Recurrent Croup

Recurrent Croup

Once again, a common theme of the Morsels is a need for vigilance. Unfortunately, sometimes those seemingly straight forward cases of vomiting in fact are due to an Inborn Error of Metabolism and it requires our vigilance to make the diagnosis.  Many of us, however, also abide by the rule that “if it looks like a duck, walks like a duck, and quacks like a duck, then it is a duck.”  So what should we make of the patient who presents with what looks and sounds like croup, but it is recurrent?

Croup Basics

  • We have dealt with the common issue of Croup previously.
  • Croup caused by viral infection effecting the larynx, trachea, and/or bronchi.
  • Characterized by barking cough and stridor.
  • Can be associated with respiratory distress.
  • Typically seen during the Fall and Winter months.

 

Croup vs Recurrent Croup

  • Viral Croup is does not usually occur more than once (or twice) in a year in a otherwise healthy child.
  • Croup like symptoms that occur more frequently (>2 a year) have been called “Recurrent Croup.”
  • Essentially, recurrent croup is not due to a viral etiology and should be considered a RED FLAG for another condition.
  • Recurrent croup can be the presentation of underlying intrinsic or extrinsic airway narrowing.

 

  • Croup

    • Usually 1-2 episodes per year
    • Ages: 6 mos – 3 years with peak at 2 years
    • Usually short in duration (1-2 days)
    • Standard therapy usually treats the symptoms

 

  • Recurrent Croup

    • > 2 episodes per year
    • Any age.  Be suspicious of croup in a child < 6 months or > 3 years of age.
    • Relapsing and remitting course. Can persist over weeks.
    • Some or no response to standard therapy for croup.

 

Recurrent Croup – Some Causes to Consider

  • Airway
    • Subglottic stenosis
      • Congenital
      • Traumatic – from prior intubation
    • Subglottic cysts
    • Subglottic hemangioma
      • Look for hemangiomas on the child’s face, particularly the beard distribution.
    • Recurrent respiratory papillomatosis
    • Vocal cord paralysis
    • Tracheoesophageal fistula
    • Tracheomalacia
  • Others
    • Foreign Bodies
    • Congenital cardiovascular abnormality
    • Gastroesophageal reflux
    • Asthma / Allergy
    • Mediastinal mass

 

Timing of Stridor

  • Not everything works as planned… but listening to the timing of the stridor can help point toward potential cause.
  • Inspiratory
    • Supraglottic problem
    • Laryngomalacia is an example.
  • Expiratory
    • Tracheal pathology
    • Ex, compression from aberrant vascular structure.
  • Biphasic
    • Glottic or Subglottic problem
    • Subglottic stenosis or vocal cord paralysis are examples.

 

The Moral of the Morsel

  • If you are taking care of a child who is presenting with what appears to be croup, but this marks the 3rd or greater occurrence of it, then you are dealing with Recurrent Croup.
  • Recurrent Croup should be considered a RED FLAG for something that isn’t as simple as a viral illness (perhaps one of those needles of serious disease in the haystack of coughing).
  • Anatomic abnormalities have been reported in a significant proportion of patients with recurrent croup.
  • Have a lower threshold for checking plain films for possible foreign bodies.
  • Most, if not all, of these patients will require bronchoscopy by ENT to rule out anatomic abnormalities.

 

 

References

Joshi V1, Malik V2, Mirza O2, Kumar BN2. Fifteen-minute consultation: structured approach to management of a child with recurrent croup. Arch Dis Child Educ Pract Ed. 2014 Jun;99(3):90-3. PMID: 24231112. [PubMed] [Read by QxMD]

Rankin I1, Wang SM, Waters A, Clement WA, Kubba H. The management of recurrent croup in children. J Laryngol Otol. 2013 May;127(5):494-500. PMID: 23544702. [PubMed] [Read by QxMD]

