What to do for croup?

[arivecchi]

What do you do when your kid has croup?

[writermama]

Quick first steps: Cool mist humidifier and/or take child into bathroom and run shower.

DO NOT give Benedryl or any other antihistamines or decongestants (can make symptoms worse)

If the child just has the barking cough, treat with the steps below. If the child has breathing difficulty (stridor, indrawing) even when the child is calm, go to the ER.

If the child's symptoms are serious, your pediatrician can give a prescription. (My kids have each had croup 2 or 3 times, only once have we had a case that needed the Rx, but we were grateful to have it.)

From Dr Sears website:
Calm your child. Croup can be frightening for your child. Crying will make the stridor sound much worse. It is important to keep your child relaxed by cuddling and staying calm yourself. Sit baby upright in your lap, play soft music, sing lullabies, read a story. If breastfeeding, offer the great pacifier.

Steam up the bathroom. Humidity helps clear child's breathing passages. Turn on the hot shower in your bathroom and close the door. While keeping your child calm, sit with them on your lap in the steamy bathroom. You should see some improvement in about ten minutes.

Inhalation of cool mist. If you have a cool mist humidifier or vaporizer, let your child breathe directly in front of the stream of mist. Once the child improves, keep the mist flowing near the bed for the rest of the night. If you only have a hot mist vaporizer, you can still use it but don't get too close, as child can get burned.

Cool night air. If necessary, bundle-up your child and take him outside into the cool night air for 10-20 minutes, or take a slow car ride with the windows open. The misty night air is why babies with croup often improve en route to the ER.

Treat the fever. Using Acetaminophen or Ibuprofen. Click on each for dosing help.

Important: Do not give antihistamines or decongestants without your doctor's advice. These may dry the narrowing air passages that the moisture is trying to open.

The above suggestions usually work well within about twenty minutes (an hour for the fever), and the child is able to settle back to sleep. You should observe your child closely by sleeping in the same room the rest of the night, as another croup attack is likely, and the above treatments will need to be repeated.

Full link here:
http://www.askdrsears.com/html/8/t084200.asp

[bubbaray]

Taking them out in the cold air helps. Bundle them up, but have them breathe in cold air.

Other than that, not much. Tylenol to help sleep. We use the cool mist humidifier, but I don't think it helps much.

[jenfromnj]

We ended up at the ped because DS was having really bad stridor, and got an Rx for steriods (a 3-day course).

But the ped also recommended running the humidifier 24/7, taking DS out in the cold air and letting him breathe it for 10-15 minutes at a time, and running the shower super hot, letting the bathroom get really steamed up, and sit in there with DS for 15 minutes or so at a time.

[Green_Tea]

We ended up at the ped because DS was having really bad stridor, and got an Rx for steriods (a 3-day course).

But the ped also recommended running the humidifier 24/7, taking DS out in the cold air and letting him breathe it for 10-15 minutes at a time, and running the shower super hot, letting the bathroom get really steamed up, and sit in there with DS for 15 minutes or so at a time.

Yes to all this. Standing in front of the open freezer sometimes does the trick. Can you get your ped to call in a script for Omnipred? Of course, that would involve actually getting to the drugstore, which might not be possible in this weather...

[arivecchi]

Thanks for all the information. He was coughing a lot last night, not as much at the moment. Good to know what to do if he gets another coughing attack though.

And yeah, we cannot go to the ped today. They are closed today.

[JBaxter]

Cool mist humidifier some ibuprophen and when it gets bad walk out side with them in the cold air. ( warm steam would make mine worse the cold air broke the cough)

[zoestargrove]

Is it possible we were up at the same time last night? My son went to bed a seemingly healthy (symptomless) kid and woke up at 1:30am gasping for air.

Thankfully, the cold winter air and steamy shower was effective for him last night. I set up the humidifier by his bed also and he fell back to sleep and slept late this morning.

He's had croup twice before -earlier this year where it was mild and he didn't have trouble breathing, only a cough and once when he was 3 where we ended up at the E.R.

