Clinical Reference Systems: Pediatric Advisor 10.0
Admission and Discharge Instructions
Description of Croupy Cough
- All children with croup have a tight, low-pitched
- The voice is usually hoarse.
Description of Stridor (seen with severe croup)
- When your child breathes in, you hear a harsh, raspy,
- Breathing is very difficult.
- Your child has severe croup (stridor only occurs with
- Stridor is usually present only with crying or coughing.
- As the disease becomes worse, stridor also occurs when a
child is sleeping or relaxed.
Croup is a viral infection of the vocal cords, voice box,
(larynx) and windpipe (trachea). It is usually part of a
cold. Swelling of the vocal cords causes hoarseness.
Stridor occurs as the opening between the vocal cords
becomes more narrow.
Reasons for Admission to the Hospital
Main complication: ________________________________________.
__ Needs IV fluids.
__ Needs IV antibiotic or other medication.
__ Needs oxygen.
__ Other reasons: _________________________________________.
Croup usually lasts for 5 to 6 days and generally gets worse
at night. During this time, it can change from mild to
severe many times. The worse symptoms are seen in children
under 3 years of age.
Requirements for Discharge
First Aid for Attacks of Stridor with Croup
If your child suddenly develops stridor or tight breathing,
do the following:
- Inhalation of warm mist
Warm moist air seems to work best to relax the vocal
cords and break the stridor. The simplest way to
provide this is to have your child breathe through a
warm, wet washcloth placed loosely over his nose and
mouth. Another good way, if you have a humidifier (not
a hot vaporizer), is to fill it with warm water and have
your child breathe deeply from the stream of humidity.
- The foggy bathroom
In the meantime, have a hot shower running with the
bathroom door closed. Once the room is all fogged up,
take him in there for at least 10 minutes. Try to help
your child not be afraid by cuddling or reading a story.
- Results of first aid
Most children settle down with the above treatments and
then sleep peacefully through the night. If your child
continues to have stridor, call your child's physician
IMMEDIATELY. If your child turns blue, passes out, or
stops breathing, call the rescue squad (911).
Discharge Instructions for Home Care (Croupy Cough without
Dry air usually makes coughs worse. Keep your child's
bedroom humidified. Use a cool mist humidifier if you
have one. Run it 24 hours a day. Otherwise, hang wet
sheets or towels in your child's room.
- Warm fluids for coughing spasms
Coughing spasms are often due to sticky mucus caught on
the vocal cords. Warm fluids may help relax the vocal
cords and loosen up the mucus. Use clear fluids (ones
you can see through) such as apple juice, lemonade, or
herbal tea. Give warm fluids only to children over 4
- Cough medicines
Medicines are less helpful than either mist or drinking
warm, clear fluids. Children over 4 years old can be
given cough drops for the cough. Younger children can
be given 1/2 to 1 teaspoon of corn syrup as needed to
thin the secretions.
- Close observation
While your child is croupy, sleep in the same room with
him. Croup can be a dangerous disease.
- Smoke exposure
By all means, don't let anyone smoke around your child.
Smoke can make croup worse.
The viruses that cause croup are quite contagious until
the fever is gone or at least during the first 3 days of
illness. Since spread of this infection can't be
prevented, your child can return to school or child care
once he feels better.
- Other medicines
- For pain or fever over 102ƒF (39ƒC) give
- Additional instructions
Follow-Up Appointment after Discharge
___ Your child needs to be rechecked and has an appointment
on _____________ at _______ with
___ Your child needs to be rechecked in ________ days. Call
your child's doctor to make an appointment.
___ A follow-up appointment is not necessary. Call the
doctor if you have any concerns.
Call Your Child's Physician Immediately If:
- Breathing becomes difficult (when your child is not
- Stridor returns and the warm mist fails to clear up it up
in 20 minutes.
- Your child starts acting very sick.
Call Your Child's Physician within 24 Hours If:
- Croup lasts more than 10 days.
- You have other concerns or questions.