Jabbour N1, Parker NP, Finkelstein M, Lander TA, Sidman JD. Incidence of operative endoscopy findings in recurrent croup. Otolaryngol Head Neck Surg. 2011 Apr;144(4):596-601. PMID: 21493242. [PubMed] [Read by QxMD]

Sean M. Fox
Sean M. Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renowned educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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48 Comments

  1. Hi, had a browse through comments and not sure whether it’s worth me pressing to get my boy tested. Any thoughts please? He had croup on and off since he was six months old. He’s now 12 months. It’s now lasted about 8 weeks. It’s worse at night. I don’t detect struggle to breathe. Maybe cough splitters at night though. I’m concerned it’s been hanging around so long with no change in it’s severity. But then again it’s not affecting his sleep much and no other symptoms seem to present. Thanks

  2. hi everyone,

    I live in Honolulu, Hawaii. my son has had croup since before he turned 2 years old up until now (he is 3 years and 6 months). we’ve been to the ER about 8-9 times, they’ve always had to give decadron but the time before the last they gave the racepenepherine. it was so scary. i had to drive him so fast in my car, going through red lights, going around cars on the sidewalk because he barely could breathe so i could get to the ER in time.

    i am seeing a chinese herbalist for my son (Silkie herbs, based in LA), via Skype and text. She gave us diet recommendations and also mailed us herbs to take to help balance his body out. We’ve cut out dairy and now i am going to try cutting out wheat.

    Tonight I finally am piecing it together —- I am almost certain that wheat is causing my son to cough. We just went to the ER on Monday (12/1) for croup and they gave him decadron. on Wednesday (12/4), i gave my son two pieces of wheat bread throughout the day and his cough was more forceful at night than it was on Tuesday night. Today Thursday (12/5) I made sure to not give him any wheat products, and tonight he maybe coughed just once! We will see how the night sleep goes. I am going to try a wheat free diet and I will let you all know how it goes.

    If it is the wheat that is causing his dry cough which turns into croup, I may have stumbled onto some gold here…I will let you know.

    I totally know what many of you are going through…hold on mamas…we will figure this out…

  3. has anyone considered tonsils my sonehad croup from 1-5 years of age having to be in croup tent a couple of times a year in the hospital- it was that bad-his tonsils were touching each other was on decadron and antibiotics several times a year – as soon as he had his tonsils out things improved i think the tosnils were the hidden infectious agent for his croup I know they dont like to take tonsils out but it sure was the answer for my son in the 80,s

  4. I stumbled across this looking for possible more information and I am heart broken by the amount of children suffering from recurrent croup. Alony with My son is 6 years old and has been dealing with croup since he was roughly 3-4 months old. We have been to the ER and doctor countless times like ya’ll as well. He had a ENT scope him through the nose came back with a negative for abnormal formalities. We went to a local pediatric pulmonologist when he was 4 years old. He was diagnosed with being a severe asthmatic. He has taken 2 puffs of dulera, singular chewable along with a dose of childrens over the counter allergy medicine every day since then. There has been no improvements. Fast forward to today he is now 6 years old and has been having at least 2-3 croup episodes for the past 6 months. The eposides seem pretty severe as he tells us he needs air during an eposide. Like everyone here we rush to ER where we are given a dose of decadron and sent home with diagnosed croup. My husband and I decided it was time to see top specialist and try to do something further to help our son. We had our first appt a couple weeks ago where it was determined he did not have severe asthma as diagnosed where we live and he has been on a high dose of asthma medication and his growth hasn’t been thriving. He has been measuring at 5% of his weight group for the past 5 years. He is 6 years old and wears 3T unders. The pediatric pulmonologist at Vanderbilt decided We will have a appointment at Vanderbilt Children’s hopsital to meet with a team of doctors they are are called the CADET team. CADET stands for Complex AeroDigestive Evaluation Team. They will place our son under while have a series of procedures and tests sdone by a team of specialist with STAT results from standing by laboratory and radiologists. I am going to be forming a facebook group with the name pediatric recurrent croup in hopes to possibly help and talk with other parents who may be going through their children having recurrent croup. Something is happening to have this many babies/children with recurrent croup and its tough not getting answers or relief they need.

