When is Croup Mild, Moderate or Severe?
Croup is common childhood ailment that annually affects 5% of all children between 1-5 years-old. It is characterized by a barking cough, hoarseness and respiratory distress mostly at night. While mild Croup often resolves itself within 48 hours, about 5% of all cases need to be hospitalized and can be classified as moderate or severe. So how is a parent to know when their child’s Croup is minor, or a moderate case, or the rare severe case? Treatment vary greatly depending on whether a case is mild, moderate of severe. There are common treatments that are not medically prescribed for mild cases, but treatment for the rarer forms do require a proven medical plan.
For mild Croup, the standard treatment passed down through generations has been humidification (simply adding a humidifier to the child’s sleeping room to immediately taking the child into the shower and arranging to let them sleep in the bathroom area.) Some parents have used oral decongestants to alleviate symptoms. However, neither of these have medical evidence to prove they are efficacious. Some pediatricians will prescribe a single oral dose of dexamethasone. (There is consensus that antibiotics do not improve symptoms in croup of any severity, as croup is usually viral in origin.)
In children with moderate to severe croup, intramuscular or oral dexamethasone, nebulized adrenaline (epinephrine), and nebulized budesonide reduce symptoms. Oxygen is the standard treatment in children with respiratory distress. Oral dexamethasone is as effective as nebulized budesonide at reducing symptoms and is less distressing for the child.
With such vastly different treatments depending on the severity of the Croup, how is a parent to know what type of Croup their child has? Unfortunately, the answer for many parents has been to err on the side of caution and transport their child to a doctor’s* office, Urgent Care or even an ER to determine if their child is part of the 95% of cases that are mild, or part of the 5% that are moderate to severe.
However, one way to determine the type of Croup is remotely, through telemedicine. Over a phone call, a doctor* can ask key questions of the parents as they describe the symptoms, the child’s cough and the family history and can write a prescription for the dexamethasone without requiring the child to be transported out of the home. A simple phone call can quickly make the determination of whether the child needs the ER or just a shower.
Croup is a leading cause of hospitalization in children younger than four years, and study results show that only 1.5 to 5% of children with Croup actually require hospitalization. The annual cost of hospitalizations for Croup in the United States is an estimated $56 million, with a majority of it being unnecessary.
* “Croup” is a generic term encompassing a heterogeneous group of illnesses affecting the larynx, trachea, and bronchi. Laryngotracheitis, laryngotracheobronchitis, laryngotracheobronchopneumonitis, and spasmodic croup are included in the croup syndrome.
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