What Your Doctor May Not Tell You About Croup

Lively seven-year-old Evelyn Smith, an article in Britain's Daily Mail newspaper tells us, died of croup after being turned away by three doctors in 36 hours.

On the evening of September 12, 2013, the little girl ran into her parents' room complaining she could not breathe. They took her to an emergency room, where at 4 the next morning a doctor finally gave her a shot of penicillin. Evelyn immediately threw up, but the doctor sent the family home. As soon as they got home, Evelyn's temperature began to soar, "never under 39.7C (103F)," the mother would later tell the inquest of her death.

A few hours later, the parents took Evelyn to a local medical center, where a nurse practitioner diagnosed the problem as inflamed tonsils, and wrote a prescription for more penicillin. She was better for a few hours, but her fever went even higher. Finally, the afternoon of the second day, the parents took Evelyn to clinic for a third time, whereupon a doctor diagnosed "oxygen saturations" and "moderate croup" (pronounced as if it were spelled croop). The doctor gave Evelyn an injection, wrote another prescription, and sent the family home yet again.

Evelyn collapsed and died at home two hours later. The doctors involved in the case were not found guilty of criminal neglect, but the judge noted "opportunities were missed."

Croup Isn't Just A Disease Of Babies And Toddlers

Evelyn's misfortune was to be treated by not just one but two doctors who worked under the misconception that croup is a disease only of the very young. While five to six of every 100 infants and toddlers catches this viral infection, it can also strike children, teens, and even adults. Just in the United States, about 1.5 million children a year are diagnosed with croup. 

Even when a child has to be put in the hospital for croup, intubation for assisted breathing is necessary in only about 1 percent of cases. Steroids and adrenaline administered by nebulizers reduce the need to intubate. Among the victims of croup who receive hospital treatment, fewer than 0.01 percent die. Treatment with pencillin or other antibiotics, however, is ineffective because croup is a viral disease.

How Can You Know It's Croup?

Also known as laryngotracheitis and laryngotracheobronchitis, croup usually strikes the throat, not the lungs, although it can become a bronchial infection. It causes a tightness and narrowing of the throat that results in a very distinctive cough. The cough in croup sounds more like a bark, specifically more like a seal's bark, than a cough. When breathing is accompanied by stridor, a high-pitched musical sound (usually louder when breathing in, but also occurring during breathing out), emergency room treatment is a must.

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Croup usually starts with the symptoms of a cold, including cough, runny nose, and sore throat. One or two days later there is a cough, with the possibility of respiratory distress. Usually the symptoms are worse between 10 p.m. and 4 a.m., and "spasmodic" croup can occur a week or two after the child (or sometimes teen or adult) appears to have recovered.

What Your Doctor Probably Won't Tell You About Croup

Since most doctor visits for croup occur in the emergency room after midnight, parents and other caretakers usually don't get to ask all the questions they would like. Here are some frequenly asked questions about croup with their answers.

What Does The Cough With Croup Sound Like?

If you have ever heard a seal bark, you will recognize the cough that is characteristic of croup. Don't waste time trying to match your child's cough to a seal sound, however. Get medical treatment.

When Is It Important To Go To The ER With Croup?

Stridor, a high-pitched sound that is louder when breathing in than breathing out, is a sign emergency medical care is required.

How Long Does Croup Last?

Uncomplicated cases of croup usually resolve within two to seven days after the onset of "croupy" cough. Sometimes symptoms last as long as two weeks. Croup can be complicated by a bacterial infection that causes bronchitis or pneumonia, usually beginning about the same time as the viral infection finally resolves itself.

How Long Is Croup Contagious?

Croup is spread by droplets of mucus or saliva. Children (teens and adults) who have croup are contagious from three days after the beginning of symptoms until symptoms are gone.

Why Won't My Doctor Give Antibiotics For Croup?

Antibiotics don't work on viral infections. Giving antibiotics can actually make the condition worse by killing all but the most dangerous bacteria in the body, giving those bacteria a chance to multiply.

In some cases, croup isn't caused by an infection at all. Croup can be caused by an allergy. Spasmodic croup (laryngismus stridulus), triggered by allergic reactions, is relatively easy to recognize since it always occurs at night, never during the day, and it causes small amounts of clear, runny phlegm rather than large amounts of yellow, sticky phlegm. This kind of croup can't be treated by antibiotics, either, but it may be responsive to antihistamines.

Is There A Vaccine For Croup?

The reason there isn't a "croup shot" is that no single virus is the only virus that causes the infection. Most cases of croup are caused by one of five different para-influenza viruses, but the disease can also be caused by the same virus that causes flu (influenza A), herpesviruses, echoviruses, respiratory synctytial viruses, measles viruses. and the rhinoviruses and adenoviruses that also cause colds. When the cause of croup is an influenza virus, the symptoms are usually much more severe.

Does Croup Usually Come With A 'Stomach Bug'?

It is not unusual for children who have croup to vomit, especially in the middle of the night. This is a sign of gastroesophageal reflux (GERD), but the problem is a tightening and loosening of the valve at the bottom of the throat just before the stomach, caused by the croup virus itself. It may appear that children also have 'stomach flu," but usually it's all the same illness. Treating croup will treat vomiting and heartburn, and treating vomiting and heartburn will ease croup.

Do Grandma's Home Remedies For Croup Actually Work?

It depends on how old your grandmother is. In the early twentieth century, treatments for croup include two strips of bacon tied around the throat, a kerosene-soaked rag applied to the chest, and a hot bath to which mustard has been added. None of these remedies works. However, the next, 1950's-era innovation does.

Are Vaporizers Helpful In Treating Croup?

In the twentieth century, most hospitals had "croup rooms" in which children would be put under a plastic tent with heavily moisturized air. This was eventually decided to be a bad idea, since the plastic sheet separates the child from his or her parents, and the moisture feeds the growth of bacteria, fungi, and molds. At home, however, the use of a vaporizer can make breathing easier, especially during the winter and in dry climates. It isn't necessary to keep the room damp, just to keep the air moist.

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Are There Any Long-Term Consequences Of Croup?

The more severe cases of the infection result in the formation of fibrous scar tissue in the throat that can permanently interfere with breathing. When this happens in children who also have allergies, then the allergy-driven form of croup may manifest itself. Treating the allergy, however, also treats the croup.