  5. We have a 7.5 year old son that has had issues with recurrent croup since about age 2. He has known allergies and asthma as well. His croup sometimes comes on very quickly and very severe (like others said he wakes suddenly in the night unable to breathe) and other times is a slow onset and we can see it coming (generally with a common cold or congestion due to allergies). Sometimes the issues are in the upper airways and lungs (asthma) and other times it is only an upper airway issue (just croup). We have been treated in the emergency department 3x in the past 4 months and given oral steroids by our family doctor an additional 2x. I am at a loss and so frustrated. He is treated appropriately for his asthma and allergies, that has been ruled out as a cause by the dr. and he had a normal laryngoscopy very recently. I just wish we could get this under control. We were told he would outgrow it but this year has been our worst yet. Anybody ever get to the bottom of their child’s recurrent croup issues?

    • My story is almost identical to yours. My son is 8, we are currently on day 11 of croup cough in the morning and a dry hacking cough (says it feels like a tickle in his throat) all day (coughs about every minute). We have tried everything and nothing is working. I am almost certain that steroids cause his dry cough but he has to have them for the inflammation during the bad croup. We live 40 mins from the nearest hospital and this last attack was the worst. I live in constant fear. Has anyone found anything to help the cough?

      • My son is 5 now premmie has had recurrent croup since 12 months an episode almost every month each of them severe respiratory distress needing adrenaline nebuliser at home even before ambulance can arrive he deteriorates so we have been given stuff at home. My older 7 yr old gets croup and barking cough but manages ok. The little one’s every day is a nightmare. All testa down and no answers .I m starting to lose hope on the ” hope he grows out ” phrase. @ Stephanie wanted to share we humidify his room at night and the living room during day very intensely ( 2 humidifier on a good day and 4 big ones on a sick day ) and saline nebulisers help to crack the cough very well. This is time tested by us and any one out here struggling with cough I would recommend to try this . Get good big humidifiers and at night right on their face to breath in well. ( Coldmist ones) ….warm will b favourable for mold .. keep an eye on the house as the humidity can come Witt other problems but I regularly clean and air the bedding and room. Hardwork but worth it .
        Hope all the little ones really do grow out soon

  6. Our grandson, age four, has had croup since he was 3 months. He just recovered from pneumonia a month ago, and currently has croup AGAIN. His doctor says “he will most likely outgrow it.” I noticed that 90% of the comments written included the very same words from these parents doctor’s. I estimate he has had croup more than 4 times, just in 2019. Last year it was once every two months. ER visits, steroids, etc. It sounds like doing the exploratory did not help any of the parents. The cough is terrible. Our grandson literally turns red because his throat hurts as he coughs.

  7. My daughter 4 she had croup about a week o. Half ago and it’s coming back strong I told her doctor I really really think is asthma at her age that’s exactly how I was and I had asthma but doesn’t listen to me I know am not a doctor but I now what asthma is I go throw it my self what can I do

    • I understand how frustrating this can be. Obviously, I cannot give out specific medical advice for individuals, but I would recommend that you have an open and honest conversation with your child’s doctor.

