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It’s finally starting to feel like winter, and with the changing weather, cold and flu season is now upon us.  We also know that more flu-like illnesses are coming when we start to hear the trademark sound of croup – “barking in the night.”

Croup is typified by the cough that sounds like a seal barking and this sound is caused by restricted airflow in the already small airways of the affected young patients who have a virus causing inflammation in the area of the voice box or larynx.

What is Croup?
Croup is by definition, a virus that infects the upper airways in the area of the voice box causing a high-pitched sound with breathing and seal-like barking cough.
The same virus if it affects adults will cause laryngitis (or a “frog in your throat”).

What causes it?
Viruses are at fault for causing croup, two of the more common ones are influenza and para- influenza. Parainfluenza gets its name since it is much like influenza (the “Flu”)  with fevers, body aches and a sore throat, but it’s course is typically less severe than the Flu.
These viruses invade the upper airways of children usually between the ages of 3 and 9, and cause inflammation and swelling in these smaller airways, restricting airflow and sometimes breathing.

How to treat croup at home
If your child has what sounds like croup and is not in distress, you can try these home remedies.  
Stay calm and keep your child calm.  These very small, inflamed airways are better if not challenged with the rapid shallow breathing that comes with crying.  Keep your child upright if necessary, in a comfortable position. 
Cool / moist air – breathing cool or colder outside air (while keeping your child’s body warm with a jacket or blankets) will bring colder air to flow over the inflamed areas in the upper airways of these children and will often make an immediate difference in their symptoms.  Humidified air or moist steam from a hot shower should have a similar effect.  Many parents have seen these effects for themselves and will try supportive care first before seeking medical care.

When to go to the Emergency Room
Most cases of Croup are mild and do not need emergency treatment, but do not ignore signs of significant respiratory distress.
If it seems that your child is using extra muscles to breathe or is blue (cyanotic) in any parts of the body, first seen around the lips or the fingers, then it is appropriate to go to the emergency room. Call 911 if the child is blue, has continuous trouble breathing or is listless.

How do we treat croup in the Urgent Care setting?
We frequently treat mild (and sometimes moderate) cases of croup with steroids, sometimes a single dose is adequate to improve the worst symptoms which typically lasts around 24 hours.
Occasionally, patients will improve with nebulizers, especially if they have a history of reactive airway disease (asthma or “pre-asthma”).
Also, it can be important to evaluate for coexisting illnesses, since ear infections can accompany croup about 50% of the time.  Otherwise antibiotics are not useful in croup. 
Supportive care is typically all that is needed as most cases of croup are mild and don’t need a hospital level of care.

And how to prevent it

Preventing croup is as easy, or is difficult, as preventing a common cold. Frequent hand washing, coughing into one’s arm, and keeping children at home when they are most infectious and sick are all reasonable preventive measures.  Unfortunately there is no vaccine for parainfluenza, the most common cause of croup.  Influenza is a common cause of croup as well and is typically associated with more severe cases.  There are medications which may shorten the illness with the Flu, and it’s still not too late to get your Flu shots.

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