lethargic and listless or very anxious appearing.

There is a type of nebulizer (racemic epinephrine) that can be given that will temporarily help relieve the airway swelling of croup. When this is required, steroids are also typically given for a more lasting effect. Often only one dose of steroids is required. A small number of patients will need admission to the hospital for repeat doses of nebulizers and steroids and very rarely may even require the help of a respirator until the airway inflammation improves.

It has been an active Fall for croup in our region so if your small child starts barking like a seal, don't panic! Be ready to handle it at home as described above and prepared to seek medical attention on the off chance it gets worse.

References: 1. 2.

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Healthy Living: November 19, 2019 - WABI

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