Scott Webb: Croup is a fairly common childhood illness that can often be treated at home, but there may be times when we need to take our kiddos to see the doctor. And I'm joined today by Dr. Farrah Shaheen. She's a pediatrician with Stanford Medicine Children's Health, and she's here today to share the signs and symptoms of croup and the various treatment options. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb.

Doctor, thank you so much for your time today. I was telling my wife before I headed down to my little studio here that I was going to talk about croup. And I was like, I think I know what croup is, but I'm not a hundred percent. So always great to have an expert here. So let's start there for folks. What is croup and what causes it?

Dr. Farah Shahin: Thank you, Scott. What is croup? Croup is a common childhood illness that causes swelling in the upper airway below the vocal cords, so specifically the voice box and the windpipe. And that swelling causes the airway to become smaller in size and narrow and makes the breathing more noisy and makes it more difficult for the child to breathe.

We know that croup is most commonly seen in younger children, so about six months of age up to three years, but can be seen in slightly older kids, so up to five, six years of age. The peak age though is, it is around two years. We know that young children are more likely to be affected by croup.

That is because their airways are smaller. And so a small amount of swelling, , can make it hard for them to breathe. Group can be caused by different things. The most common type of group is caused by a virus or a, by a viral infection. The most common virus being, , para influenza virus. Other viruses such as COVID 19, RSV or respiratory syncytial virus, adenovirus, and other viruses can also cross croup.

So anytime that these viruses are more active, we see croup more often. So that usually happens in the fall and early winter

Scott Webb: All right. So it's generally the younger ones, as you say, six months to about three, but maybe as old as five or six. Wondering what the symptoms are. Is it coughing? How do we know, or when might we suspect that our child has croup?

Dr. Farah Shahin: Usually begins like, , a regular cold with cough, runny nose congestion. And then a couple of days later. Children may experience a change in the voice or hoarseness. And then they, develop this croopy cough, which sounds like a seal or a bark. A lot of children develop a fever along with those symptoms.

It can range from mild to a low grade temperature up to a very high fever. Usually we notice that the symptoms are worse at night and can wake the child up from sleep. , in croup, as the swelling in the airways become worse, we also notice this, , high pitched Noisy breathing.

We call that stridor. It's like a whistling noise when the child is breathing in. Kids with croup, we notice that sometimes they can breathe faster than normal. And, I always tell families that, with croup, we notice that children, have more severe symptoms or they feel worse when they are upset or crying or agitated.

So I always recommend to parents and caregivers to keep their sick children with group kind of quiet and calm. , this makes it easier for them to

Scott Webb: Sure. And of course, maybe easier said than done with six months to three year olds, but certainly worth the effort. And I'm guessing we don't always need to rush off to the doctor or perhaps the ED or anything like that. We can probably treat croup at home. So give us a sense of what we can do at home if we suspect that our child has croup.

Dr. Farah Shahin: You're absolutely right. there are some things that we can do to treat. With some simple home remedies, like with any other type of infection or cold, it is always important to keep your child hydrated by encouraging lots of fluids. I always say, you know, don't focus on, , solid foods, but definitely focus on liquids to make sure the child, is well hydrated.

 In order to help with the group symptoms, it would be a good idea to use a cool mist humidifier, or take the child into a steamed bathroom. So not into the shower with the, steam, and the hot water, but kind of rather in the steamed bathroom. One thing that could help is taking the child outside into the cool, moist night air allowing the child to breathe that cool air during the night by either opening a window or opening a door.

Of course, make sure that the child is, warmed up. Something that we, , often see is when children are coming in to the clinic or urgent care at nighttime, when the air outside is cool and moist, and then by the time that the parents park their cars, walk up to the clinic, walk into the clinic and the child breathes in that cool air, their symptoms actually can get better just because of that.

 Other things to keep in mind, like I said, because with croup, children can have high fever. So, treating the fever with over the counter medications such as acetaminophen or ibuprofen will make sure that the child is more comfortable and can help with their breathing. The other things that you can do is because croup symptoms tend to happen, or be worse at night.

