Most children with croup can be treated at home. Still, croup can be scary, especially if your child needs a visit to the health care provider’s office, emergency room or hospital. Treatment is usually based on how severe the symptoms are and include:
Comfort measures
It’s important to comfort and calm your child because crying and distress can worsen airway swelling, making it harder to breathe. Hold your child, sing lullabies or read quiet stories. Offer a favorite blanket or toy. Speak in a soothing voice.
Medicines
Your child’s health care provider may prescribe these medicines:
- Corticosteroid. A corticosteroid — such as dexamethasone — may be given to reduce swelling in the airway. Symptoms will usually start to improve within a few hours. Your child may take pills over several days. Or your child may get a single dose of dexamethasone as a shot because of its long-lasting effects.
- Inhaled medicines. These are used if your child is having a lot of trouble breathing. Inhaled treatments may be used to ease the whistling sound (stridor) and make it easier to breathe.
- Epinephrine. Epinephrine is effective in reducing airway swelling with more-severe symptoms. The medicine may be given in an inhaled form using a nebulizer. It’s fast acting, but its effects wear off quickly. Your child likely will need to be observed in the emergency room for several hours to see if a second dose is needed before going home.
- Steroids. An injectable steroid is often given if the child can’t take steroids by mouth (oral). This medicine can help prevent the illness from getting worse.
- Other medicines. Your child’s healthcare provider may prescribe other medicines if he or she feels your child’s croup is from allergies or reflux. The provider may also recommend acetaminophen or ibuprofen for a fever or discomfort. Antibiotics are not useful if the illness is caused by a virus.
A stay in the hospital
Fewer than 5 percent of children with croup require hospitalization. For severe croup, your child may need to spend time in a hospital to be monitored and receive more treatments. Children are usually hospitalized when:
- Oxygen therapy is needed to keep the child’s oxygen levels in a safe range
- Croup is complicated by severe dehydration requiring intravenous fluid therapy
- Multiple doses of inhaled epinephrine are needed to provide relief
- Severe symptoms persist despite initial treatment, especially if the child’s breathing is becoming fatigued
Some children may require observation in the hospital for only a few hours to half a day. Others may stay in the hospital for a day or two. It is unusual to require more than a two-day hospitalization for croup. If this happens, an additional evaluation may be performed to assess for other causes of stridor and breathing difficulty. This may include X-rays and/or consultation with an ear, nose, throat specialist.
For a milder case, these methods may help at home:
- Have your child rest and drink plenty of fluids.
- Don’t smoke in the home. Smoke can make your child’s cough worse.
- Keep your child’s head raised. Prop an older child up in bed with extra pillows. Never use pillows with babies younger than 12 months.
- Sleep in the same room as your child to help your child right away if he or she starts to have trouble breathing.
- Stay calm. If your child sees that you are frightened, it will increase his or her anxiety and trouble breathing.
- Comfort your child. Sing your child’s favorite bedtime song or offer a favorite toy.
Breathing in steam or cool night air may also help your child to breathe easier. You may want to try:
- Putting a humidifier in your child’s room.
- Putting a warm, wet washcloth over your child’s nose and mouth as he or she breathes.
- Creating a steam room in your bathroom. Turn on the hot water in your bathroom shower. Keep the door closed so the room gets steamy. Sit with your child in the steam for 15 to 20 minutes. Don’t leave your child alone.
- If your child wakes up at night, try bundling him or her and go outside to breathe in the cool night air.