      All the best,
      sean

  8. My great-niece is now 5,and has had croup several times since the age of 2. The thing that scares me is that each round seems to get worse. She’s had to be rushed by ambulance to Children’s Hospital these last 2 rounds. The first time she had to get epinephrine to bring her out of the stridor breathing. This last time she had to be given 3 rounds of epinephrine to help with the stridor. Her chest goes in as far as it can possibly go during these attacks. It all starts with a croup cough hrs before. It’s so hard to sit in the back of the squad and look down on this small child trying to breath. The ENT this last time was even panicking. My niece brought my great-niece over to stay the night with me today,and I noticed her hoarse voice starting. I’m panicking because I know that usually one of the symptoms before the attacks start. I immediately turned on my central air,window air conditioning, and a small fan to get it really cold in here. It seems to help much like the freezer trick. Her hoarse breathing has calmed down,and she seems to be sleeping ok right now. I Pray to God it stays that way,and it doesn’t get out of control. The Dr said that once you have the croup that you can always get it again. Some kids out grow it,and some may suffer for yrs trying to keep it in check. The ER Dr said it has absolutely nothing to do with asthma,and breathing treatments can make it worse. They said they will only do the treatments if they are having a stridor attack. It all sounds crazy to me!! Your first thought would be some form of underlying asthma causing it,but he said,absolutely not. IDK,I just wish she’d outgrow it already. Scares me to death to watch a child trying to get a breath. Especially since I loss my twin grandsons in 2013 (micropreemies). 1 lived 9 hrs and 1 lived 12 days. We had to stand there and watch them get bagged when their oxygen would drop real low. I just wish there was a cure for all of our babies. God Bless all of you,and your babies. I Pray God heals all of them!!!

  9. Omg this thread has made me feel like I’m not alone! My son has had dexamtehasone treatment 8 times this year and we have been given emergency dex for at home, he never had croup until this day a year ago he was hoppostalised with it since then it’s just been recurrent, ent have seen him and are continuing their investigations but it takes so long, he has been in a&e 3 times this week with a chronic cough which he has had for months but just won’t go awAy, had to stop antihistamines as he had allergy testing yesterday, all came back clear, and the minute he stopped them he was put on steroids for his cough, chest is always clear! I just don’t sleep I’m terrified I’m goi g to wake up to the worst ever!

  10. My daughter is 5 years old. Exactly one year ago she had her first episode of croup. In one year she has had 5 episodes of croup all ending up in er or urgent care. This summer alone she has had croup twice two weeks apart. Currently she takes singulair,Zyrtec, and Flonase. She was also tested for allergens and came back she was not allergic to any. I am making an ent appointment this week. I hope she gets the answer she needs.

  11. my son is almost 4 years old he had croup since he was 2 years old . almost having 10 episodes per year with a peak in winter . we tried many things this winter and the number of cases reduced compared to last year. we gave him Nasonex as his doctor thinks that he got nose allergy causing mucus to start the croup . we also used Zyrtec. his last episode was few days a go , he tends now to have it in the early morning not at night . i’m very worried now as i see many cases last till even 14 years old !!. i was hoping that by max 6 years old he will grow out of it . doe you know any families that had a child with recurrent croup and actually the child grow out of it ?!

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  13. Wonderful blog! Do you have any recommendations for aspiring writers? I’m planning to start my own site soon but I’m a little lost on everything. Would you suggest starting with a free platform like WordPress or go for a paid option? There are so many options out there that I’m completely confused .. Any ideas? Kudos!

    • There are no great, universal answers to this question. I prefer free platforms as my site is not one that generates revenue (ex, no ads).

      Biggest recommendation would be to write about what you love… and that way it will be less “work”… although it will still be work.

      Hope that that helps,
      sean

  14. My son’s is 14 months. Has had bronchitis at 41days old. This winter he has had croup 6 x in 4 months. He has snored since birth and is very low on his growth chart for weight. We have seen an ent before for the cough and snoring did a scoop down his nose and they said it wasn’t Abnormal. So what’s next? Like it’s terrible having a kid so young scared at night coughing himself awake. Get the steroid and it helps a little. Couple weeks later and it’s back again. So what the heck do I ask my doctor to look for next? Please help. See my pediatrician next week and I need to get to the bottom of this.

