Nov 23, 2009 10:38 am US/Eastern
Dr. Mallika's Files: Case Of The Croup
Each week Dr. Mallika Marshall shares cases based on true stories from a local urgent care clinic, exclusively on wbztv.com. Names and identifiable characteristics of patients have been omitted or changed to protect patient privacy.
This Week's Case:
A 13 month old boy is brought to urgent care because his parents say he's been "breathing funny". He started getting sick two days ago with a runny nose, a low-grade temp, and a junky cough. Last night they noticed that he was making a funny noise while sleeping. They were worried so brought in him to be evaluated. He vomited a couple of times after a coughing spell but has not had any diarrhea.
On exam, the child is sitting quietly in his mother's arms watching my every move. His lungs are clear but he becomes agitated and begins to cry. With that, he all of a sudden starts making raspy sounds during inspiration. He also is noted to have a cough that resembles the bark of a seal. The rest of his exam is unremarkable.
Discussion
This child suffered from "croup", a condition which causes swelling along the vocal cords. It's usually caused by a viral infection. Croup commonly affects children between the ages of 3 months and 5 years of age.
Croup is characterized by a cough that sounds like a seal barking. Most children will first develop mild cold symptoms with a runny nose and cough. But over several days, the cough evolves, becoming more frequent and harsh. Children may also developed labored breathing or "stridor". Children with mild croup may not make any noise at rest, but when they begin to cry, the stridor appears.
Most cases of croup can be managed at home. Cool or moist air can be soothing so try taking your child outside to breathe in the cold, night air. Sit with them in the bathroom and while you run a hot shower allow them to breathe in the steam. Or open the freezer door and have them breathe in the cool humid air that escapes. And place a humidifier in their room at night.
It is okay to give your child fever-reducers (like acetaminophen or ibuprofen) but avoid cough medicines unless you've spoken to your doctor first.
If you're concerned about your child or they're having trouble breathing, seek medical attention right away. In a doctor's care, your child may receive aerosolized treatments and/or a steroid medication which can help decrease swelling around the vocal cords and improve his symptoms.
Croup usually lasts less than a week and most children recover just fine. Rarely, children develop significant respiratory distress and need to be hospitalized.
Discussion
This child was given an oral steroid medication called dexamethasone as well as a saline mist treatment in urgent care. His breathing became much less noisy during the hour he was observed. He was sent home, and his parents were advised to buy a humidifier and give him fever-reducers. He had fully recovered in another 3 days.
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