I'm thinking of calling the dr. this morning. I'm a little nervous of it getting worse tonight. I've read that often times the second night is the worst. (but, that hasn't been our personal experience) We're in the middle of the storm here. I'd rather have a steroid prescription at the ready if I need it than trying to rush to the E.R. in the middle of the night with icy roads.

[Beth24]

Alternating the steam in the bathroom with cool night air (or in your case freezing) really works for us. Good luck with it tonight!

[lmh2402]

we had our first croup last week (came on mon night into tues morning).

first night we almost went to ER, but got it settled by getting him in bed with us and opening all the windows wide open

it was FREEZING in the room, but he finally was able to calm and rest

the next morning we went to the ped and he gave us a steroid. we ended up needing the steroid for three days. but it really worked wonders with the cough - it was markedly better after the first night. and by the third night he was still coughing a ton, but it was "just" super congested. no more bark or stridor

a week later, he is still extremely congested and coughing. but i'm just letting it run its course

good luck! if it seems bad, maybe call the ped emergency line and see if they'll phone in a script for a steroid that you can pick up or have delivered before tonight?

[zoestargrove]

Our pediatrician's office is closed today too. Our pedi is on call this afternoon and I'll call then to see if we can get a "just in case" prescription.

[Tondi G]

Everything that was already posted. Just know that the Steroid liquid is AWFUL.... I mean DISGUSTING. When DS2 had croup I was only able to get 1/2 a tsp down him before he threw it all back up. I have a friend who's son is on all kinds of meds and she suggested following the liquid with a hershey's kiss .... my DS wanted nothing to do with that med. We tried 2 times and each time, just as we got to 1/2 a tsp he would vomit. we had to go without, I figured that making my child to throw up wasn't going to help him feel any better.

steam and then bundled up and out in cool night air were the ticket.... luckily with a dose of Motrin he went back to sleep and was ok. It lasted a few days.

[Melbel]

In addition to the great advice above, we have found that Pulimicort (an inhaled steroid used in nebulizer) works wonders for DS' croup attacks (at age 10, he STILL had croup). The inhaled steroids are much milder than than the oral steroids (DD1 was on Pulmicort daily for over a year). Be forewarned, the second night is often worse than the first. :grouphug:

[MommyAllison]

Everything that was already posted. Just know that the Steroid liquid is AWFUL.... I mean DISGUSTING. When DS2 had croup I was only able to get 1/2 a tsp down him before he threw it all back up. I have a friend who's son is on all kinds of meds and she suggested following the liquid with a hershey's kiss .... my DS wanted nothing to do with that med. We tried 2 times and each time, just as we got to 1/2 a tsp he would vomit. we had to go without, I figured that making my child to throw up wasn't going to help him feel any better.

steam and then bundled up and out in cool night air were the ticket.... luckily with a dose of Motrin he went back to sleep and was ok. It lasted a few days.

Yes, the generic prednisolone tastes AWFUL! Definitely have it flavored, even if you have to pay for it (Target does free flavoring, I think lots of pharmacies do). Raspberry flavoring did the trick for us (DH tasted a tiny bit too and said it tasted like candy w/the raspberry).

[zoestargrove]

I was wondering why they don't prescribe an inhaler for this. Well, my dr. called in a 3 day prescription for oral steroids. She recommended we give it to him tonight. (play it by ear the other 2 nights.) I feel less anxious about tonight having that saftey net. It was a harrowing drive to the ER the first time and the roads were completely clear when we went 3 years ago because of bad croup. I didn't want to try and do that during a snow storm.

Melbel, I was a little surprised at age 6 he was still getting croup because most of what I read suggested it was generally younger than 5. I was really hoping this was our last dance with croup, but I guess I can't go by age alone.

[bubbaray]

Interesting. Our pediatric asthma specialist says that inhaled steroids don't work for croup.

[arivecchi]

Thanks all. We already had a trip to the ER with another croup attack months ago and they did give him oral steroids that time. I am following your tips but don't think we can venture out to get steroids. It's pretty hard to get around here right now - which is crazy.

