Croup questions

[bubbaray]

OK, I need Croup for Dummies. *I* had it many many times as a child, but in hindsight, my respirologist thinks I had misdiagnosed childhood asthma. So, my recollections of the cough and treatment (hospitalization in an oxygen tent -- remember, I'm old) aren't likely even close to what happens today.

DH is now awake and gave me a briefing on what happened at the hospital last night. He said they did not hear wheezing and quickly ruled out an asthma attack (DD#1 has asthma, as do I). The cough improved dramatically in the cold air. They gave her one dose of oral steroids (I'm assuming pediapred, which she had previously for anaphylaxis and DD#1 has had for asthma). They also gave her tylenol for fever -- she's had a fever since Monday. The cough only appeared wtihin the past 24 hrs, so the dr's actually think she's been hit by two different viruses (b/c the cough and fever should hit together, not fever then cough).

Anyway, I'm googling (you knew I would) and getting conflicting info on how long croup is contagious. Some sites say until the fever is gone, other say until the cough is gone. Others say 5 days after the onset of cough.

BTW, I found this site with a list of childhood diseases and contagious periods: http://www.med.umich.edu/1libr/pa/pa_incubate_hhg.htm

[alexsmommy]

As you can see, I had the same questions

http://www.windsorpeak.com/vbulletin/showthread.php?t=343072&highlight=croup

Good luck!

[o_mom]

OK, here goes - usual disclaimers... I'm not a doctor, just have kids with croup. :)

Croup is not a specific illness, it is a symptom. Think of it like cough, runny nose, etc. It is caused by swelling in the upper airway. In an adult, the swelling would simply cause a sore throat, but in a child with a smaller airway, the constriction causes the barking cough and stridor. Stridor is the noise you hear on breathing in (wheezing is noise when breathing out). Some kids have smaller airways than others, so they get croup easier (I have been blessed with three of these, thanks to DH who had it every year until he was 12 <sigh>).

The underlying virus is contagious as long as the usual virus - for daycare, 24 hrs fever free is the usual for a cold virus. We have had croup come with NO cold symptoms and then the runny nose etc. start later, we have had it come before or after a fever, but usually toward the beginning of an illness.

For many kids, simply keeping the air humid and either warm or cold can be enough to control it. Sitting in a bathroom with a steamy shower running, humidifier in the room, outside in cold air or open the freezer and let them breathe the cold air are ways to do this. Saline (I think, or maybe it's distilled water) in a nebulizer is an option too. If it is more than can be controlled by those, steriods (oral, inhaled or injected) are the next step. If things are really bad (repiratory distress) then they do epinepherine by nebulizer and more at the hospital.

It usually peaks on the second day and then subsides. Our first time, I didn't recognize it at all as he didn't have a barking cough, but went straight to stridor. By the time we went to the ped he was in distress and was transported to the ER by ambulance. Now that we know what it is, I start pulmicort in the nebulizer at the first sign and we haven't had a really severe case. Usually 2-3 days of the steroids (or one dose of injected that lasts longer) is what we do for it.

Dr. Sears has a great page on croup and what to watch for: http://www.askdrsears.com/html/8/T084200.asp

You are probably familiar with the distress signs from the asthma, just the stridor sound is different.

[bubbaray]

Well, OK, then. More confused than ever. LOL. (ETA -- from other thread, not omom's post)

I think I'll keep her home today just to be on the safe side. I'll play the parade by ear, though being in the cold might be a good thing.

[bubbaray]

THanks omom! Super helpful! :)

[bubbaray]

OK, so yeah, no barking cough last night or previously (though I'd say it is barking today). Definitely had stridor last night. I may try saline in the nebulizer, we have that. I wondered why they didn't give us pulmicort -- I'm so conditioned to give breathing treatments at the first sign.

The dr gave DH a bit of a hard time about choosing to go to Children's instead of our local trauma hospital (which has a peds ward, but is not a specific peds hospital). He said her stridor was pretty bad and driving 20 minutes (which must be a land speed record, LOL) over 10 minutes wasn't a great decision. I'm not sure I agree with that. Our local hospital is more geared up for severe trauma, not peds patients. I suppose if she had been in worse shape, I would have made a different decision. Its not a bad hospital and IS where the ambulance took her for the anaphylaxis episode nearly 2 years ago.

I also think the dr at Children's might have been one that DD#1 saw during a very severe asthma attack in June. Sounds like the same guy. Super fab. According to DH, DD#2 charmed the pants off of the staff at Childrens. LOL

[o_mom]

OK, so yeah, no barking cough last night or previously (though I'd say it is barking today). Definitely had stridor last night. I may try saline in the nebulizer, we have that. I wondered why they didn't give us pulmicort -- I'm so conditioned to give breathing treatments at the first sign.

The dr gave DH a bit of a hard time about choosing to go to Children's instead of our local trauma hospital (which has a peds ward, but is not a specific peds hospital). He said her stridor was pretty bad and driving 20 minutes (which must be a land speed record, LOL) over 10 minutes wasn't a great decision. I'm not sure I agree with that. Our local hospital is more geared up for severe trauma, not peds patients. I suppose if she had been in worse shape, I would have made a different decision. Its not a bad hospital and IS where the ambulance took her for the anaphylaxis episode nearly 2 years ago.

I also think the dr at Children's might have been one that DD#1 saw during a very severe asthma attack in June. Sounds like the same guy. Super fab. According to DH, DD#2 charmed the pants off of the staff at Childrens. LOL

Using Pulmicort isn't as widespread as oral pred or injected decadron. There was a good study that showed it was just as effective, but it is still an off-label use so many haven't heard of it. I had a long talk with our doctor about the options and since we have a nebulizer at home, it made the most sense. It depends on the situation, too. Many parents don't have a nebulizer, so Rx for oral or an injection in the office is cheaper. As well, until about a year ago, there was no generic Pulmicort here. It was $50 the one time we filled a 30 day supply and it expired before we could use half of it - that was our 20% copay, BTW - after that we got the free samples and just used that. For us, Ds1 had it about 4 times in the year after his first attack and I felt better about the lower exposure/more targeted approach of the Pulmicort than a systemic oral/injected. If it was just a once or twice thing, it probably wouldn't make too much difference. ETA: Also, some kids fight the nebulizer like crazy and so the other routes are faster and easier.

One other thing is that the steriods, even inhaled, take 6-12 hrs to really kick in, so it is not an immediate thing like giving albuterol for asthma. It is not going to help the immediate problem. Sometimes just oxygen/humidity can help enough until the steriod kick in, so it is hard to say what they gave her.

Our first ER trip was to a general hospital (also a large trauma center where they take the race car drivers that crash :) ) and they were just fine with treating croup. Croup is a very common thing in kids and I would expect the general hospital to be able to take care of it. Now I could go on about the wisdom of putting a 2 yo in a 'curtain area', lol, but medically it was fine.