3 Things You Should Know About Croup

Croup is a common illness among children that causes swelling of the larynx and trachea. Croup generally begins as a common cold that slowly turns into a characteristic cough that sounds like a seal barking. Pharmacists can play an important role in counseling parents on safe home treatments for croup. Check out these 3 things you should know about croup.

Croup usually occurs in young children.

Children are most likely to get croup between 3 months and 3 years of age since the airways are small in this age group.¹ Croup can occur at any time of year, but it is more common during the fall and winter months. Educate parents that frequent handwashing is a great way to prevent croup.

There are 3 different types of croup.

1. Viral croup is the most common type that is usually caused by a parainfluenza virus.^2,3 Children can become infected through the air from coughing or sneezing, close personal contact, and touching contaminated objects or surfaces and then touching the mouth, nose, or eyes.³ Children usually have a low grade fever, develop a barky cough, and may exhibit stridor, which is breathing that produces a high-pitched whistling sound.²

2. Spasmodic croup is caused by an allergy or reflux from the stomach. It is similar to asthma and usually responds to allergy or reflux medications.

3. Croup with stridor can become life threatening of a child has trouble breathing and may need to be hospitalized. Approximately 5% of children seen in the emergency department for croup require hospitalization.¹

Home treatment can alleviate symptoms for viral croup but prescription medications may be necessary.

Children may awaken in the middle of the night with croup, so comforting measures such as a bedtime song can help to alleviate symptoms. Educate parents that children with a fever (100.4 ° F or higher) can be treated with acetaminophen or ibuprofen (children older than 6 months of age). It is important for children with croup to drink plenty of fluids. Over-the-counter (OTC) cough and cold preparations should be avoided due to the risk of life-threatening adverse effects.⁴ Reported adverse effects have included convulsions, tachycardia, and death. The FDA has recommended that these OTC medications not be given to children younger than 2 years of age, and manufacturers have voluntarily re-labeled these products to say “do not use in children under 4 years of age.”⁴

If croup symptoms persist or worsen, then a steroid such as prednisolone or dexamethasone may be prescribed to help reduce airway inflammation. Epinephrine may also be used to reduced airway inflammation in the hospital setting. Educate parents to seek emergency medical attention if their child experiences the following:

• Persistent stridor
• Cannot speak or make verbal sounds
• Struggling to breath
• Has bluish lips or fingernails
• Drools or has extreme difficulty swallowing saliva

References

• Croup. Mayo Clinic website. http://www.mayoclinic.org/diseases-conditions/croup/home/ovc-20166699. Accessed April 3, 2017.
• Croup and your young child. AAP website. https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Croup-Treatment.aspx. Accessed April 2, 2017.
• Human parainfluenza viruses. CDC website. https://www.cdc.gov/parainfluenza/. Accessed April 3, 2017.
• Use caution when giving cough and cold products to kids. FDA website. https://www.fda.gov/drugs/resourcesforyou/specialfeatures/ucm263948.htm. Accessed April 3, 2017.