Croup is one of those things that young children seem to get often in novels, and no doubt in real life as well. It generally occurs in kids between the ages of three and six, and its most common symptoms are a high-pitched cough and difficulty in breathing. Medically, croup is known as acute obstructive laryngitis, and its causes are myriad: a bacterial infection like flu or diptheria; an allergy; a swallowed object; or even, at the scariest extreme, a tumor of the larynx. Treatment depends on cause: antibiotics for a bacterial infection; epinephrine or similar drugs for an allergy; removal of the blockage. Steam inhalation from a vaporizer or hot-water faucet can often relieve breathing difficulties, but in severe cases oxygen may be required, or the cutting of an opening in the trachea to prevent suffocation. I hope none of you ever have to do this to any child you know, and that, if you do, your first aid skills are up-to-date.

NOTE: This writeup is a first-hand account of dealing with an extreme case of croup in a toddler rather than any new medical insights.

Though mostly regarded as relatively benign, my experience with croup reigns as one of the most frightening incidents of my parenting life.

In early October, my oldest son, SweetfaceBoy, developed a barking cough on the day he went to his doctor to have his stitches pulled from his left foot. The doctor diagnosed it as croup. SweetfaceBoy was to not play hard for a day or so and try to talk as little as possible. Despite spiking a fever overnight and staying home from school the next day, within three days he was fine.

A few days later, my nephew, Vonda MaShone (who Supervixen and I are raising), had a less-severe, but still noticeable seal-like cough. He was still able to go to school without a problem.

Then at 12:21 a.m. on Thursday, October 24, 2002, I awoke to my youngest, 22-month-old RunningHammer, struggling with a hoarse, faint cough. Supervixen was the first out of bed, and I was up and out by the time she came in to the room with him in her arms.

His face was a tear-stained mask of wide-eyed fear. The first thing I noticed is that his lips were blue. I slipped on my shoes and took him from wifey. Shaking, he inhaled in short, quick gasps which collapsed his chest cavity slightly, but he hardly exhaled at all. Normally his cry can shatter windows. Now it was barely a whisper.

"He can't breathe," I said. "I'm taking him to the hospital."

With the calmest voice I could muster, I buckled him in to his carseat. ("Don't worry, buddy. You'll be just fine. We'll get you all fixed up.") More chest heaving and collapsing. Worse now. Panic on his face. I started the Volvo, and stomped on the gas all the way to the hospital. At one point, he ceased to make any sound at all. ("You still there, pal?") A squeeze on a bare foot got him complaining again. I got there literally in five minutes.

It is amazing how saying "My son can't breathe" focuses an emergency room like a laser. He was whisked in to the ER and within a minute a respiratory therapist arrivied to give him a breathing treatment. A nurse came in to give him a shot. To my little guy's credit, he had a lot of fight in him, twisting and squirming away from the tube of mist being blown in his face. I took this as a good sign.

"I think it's an asthma attack," I told the therapist.

"Nope," she said after listening to him cough. "It's croup. Listen. The cough is in his throat. His windpipe is inflamed."

She added that this was the second one she'd seen that day. Apparently there was some virus going around carrying it. When I asked why my other boys were not as badly affected, she said babies and toddlers are not as strongly developed to combat the sickness, whereas older children can almost shrug it off.

A doctor came in a few minutes later. He ordered another treatment and then x-rays and said he'd like to keep RunningHammer around awhile for observation. He might stay for a few hours or overnight, he'll just have to see. On his chart my son was listed in guarded condition.

We were shown to a separate room in the ER, not a curtained cubicle. Another treatment followed, which RunningHammer tolerated well. We rode in a wheelchair to x-ray, which the little guy apprehensively enjoyed. Several attempts were made by the x-ray tech before he could get a shot he could use. We were wheeled back.

An unexpected side effect of all the medicine was that it turned him into a wired, amped, hyper little boy, only wanting to play with the two Hot Wheels cars and super ball I had stashed in his diaper bag.

Finally, the head ER doctor came in and said based on the medicine he had and x-rays, RunningHammer had not improved as significantly as he would've had liked. So, erring on the side of caution, he was admitted at 3:30 a.m., still in guarded condition.

More paperwork. Another phone call to update Mommy. A sip of juice. Diaper refreshment. We had our own room. Unfortunately, the crib was one only Hannibal Lecter would love so I walked with him for a while until he put his head on my shoulder. At 4:30 a.m. he fell asleep, oblivious to the nurses that came in to install a cool air humidifier, take his temperature and listen to his throat.

Supervixen came to relieve me the next morning so I could go to work. RunningHammer had eaten some breakfast by this point, but was still raspy. Kisses and hugs and off to the rock pile.

Observation throughout the next day, a few more x-rays and breathing treatments and at last he was discharged at 7:00 p.m. Friday night. By that time, I'd put a cool-air humidifier in his room and he had a nice long sleep in his own comfy crib.