    • I’m sorry to hear of your child’s persistent symptoms. I, obviously, cannot give specific medical recommendations to individuals over the internet. I would support your decision to see your pediatrician and discuss this further though.
      -sean

  15. My son is 14 and has “chronic croup”. He had has first bought with it when he was 4 months old. He has always had boughts of it every 2-3 months year round. He was around 8 before he didn’t have to be admitted to the hospital for it…always 2 week stays under oxygen tent each time. His doctor swears that I am an expert and makes sure I have what he needs at home to treat him when it happens. He had it again last week and I’m worried it has turned into pneumonia…not common with him, the weather has been awful here lately. He has had so many test done when he was younger and the best answer we have received was that his is caused by acid reflux which is caused by stomach spasms….with no answer to what causes his stomach spasms. Also, the acid reflux caused his tracheomalacia. It doesn’t help that on top of that he has Autism/ADHD combined type, a vision impairment and now struggling with some hearing loss. I wish we could find a doctor that could help him.

    • Wow. I feel so much for you. I thought i was alone with all my 5 y.o. boy has been going through. Has this recurrent croup every time weather changes drastically or seasonal changes, and is happening atleast 5 or 6 times to the point I kinda lose count as I was slowly losing hope last fall and winter. Docs kept saying oh it’s just croup etc he will be fine, grow out of, meamwhile he is 100 percent always on his toes, is 72 lbs at 5 almost 6, docs say he has asthma albuterol does nothing noticed, constantly has cough in cold months w sneezing runny nose, and possibly has ADHD or I’m fearing is on autism spectrum but undiagnosed . It is so hard having to drag our children in and out of all of these docs over the course of there lives only to be left even more confused and hopeless feeling, it really scares the crap out of me. I have 3 older sons 1 in high school and 2 in middle and I NEVER EVER had to deal with all of these possible and unsure what they are healthy problems. I am fearful that something is going.on that is causing our children to be so sick and at such young ages!! What is going on anymore. Bless all of you and your children. I will be praying for all of the children and fams struggling.w.this health crisis I believe we are living thru. May God bless all in this chat and the children.

  16. I finally feel like I’m not alone. My 5-year-old daughter just had 4th episode of croup in the last 8 months and 4 episodes of croup last year. She had her first croup just after starting a daycare at age of 4. She never had croup before starting a daycare. We had to take her to ER 3 times, twice last year and once this year. We took her to ENT and were told she would have to get bronchoscopy and endoscopy under full anesthesia, but like a lot of parents we are very concerned about such an aggressive procedure. Last week I went to another pediatrician and I mentioned that my daughter has acid reflux symptoms, especially before going to sleep. She would always complain about something in her throat and feeling like she is going to vomit when she is laying down at night. She also complained few times about her stomach feeling hot and she gets the hoarseness in her voice and clears her throat often. Additionally, she had cough 5 weeks straight. All these symptoms started after she went through severe stomach virus last year. The evening episodes gave her panic attacks and she was in my opinion misdiagnosed by her pediatrician as having Anxieties. We went through the counseling sessions which eliminated panic attacks, but she is still scared when she has the Acid reflux symptom at bed time. After hearing all this, the new doctor decided to put her on medication to treat the acid reflux for a month to possibly 3 months. She has been taking that medication for less than a week now, so it is very hard to say if this will resolve the problem or not. Additionally, we took her to the allergist and the skin test showed she is allergic to weeds and dust mites. We have washed and removed some of the carpets, bought new mattress, the pillow and hypoallergic mattress covers as well as the special vacuum that kills the dust mites and all the viruses and bacteria. She was on Zyrtec for over 2 month and 1 week after I stopped giving her Zyrtec she got croup again. She is back on Zyrtec. My hope is that with the allergy and acid reflux treatments she will discontinue having croup and we won’t have to put her through bronchoscopy and endoscopy. Let me just add these croup episodes are very different each time, sometimes they come as secondary effect after a cold or upper respiratory infection turning into stridor at night and some barky cough while other times it just starts with a stridor and then turns into cough and other cold symptoms. She has them different times of year. She has been treated with steroids each time.

    • Yesterday I took my daughter to another ENT and she performed nasal endoscopy and confirmed inflammation of her voice box and throat area which supports the acid reflux. She prescribed Zantac in addition to Prevacid Solutab that my daughter has been taking for the last 3+ weeks. So now she is on Prevacid in the morning and Zantac at night. Additionally, the doctor recommended Nasacort at bedtime. I really hope this new treatment will completely eliminate the croup. I wish all of you moms that you find knowledgeable medical staff that can find the root cause of your child’s issues and will be able to implement treatment plan to help eliminate the croup.

