Stridor: A Complication of Croup

• Stridor is a harsh, raspy tight sound best heard with breathing in
• Loud or constant stridor means severe croup
• All stridor needs to be treated with warm mist
• Most children with stridor need treatment with a steroid (Decadron)
• For any stridor, see FIRST AID for treatment

Cause

• Most often, caused by a virus
• Croup symptoms can also be caused by a food allergy. This can be life-threatening.

Return to School

• Your child can go back to school after the fever is gone. Your child should also feel well enough to join in normal activities. For practical purposes, the spread of croup and colds can't be prevented.

1. What You Should Know:
   • Most children with croup just have a barky cough.
   • Some have tight breathing (called stridor). 
   • Coughing up mucus is very important. It helps protect the lungs from pneumonia.
   • We want to help a productive cough, not turn it off.
   • Here is some care advice that should help.
2. Humidifier:
   • If the air in your home is dry, use a humidifier.
   • Reason: Dry air makes croup worse.
3. Homemade Cough Medicine:
   • Goal: Decrease the irritation or tickle in the throat that causes a dry cough.
   • AGE 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 ml). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old.
   • AGE 1 year and older: Use HONEY ½ to 1 teaspoon (2-5 ml) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough. If you don't have any honey, you can use corn syrup.
   • AGE 6 years and older: Use COUGH DROPS to coat the sore throat. If you don't have any, you can use hard candy.
4. Non-Prescription Cough Medicine (DM):
   • Non-prescription cough medicines are not advised. Reason: No proven benefit for children and not approved under 4 years old. (FDA 2008.)
   • Honey has been shown to work better for coughs. (Caution: Do not use honey until 1 year old).
   • If age over 4 years old, you might decide to use a cough medicine. Choose one with dextromethorphan (DM). It's present in most non-prescription cough syrups.
   • When to Use: Give only for severe coughs that interfere with sleep or school.
   • DM Dose: See Dose Table. Give every 6 to 8 hours as needed.
5. Coughing Fits or Spells:
   • Breathe warm mist (such as with shower running in a closed bathroom).
   • Give warm clear fluids to drink. Examples are apple juice and lemonade. Don't use before 3 months of age.
   • Amount. If 3 - 12 months of age, give 1 ounce (30 ml) each time. Limit to 4 times per day. If over 1 year of age, give as much as needed.
   • Reason: Both relax the airway and loosen up any phlegm.
6. Fluids:
   • Try to get your child to drink lots of fluids.
   • Goal: Keep your child well hydrated.
   • It also will thin out the mucus discharge from the nose.
   • It also loosens up any phlegm in the lungs. Then it's easier to cough up.
7. Fever:
   • For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. See Dose Table. Note: Lower fevers are important for fighting infections.
   • For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.
   • For babies, dress lightly. Don't wrap in too many blankets. Reason: Can make the fever higher.
8. Sleep Close By to Your Child:
   • Sleep in the same room with your child for a few nights.
   • Reason: Stridor can start all of a sudden at night.
9. Calm Your Child if He or She has Stridor:
   • Crying or fear can make stridor worse.
   • Try to keep your child calm and happy.
   • Hold and comfort your child.
   • Use a soothing, soft voice.
   • For a few days, give in more than usual to his or her demands.
10. Avoid Tobacco Smoke:
    • Tobacco smoke makes croup much worse.
11. Return to School:
    • Your child can go back to school after the fever is gone.
    • Your child should also feel well enough to join in normal activities.
    • For practical purposes, the spread of croup and colds cannot be prevented.
12. What to Expect:
    • Most often, croup lasts 5 to 6 days and becomes worse at night.
    • The croupy cough can last up to 2 weeks.
13. Call Your Doctor If:
    • Stridor (harsh raspy sound) occurs
    • Croupy cough lasts more than 14 days
    • Your child becomes worse