Like I said, no medical insights, but if you have a little one and suspect the croup, invest in a cool-air humidifier, pay attention and as soon as things turn south, head to the doctor.

I saw an emergency room nurse in my clinic for a cough that was not going away. I listened to the story, examined her and said that I thought she had croup. I gave her instructions and sent her out.

I ran into her a few weeks later. She grinned at me. "I thought you were completely full of it when you said I had croup. But nothing else was working, so I followed your instructions. I was so much better the next day that I decided that you were right after all."

I grinned back. "Kind of embarassing to have one of those little kid illnesses, right?"

I have seen two cases of croup in the last week. In adults, not children. They look surprised when I say that I think they have croup, but it looks different in adults than children.

Croup is a viral illness also known as acute laryngotracheitis, or tracheobronchitis. The virus inflames the back of the throat and down the trachea, inflames the vocal cords and sometimes the bronchi as well. This is an upper airway illness, as opposed to a lower airway illness. Lower airway would be things like pneumonia, influenza or an asthma exacerbation.

Small children have a narrower airway than adults. They can get a terrifying barking cough. Some really do sound like a seal barking. Cold air and humidity help to soothe and reduce the swelling, so the classic winter emergency room visit is the parent saying, "She has this horrible cough but she coughed less once we got her in the car." For small children, we often use a one time dose of steroids to reduce the inflammation and swelling. If the swelling is worrisome, we hospitalize them and put them in a cold air mist tent, with oxygen if needed.

This is not epiglottitis, which is a bacterial infection of the epiglottis. The airway can completely close off and suffocate a child. We intubate and give iv antibiotics. The child looks very ill, sits up and forward, drools because they can't breathe well enough to swallow. Call an ambulance immediately.

The oldest person I have seen with a barking cough is a 9 year old. Mostly the barking cough is in children under two. Older children and adults get laryngitis or are hoarse, and they cough a lot.

The clinical picture in people over two is hoarseness, a cough that doesn't respond very much to cough medicine or inhalers such as albuterol (both of which work more on lower airways), fever the first couple days or not at all, a mild but not severe sore throat and mild or no nasal congestion. One patient this week said, "It feels all hot from the back of my nose down into my chest."

Strep throat can cause vocal changes, but it's the "talking with mashed potatoes in your mouth" voice, not laryngitis. The larynx is usually not inflamed in strep. It is the enlarged tonsils that make the voice funny in strep, and usually adults don't have that. Also, the throat hurts more in strep, little or no congestion, more fever, that rare but distinctive rash, headache and often stomach ache.

I am always hopeful that my patient is up to date on their diptheria vaccine, too. I have not seen diptheria and don't want to.

Croup is a virus, so antibiotics do not help. For adults, the treatment is similar to children.
1. Humidified air. Steam up the shower before bed, or put a bowl of very hot water on a table, put your head over it and a towel over you and the bowl, to hold in the steam. Hot air humidifiers tend to breed bacteria very efficiently, so I don't recommend them.
2. Cold air. Turn down the thermostat, crack the window.
3. Rest your voice. Stop talking. Really.
4. Rest and recuperate. Let your immune system work on the virus instead of you running around like a crazy person.

Adults are often somewhat miffed when they are told that they have croup and to treat it with cold air, humidity and not talking. It seems too simple and a bit silly. But you did want to get better, didn't you? Call it laryngotracheitis instead, that sounds a lot more grown up.


for Science Quest 2012

Mr Croup is one of the bad guys in Neil Gaiman's novel Neverwhere. He is the one that talks, whereas Mr Vandemar is the one that does most of the violence. He is incredibly vicious and cold-blooded, and makes Hannibal Lecter look like a shoplifter. He is one of the most amusing evil characters in print. In Terry Pratchett's The Truth, the equivalent of Mr Croup is Mr Pin. There is some evidence to suggest that Mr Croup is basically a personified fox.

Croup (kr??p), n. [F. croupe hind quarters, croup, rump, of German or Icel. origin; cf. Icel. kryppa hump; akin to Icel. kroppr. Cf. Crop.]

The hinder part or buttocks of certain quadrupeds, especially of a horse; hence, the place behind the saddle.

So light to the croup the fair lady he swung, So light to the saddle before her he sprung. Sir W. Scott.

 

© Webster 1913.


Croup (kr??p), n. [Scot. croup, cf. croup, crowp, to croak, to cry or speak with a hoarse voice; cf. also LG. kropp, G. kropf, the crop or craw of a bird, and tumor on the anterior part of the neck, a wen, etc. Cf. Crop.] Med.

An inflammatory affection of the larynx or trachea, accompanied by a hoarse, ringing cough and stridulous, difficult breathing; esp., such an affection when associated with the development of a false membrane in the air passages (also called membranous croup). See False croup, under False, and Diphtheria.

 

© Webster 1913.

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