Croup, otherwise known as largeotracheobronchits, meaning inflammation of the larynx, trachea and bronchitis, is one of the most common occurrences in children between the ages of six months and three years old. The condition is thought to be an inflammatory reaction to any number of common viral infections.
Croup usually begins with a runny nose, and a day or so later, the child develops a tight barking cough that closely resembles the bark of a seal. The cough usually comes in frequent paroxysms or waves, and then the child is relatively quiet in the interim periods.
The cough is tight, not wet, but also not wheezy as occurs with asthma. The tightness occurs because the larynx or windpipe is narrowed; therefore the child “pushes” hard to expel the air. Hence the bark and tight sound.
The First Night is the Worst
Generally the first night is the worst, the second night is a little better and the third night better still. In the usual scenario, the child is relatively unaffected during the day, doing all their usual activities.
In the typical croup case, the child has minimal or no fever, no congestion in the lungs and no ear pain.
The main thing to consider is whether the cough comes from a much different illness called epiglottitis or infection of the epiglottis. This is a dramatic bacterial infection that is very rare.
I have seen one case in my entire career while working as an ER doctor. With epiglottitis, the child has a barking cough as with croup, but he is also very sick, drooling and can’t swallow anything. The child is short of breath and has a look of panic or doom on his face.
With epiglottitis, emergency care is essential including whatever tests and interventions are needed for that particular case. This is truly a life threatening condition, albeit a very rare occurrence.
Traditional Croup Treatment Compared with Today
Interestingly, in my thirty-year career, I have seen a most definite shift in how we doctors tend to treat croup.
In my first five or ten years as a physician, while practicing in small town New Hampshire with mostly young families as patients, I saw hundreds of cases of croup each winter. I don’t remember doing a single throat x-ray (to rule out epiglottitis), and I never sent a single patient to the ER.
We generally had a ride-it-out attitude that is so different from the more aggressive treatment typically favored by today’s doctors and experienced by most parents of children with croup. I explained the life history of croup to the parents, and gave them my four main interventions listed below. With this treatment, I had not a single bad outcome in all those years with all those children.
Now it seems as though many if not most children get an x-ray, blood test, and treatment with one dose of steroids and adrenaline. Again, besides the rare time when you can’t be sure you are not dealing with epiglottitis, there is no need for these things.
Easy Steps to Prevent a Trip to the ER
Here is the simple treatment I have used all these years with so much success. Following it resulted in literally no trips to the emergency room!
- The parents need to remain calm and relaxed. The sound of a croupy cough is disconcerting enough to any child! Any additional tension and anxiety from the parents just escalates the situation.
- It is important to get liberal fresh air into the child’s room by opening the window. Just a crack if the weather is cold, but fresh air is necessary. At the same time, keep the child warm, even a bit on the sweaty side, and give him/her frequent sips of warm tea (such as chamomile) and traditional bone broth.
- For medicines give one-half teaspoon of high-vitamin cod liver oil per day, as the vitamin A content has been shown to help all viral infections. Give the homeopathic combination spongia/bryonia, 3 drops every hour while the child is awake. This remedy often dramatically cuts the severity of the croup. Then give a natural form of vitamin C or liposomal vitamin C about 250 mg every two hours while awake. Continue these medicines until the whole illness is resolved.
- For bad episodes, particularly on the first night, go into the bathroom with the child, close the door, stopper the tub and let the hottest shower run until the room is steamy. Let the child breath in the steam air for five to ten minutes for bad croup episodes. The alternative is to simply take the child (dressed up of course) briefly out into the cold night air. For some reason, this often dramatically breaks an acute episode. If the weather outside is warm, open the freezer door and let the child breath in the cold air. Occasionally parents alternate these two treatments with good effect.
With these simple interventions and the usual close observation of your child along with rest and nourishment, the three days of croup should be easily manageable with no aggressive treatments necessary. Your child will soon be up and about, with no adverse consequences.
Thomas Cowan, MD, has studied and written about many subjects in medicine including nutrition, homeopathy, anthroposophical medicine, and herbal medicine. He is author of Human Heart, Cosmic Heart, the principal author of The Fourfold Path to Healing and co-author of The Nourishing Traditions Book of Baby and Child Care.
Dr. Cowan graduated from the Michigan State University College of Human Medicine in 1984. After his residency in Family Practice at Johnson City Hospital in Johnson City, New York, he set up an anthroposophical medical practice in Peterborough, New Hampshire. Dr. Cowan has served as vice president of the Physicians Association for Anthroposophical Medicine and is a founding board member of the Weston A. Price Foundation.
He has lectured extensively throughout the US and Canada. He has three grown children and currently practices medicine in San Francisco where he resides with his wife Lynda.