[o_mom]

Interesting. Our pediatric asthma specialist says that inhaled steroids don't work for croup.

Your asthma specialist is wrong. :)

There have been several studies (including ones published in NEJM going back 10+ years) that show it is an effective treatment for croup and as effective as oral or injected steriods. It is an off-label use in the US, but approved use in other countries from what I found.



I was wondering why they don't prescribe an inhaler for this. Well, my dr. called in a 3 day prescription for oral steroids. She recommended we give it to him tonight. (play it by ear the other 2 nights.) I feel less anxious about tonight having that saftey net. It was a harrowing drive to the ER the first time and the roads were completely clear when we went 3 years ago because of bad croup. I didn't want to try and do that during a snow storm.

Melbel, I was a little surprised at age 6 he was still getting croup because most of what I read suggested it was generally younger than 5. I was really hoping this was our last dance with croup, but I guess I can't go by age alone.


Mainly the reasons come down to cost and convenience. The inhaled steriod that has been studied is Pulmicort. It is pricey, even for the generic (ours was $130+ for one box last time we filled it - that is the insurance negotiated rate and generic compared to $5 for oral). For young kids, it needs to be given by nebulizer, which would add costs ($100+) if you don't have one already. The powdered form is not a traditional inhaler like Albuterol is, so it cannot be used with a spacer. There is a learning curve for that and it is unlikely that many kids under 5 would even be able to do it without lots of practice (which you don't have time for in an acute case of croup).

I feel your pain, though. I thought we were over the hump, but have recently had it again at 5 and 7 yrs. Luckily we have the nebulizer now and Pulmicort on hand because we get it so often. <sigh>

[zoestargrove]

Thanks O-mom for answering my questions. :)

[bubbaray]

Well, see, then WHY didn't he #$%^^ tell me -- we have buckets of pulmicort around here (for DD#1's asthma). He saw DD#2 days after an ER visit (and oral steroids) for croup. And told me that he won't prescribe inhaled steroids for croup unless the child also has asthma (which DD#2 d/n have).

Sigh. I wonder if its because its off label???

Frankly, it would have been WAAAY easier to just give DD#2 some pulmicort than to haul her to the ER at 2am. Its not complicated for us if he'd just give us an Rx for the liquid pulmicort, we already own a nebulizer. Sheesh.

Now I'm pi$$ed at him about this too. I'm super pi$$ed at one of the nurses in his office too. NOT HAPPY.

[edurnemk]

Run the shower on hot and sit with your kid in the steamy bathroom for a while, until it starts to get better. Then run the cool mist humidifier in the room all night. With DS he usually gets croup 2 nights in a row and then it's gone.

Only one time it lasted longer and he got an RX for prednisone.

ETA: If he has difficulty breathing he needs to go to the ER.

[o_mom]

Well, see, then WHY didn't he #$%^^ tell me -- we have buckets of pulmicort around here (for DD#1's asthma). He saw DD#2 days after an ER visit (and oral steroids) for croup. And told me that he won't prescribe inhaled steroids for croup unless the child also has asthma (which DD#2 d/n have).

Sigh. I wonder if its because its off label???

Frankly, it would have been WAAAY easier to just give DD#2 some pulmicort than to haul her to the ER at 2am. Its not complicated for us if he'd just give us an Rx for the liquid pulmicort, we already own a nebulizer. Sheesh.

Now I'm pi$$ed at him about this too. I'm super pi$$ed at one of the nurses in his office too. NOT HAPPY.

Didn't mean to get you pi$$ed. :hug:

Who knows why... sometimes doctors get stuck in a rut or if it is out of their area they aren't as informed.

[bubbaray]

Didn't mean to get you pi$$ed. :hug:

Who knows why... sometimes doctors get stuck in a rut or if it is out of their area they aren't as informed.


That's OK. I'm just frustrated -- spent the morning with my/our dr sorting out this asthma crap.