Then I recommend, for caregivers to stay close to their children, especially at night. So if the child begins to have any difficulty breathing or seem to need additional help, then the parent or the caregiver is right there. It is always a good idea to avoid smoking in the home. That applies to croup and all other respiratory, illnesses as well.

And of course, you know, talk to your pediatrician or, learn more about groups so when it happens, you know when to seek, immediate medical attention or, what to look out for to indicate that the child is getting worse rather than better.

Scott Webb: Yeah, that was going to be my next question. When it begins to get worse and not better, is that when we call the doctor? Is that when we come into the clinic?

Dr. Farah Shahin: Yeah, so it is important for, you know, parents to be familiar with what to look out for and I always like to think about, things that would make you call 911 and or head to the emergency room right away. Or what to look out for in order to call your pediatrician or potentially be seen in the next day or two.

 So things that would require an immediate medical assistance, or reasons for you to call 911, is if a child is turning blue or very pale. In these cases, we worry about restricted airflow to the lungs because of the swelling that croup is causing and that can impact how much oxygen is getting into the child's lungs.

 It is definitely very concerning if your child can't speak or can't cry, because they cannot get enough air. Again, that indicates that the swelling has gotten much more severe, or is more significant that, you know, you need to be seen. If a child is lethargic, which means they're very sleepy, they're not responding to the parent or the caregiver, in that case, child needs to be evaluated.

 Other symptoms or other things to look out for, which can potentially not require to be seen immediately, but to be evaluated in the clinic by your pediatrician is. If you notice that the child is having a harder time breathing. So what does that mean? That means if your child is breathing faster than normal.

Or when you look at the child's chest and you notice that the skin and the muscles between the ribs , and also below the ribcage. If those look like they are caving in, they're being sucked in and out forcefully, , again that just indicates that the child is putting a lot of effort to breathe. If you notice that your child is making a whistling sound, , that is getting louder with each breath, , so we call that stridor.

If you notice it when the child is crying or agitated, again, this is one of the reasons why it's to keep kids with croup kind of quite calm, and that will help them breathe better. But if you notice that whistling noise when they're breathing in or that stridor when they are resting, so that definitely indicates that the infection is worse.

 The other thing to keep in mind is if you notice that the child is drooling, or is having a hard time swallowing their saliva, definitely need to be seen because we worry about a more severe infection that's usually affecting the windpipe, present similarly to croup. So if you notice that, talk to your pediatrician and get your child some help.

Scott Webb: And doctor, if we're pretty sure that our child has croup and we want to take them to see a provider, a doctor, whomever, what can we expect?

Dr. Farah Shahin: So because croup is, the swelling in the airway, so there is actually a medicine that can be given to the child to help reduce that swelling. And it is usually given in the form of a single dose of a steroid medicine.

So that medicine can either be an oral, liquid that the child drinks or it can be an injection. So this is often done either at the clinic or at the emergency room. Now, if the child needs more than just that, that's usually done at the emergency department for more moderate to severe symptoms.

And other treatment options include, a breathing treatment. So it's an inhaled medicine that the child takes. And If we decide that the child does need it, then they need to be monitored for a few hours because we worry sometimes that if the effect of that medicine wears off, that the group symptoms will return.

So again, this is something that is often done at the emergency room or if it is done, sometimes your child may be admitted to the hospital just for observation and to keep a close eye on them. . Because with croup, you can have fast breathing and you can have fever, so those are some of the ways that a child can lose fluids.

So, we want to make sure that the child is not dehydrated, so your child may potentially get intravenous fluids if they are seen at the emergency department. And other things that can be done is monitor oxygen levels to make sure that the child is getting enough air into the lungs.

In very severe cases I would say ,and this is rarely needed, a breathing tube may actually be placed into the throat, into the windpipe to help the child breathe. A lot of parents ask about other treatments that can potentially be used for other types of infections or illnesses, such as antibiotics or cough medications or decongestants.

And we really recommend against these medications for patients with croup just because, as we have said earlier, CROUP is usually caused by viruses. So specifically, antibiotics are usually medications to treat bacteria rather than viruses, so they are not really recommended.

