CROUP or Why Does My Child Have a “Barky Cough”?

Croup, or laryngotracheobronchitis, is caused by many viral infections and falls into the category of upper respiratory infection along with the common cold. Croup tends to occur in the autumn and early winter months. In croup, the major areas affected are the ones referred to in the long name of this illness (above); the larynx, trachea and bronchi, which are all structures that convey air from the mouth and nose down toward the lungs. As with all colds or upper respiratory infections there is inflammation of the mucosa (most superficial covering) of the inside of the nose, mouth, throat and upper respiratory tract, leading to mucous production and irritation of those sites.

In croup, the area of the upper respiratory tract most prominently affected is the larynx, or the voice box area located very close to the firm lump in the front of your neck, the “adam’s apple”. When vocal cords are irritated and swollen, adults merely get hoarse or raspy talking and a “normal” sounding cough. Children have a much narrower windpipe and therefore with even the slightest swelling of their vocal cords, there is less room for air to get by and they also get hoarseness along with a cough and raspy breathing. There is also a characteristic barky (yes sounds like a animal barking) kind of cough and occasional difficulty breathing. All symptoms tend to be worse at night, a time when all illnesses seem to worsen.

For the most part this illness remains mild and the only treatment needed is a cool mist humidifier, fluid intake, elevated head at night and reassurance for the child and parents. Rarely a child may progress to real difficulty breathing, with a characteristic whooping noise when taking a breath in versus a wheezing sound when breathing out found more commonly in those with asthma. So if your child exhibits difficulty breathing along with the above symptoms, call your doctor for further instructions.

Once a child has had croup, parents seldom forget what the barky cough sounds like and can make the diagnosis themselves. Usually, as with other upper respiratory viral infections there is a mild amount of fever and the child is not real sick. If there is sudden high fever with the onset of “croup” and your child is drooling, cannot swallow or speak, and is very anxious, you must call your doctor immediately or call 911. This symptom complex describes a rare but life threatening illness called epiglotitis which can be very dangerous. I stress that this is a rare illness which used to be far more common before we were able to vaccinate against the bacteria which causes this illness.

Pneumonia, Bronchitis and Kids – More Common Than You Think

Pneumonia in kids is probably more common than we all realize. It represents an infection of the lung tissue which can be caused by viral illnesses, bacterial illnesses or a type of organism that is somewhere between a virus and bacteria called mycoplasma. The most common cause of pneumonia is usually viral, but viral illnesses can predispose lung tissue to become infected with bacteria. Other ways of acquiring pneumonia are by inhalation (this is unusual but certain illnesses such as tuberculosis and anthrax may be acquired in this manner).

The best way to diagnose kids with pneumonia is through a thorough history and physical exam that your doctor will perform on your child. Another way that can be used to diagnose pneumonia is through the use of a chest X-ray, but small areas of pneumonia or early pneumonia might not show up on X-ray. Your Doctor will be able to diagnose this early on by piecing together what you tell him and his observation and examination of your child.

One thinks of pneumonia as an illness with high fever and severe productive cough but this is not always the case and sometimes all that is seen are the symptoms created by the body to help compensate for the changes occurring in the lungs. If a large amount of lung tissue is involved and it becomes difficult for the gas exchange (oxygen in and carbon dioxide out) to take place then a signal is sent to the brain to increase the rate of breathing so that more air is forced in and more oxygen can be extracted. When it is even more difficult to breathe the child may use muscles not ordinarily used to help with breathing such as abdominal muscles and neck muscles and one can observe this. With further progression of the disease less oxygen will reach the body and mild blueness or cyanosis will be seen in the skin.

OK we’ve talked about the more severe problems with pneumonia but let’s get back to the beginning and restate that most pneumonia is mild and might very well be a natural progression of a cold. In a considerable amount of children with mild pneumonia the diagnosis might never be made because it is not severe. And because most of these are viral in nature, they will clear up as the cold clears without the use of an antibiotic, and the child never exhibits the signs and symptoms mentioned in the previous paragraph.

If your Doctor pieces together the parts of the history and physical exam and decides your child might have pneumonia, and if your child appears sick or ill, he might very well begin an antibiotic because the exact nature of the pneumonia might be difficult to determine. Most of the time pneumonia can be adequately treated at home without the need for hospitalization and he/she will recover fully without any subsequent problems.