This asthma guy is considered one of the best in the country, leading researcher, blah blah blah. I don't think he's particularly keen on off label uses though. I've asked him about Alvesco for kids (labeled for use over age 12 here) and he didn't even want to discuss it (I use Alvesco myself and my pulminologist is a fan of it). Turns out the other asthma specialist in the exact same clinic IS using Alvesco on children as young as 6 and having fabulous results. The nasty nurse let that slip last week and you can bet I'll be discussing that with him next visit.

Its just been a bad few weeks for asthma & croup in our house and frankly, I'm DONE with it. I'm ready for summer. Right freakin' NOW!

[o_mom]

Its just been a bad few weeks for asthma & croup in our house and frankly, I'm DONE with it. I'm ready for summer. Right freakin' NOW!

Seriously. I'm about to book a hotel in Vegas. Alone.

[zoestargrove]

Arivecchi, how did your son do last night? I hope it was able to sleep through soundly.

[arivecchi]

Thanks for asking! I called the ped's office yesterday and the ped on call asked that I take him outside for a while which we did. We then gave him ibuprofen before going to bed and he did not cough all night. He did cough a bit in the morning but seems to be doing much better!

[TwinFoxes]

Thanks for asking! I called the ped's office yesterday and the ped on call asked that I take him outside for a while which we did. We then gave him ibuprofen before going to bed and he did not cough all night. He did cough a bit in the morning but seems to be doing much better!
Glad he's better...I didn't even see that he was sick before!

[Melbel]

Well, see, then WHY didn't he #$%^^ tell me -- we have buckets of pulmicort around here (for DD#1's asthma). He saw DD#2 days after an ER visit (and oral steroids) for croup. And told me that he won't prescribe inhaled steroids for croup unless the child also has asthma (which DD#2 d/n have).

Sigh. I wonder if its because its off label???

Frankly, it would have been WAAAY easier to just give DD#2 some pulmicort than to haul her to the ER at 2am. Its not complicated for us if he'd just give us an Rx for the liquid pulmicort, we already own a nebulizer. Sheesh.

Now I'm pi$$ed at him about this too. I'm super pi$$ed at one of the nurses in his office too. NOT HAPPY.

Our former pediatrician told us bad info back when DS was 4 and very sick with croup, bronchitis, tonsilitis, etc. Strangely, the same pediatrician had given the NPs an article the month before saying that Pulicort worked for croup (one of the NPs shared this info with me). I was beyond mad and refused to go to that doctor in the group again. He was so lax about treatment (no scrips) when the other doctor in the group that I saw the following day prescribed numerous meds and had him come in daily for rechecks because he was SO sick. Although I recognize that everyone makes mistakes, he lost my trust. The Pulmicort has worked about 5-10 times for DS after only one treatment. I would much rather give him the low dose inhaled steroids compared to liquid. We have Pulmicort here for DD1 anyway. I do not hesitate to give DS a treatment as needed.


Thanks for asking! I called the ped's office yesterday and the ped on call asked that I take him outside for a while which we did. We then gave him ibuprofen before going to bed and he did not cough all night. He did cough a bit in the morning but seems to be doing much better!

I am happy to hear he is doing so much better! :)

[egoldber]

So glad he's better!


I've asked him about Alvesco for kids (labeled for use over age 12 here) and he didn't even want to discuss it (I use Alvesco myself and my pulminologist is a fan of it). Turns out the other asthma specialist in the exact same clinic IS using Alvesco on children as young as 6 and having fabulous results. The nasty nurse let that slip last week and you can bet I'll be discussing that with him next visit.

Interesting. The PA practically jumped at the chance to offer me Alvesco for older DD earlier this week. And your guy is really against Advair too right? Is that for the same reason?

[BabyBearsMom]

Glad he is doing better!!

[arivecchi]

I am just glad we did not have to go to the ER last night. Our alley has not been plowed so I am not even sure we could take our car out! I was stressing about that!

[zoestargrove]

awesome! I'm glad it was a good night.