One more thing to add is, if your child develops repeated bouts of croup, especially more than two illnesses in a year, then that child is said to have recurrent croup. So, what to do in this case? Of course, it's always a good idea to talk to your pediatrician, and you could potentially be referred to an ear, nose, and throat doctor.

ENT doctor, or a pulmonologist. So we worry in these cases about your child having some narrowing of their airway, that might be predisposing them or putting them at a higher risk to develop croup. So definitely talk to your pediatrician, if that happens.

Scott Webb: Doctor, it makes me wonder when we think about croup and little ones and possibly, you know, commiserating at preschool, that kind of thing, it makes me wonder if croup is contagious.

Dr. Farah Shahin: Okay, so that's a great question, because, as I said, croup is caused by viruses and viral infections, so with regular colds, it's affecting the upper parts of the airway versus with croup, it's affecting more the voice box and the windpipe, but cause of these, of this disease is a virus that is easily, spread between kids.

It usually is spread by respiratory secretions or by, you know, coughing, sneezing. So while the child is sick, of course, they are highly contagious. So this is why we recommend if your child is having these symptoms. they're not feeling well, they're having fever, then they're definitely more likely to be spreading that virus that's causing croup to other kids.

, it's not necessarily going to cause croup for them, but it can cause that viral infection or cold symptoms that you know, the child has started with. So I generally recommend, waiting a few days, maybe two to three days after the symptoms have peaked. Of course, as long as the fever's gone for 24 hours without using any fever reducing medications, that indicates that the child is less contagious and it's okay for them to go back to daycare or school.

Of course we want the child to be comfortable. So as long as they are not continuously coughing or, having difficulty breathing and they don't need one on one assistance at school and can, you know, re engage and, energy levels are back. They can, do things, be more active, eat fine and play well and all then they are definitely safe to go back to school and daycare.

Scott Webb: So a good sense, Doctor, then of what we can look for and listen for in terms of symptoms, some home remedies, , things that, you and others may do to help, and worst case scenarios, breathing tubes, things like that. Let's hope for all our sakes that it doesn't come to that. So let's just finish up here, Doctor, and talk about ways that we can prevent croup.

I know they're small and the airways are small and just wondering, is there anything we can do to try to prevent it?

Dr. Farah Shahin: Absolutely. So always prevention is key. And I always like to go down to basics. And the same applies to honestly any respiratory illness or any infection is to follow simple hygiene measures. So that means, you know, frequent hand washing to prevent infections with these viruses that may potentially lead to croup.

Hand washing needs to be done with soap and water. We recommend for about 15 to 30 seconds. That is considered ideal. If you don't have access to water and soap, then a good alternative would be an alcohol based hand sanitizer. It is unfortunate that we don't have a vaccine against the most common virus that causes croup, which is parainfluenza virus.

However, we do have vaccines against other viruses that can cause croup, as I had mentioned. Viruses such as COVID 19 or influenza, , and recently RSV as well. So if your child is able to get that vaccine to protect them, then go for it. If your child is too young to receive it, then I do recommend parents, caregivers, grandparents, older siblings, anyone who is eligible for these vaccines should be getting it as part of, you know, protection for all.

It's always a good idea, especially with the younger babies, to avoid close contact with grown ups and kids who are obviously sick. If possible, it's always a good idea to avoid crowded or poorly ventilated public spaces because the kids are more likely to pick up something in those spaces.

If your child is sick with any of those viruses, it is a good idea to keep them home. Do not send them to daycare or school because that may cause others to become ill and can potentially put them at harm.

Scott Webb: Yeah good stuff today, doctor. I, as I prefaced, I didn't know exactly what croup was or certainly what causes it. So I have a really strong sense of that here today. And as I said, what to look for, what to listen for, what we can try at home, what you can do, and they can do at the clinic to help our kiddos.

So I appreciate your time and your expertise. Thanks so much.

Dr. Farah Shahin: it's my pleasure, thank you for having me and I'm glad to be able to talk to you about group today.

Host: And for more information, go to stanfordchildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.