Bronchitis is a wastebasket term describing what is thought to be inflammation and mucous collection in the tubes that lead from your nose and mouth down into your lungs due to many causes- again usually viral. Any cold with a significant loose cough probably represents some degree of bronchitis or tracheitis (higher up). Generally, it also does not necessarily need an antibiotic to “cure” it because bronchitis, like mild pneumonia, will also go away as the cold resolves. There are instances, again, when your child’s doctor might very well decide to use an antibiotic for your child and those would include when your child looks sick or ill (because significant bronchitis and pneumonia can look exactly the same) or if your child has any sort of chronic lung condition such as asthma or cystic fibrosis where the chance of bacterial infection is increased.

So, especially during the winter months, if your child is diagnosed with pneumonia or bronchitis, you needn’t panic or assume the worst. Just follow your child’s doctor’s advice and he/she will be just fine.

Their Coughing is Louder Than the Caroling: What’s a Parent to Do?

Coughing children are a big problem…especially during the holidays. They can’t sleep. They keep their already sleep-deprived parents awake. They sound dreadful. They cough so hard they barf (ick).

Every parent, at some time, comes to me desperately seeking a cure for their child’s cough. The children are usually desperate too, though after his mom told me that he had coughed for a month, one patient of mine seemed quite gleeful, exclaiming “And I have snot rockets!”

What can an exhausted parent do to help the hacking little one? Isn’t there a medicine to stop that cough?

The marketers of cough and cold medications would like you to think so. Take a tour of the cough and cold aisle in your local drugstore and you will see some very seductive terms: cough syrups are marketed as “mucolytics” (break down that disgusting thick sludge in your lungs!), “expectorants” (out, out, damn goo), and “suppressants” (STOP that painful, hacking cough.) True, “seductive” may be a strange descriptor when discussing snot, but these terms can be very tantalizing to a frantic parent whose kid is hacking up a lung.

A sure fire cough remedy, however, is not as easy to find as these product descriptions would suggest.

Though I would love to have a cure for cough, several widely cited studies have concluded that no cough syrup, whether over-the-counter (OTC) or prescription, actually works. They don’t help kids get better faster. They don’t help kids feel better. They don’t help kids (or parents) sleep through the night. Furthermore, a variety of rare but serious health problems have been associated with use of these medications in children, including death, convulsions, rapid heart rates and decreased levels of consciousness. The American Academy of Pediatric’s Committee on Drugs recommends “that parents be informed about the lack of proven effects and potential risks of cough preparations.” In other words, we should tell our patients that cough medicines don’t work and may be harmful. The American College of Chest Physicians agrees.

I once gave a mom that news that there was no immediate cure for her child’s cough. “Our family,” she said, quite irate, “cannot afford another night without sleep!” Her point was well taken: colds can cause a great deal of stress in families’ lives. So what is a desperate parent to do? Is there any remedy that will help their hacking child?

Though I can’t immediately cure most coughs, there are some helpful treatments that are safe to use for children of all ages.

• Taking a steamy shower once or twice a day can loosen the thick mucous in the nose and upper airway. Carefully holding your child’s head over a steamy pot or a vaporizer can also loosen the phlegm.
• Nasal saline drops or saline rinses can be extremely helpful. Babies will hate having water in their nose but it will loosen their mucous and after some spluttering and coughing, they will appreciate your efforts in clearing their breathing passages.
• For children over 1-year-old, honey is a delicious and effective remedy for cough: see my previous post on honey as a cough remedy for further details.
• And as with any illness, staying well hydrated will help the immune system fight the infection and can also keep the mucous loose and flowing.

In the end, it is love and time that will cure most coughs, which are usually caused by cold or flu viruses. As usual, please seek medical advice from a physician and not the internet if you have any serious concerns, especially for children who have difficulty breathing, have a persistent cough for more than two or three weeks, or who seem very sick.

Tips for Parents:

• Tried-and-true home remedies can be very helpful for relieving symptoms of colds and the flu: try honey for children over 1 year old.
• OTC cough and cold medicines do not cure children or adults when they have nasal congestion and cough. They may be helpful for short term symptom relief. And they are rarely harmful (except to the wallet) for older children and adults. But if you try them and they’re not helping, there is no need to continue to use them.
• OTC cough and cold medicines should be avoided in young children (<2 years old.).
• Read medicine bottles closely and use the measuring devices that come with them when giving children any medicine.

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