      • may i ask if these medications eliminated the croup? i am suffering the same with my lo (he is two yrs now), his first croup episode strike at Feb 2017 and ever since these episodes reoccurred 6 times.. the time interval between each episode is getting shorter as well, i mean at first he would get an episode every 3 months then every two months then monthly and recently in only 15 days! his ENT advised endoscopy but i am totaly afraid and reluctant about it.. another doctor suspected anti-reflux medication, so i am asking whether it caused any progress with your daughter, may be i can find hope at least while putting him on further meds.

  17. My daughter she just turn 2 years and have a cough for over 2 month, she was diagnosed with pneumonia and she still have the cough especially at night doctors said she might have asthma but I don’t think is that if anybody can help me I’m so frustrated

  18. My 4 year old son has had croup 5 times since he was 18 months old, but three doses of croup meds have been given to him in the last 2 months. He has had a horrible dry cough every 30 secs-1 min the last 24 hours, and this cough has stayed with him the last five weeks. Have vicks on his chest / back / feet, given chinese herbal cough syrup Nim Jom a few times a night if it’s really bad, Advil on harsh nights, the cool mist humidifier is on max the last 5 weeks and very clean with colloidal silver added to the water, we do not have mold issues in the sills or his room, and he’s starting to look pale from crummy nights of waking up for two hours at a time and coughing incessantly. I am stuck of where to go next and could REALLY use some advice. ….See the doc and get a referral? I don’t now what else to do for him.

    • Hi Helena,
      Have you brought him to see an ENT? I brought my daughter because the pediatrician referred me to one. They did a scope in the office and said she has reflux which might be the cause of the croup but they want her to have a bronchoscopy under anesthesia which my husband and I are not really comfortable with. She’s 20 months and has had croup 8 times, 5 of those which she had to be hospitalized. My advice to you would be to see an ENT maybe they can find out why your son gets it so much this way they can treat him accordingly. The ENT had given my daughter medicine to take daily for reflux and it seems to be helping. Also do you have a fireplace or wood stove? The doctor at the hospital last time I was there had told me never to put the fireplace on as it is not good for croup either and we had been putting it on a lot.

      • I really appreciate your response, that’s what we’re going to do this morning. Take him and get him referred to the ear nose and throat doctor. It’s just ridiculous that his cough has gone on this long, last night was a couple three hour chunks of time where he was coughing nonstop for the whole three hours… It was really tough. We took him outside for cool air, gave him Benadryl and that helped him sleep the last couple of hours… But I’m also nervous on him getting anything invasive done. We do not have any wood stoves and fireplaces or anything that would provide smoke in the home, and his cool mist humidifier was on high and has been cleaned and added with colloidal silver as well… Just a frustrating scenario with him being so sick.

  19. my son is almost 7 & has this recurring croup cough since he was born. he had two bronchoscopys leading to discovery of bronchialmalaysia, laryngeal Malaysia & a hernia as well as severe acid reflux. he has to be hospitalized & treated when he goes through his “episodes”. But somehow the pulmonologists the gastroenterologist and the ent all point to mucous asthma caused by acid travel up his esophogous creating the asthma. but that doesn’t explain the recurring croup. I get told He will grow out of it. he takes 8 medications a day one of them being erythromycin to help with stomachs empty (I was told) along with his acid reflux pills inhalers nose sprays and the isopropeum bromide med treatments. there must be something else causing all these children to be sick…

  20. Interesting read! My son is now 7, almost 8, and gets croup 6+ times per year since he was 2. He has it now (second time this month!). He’s been to an ENT and his airway anatomy was ruled as normal. We use a nebulizer at home with albuterol solution. Doesn’t seem to help with strider, but improves his oxygen levels. So frustrating when he wakes up not being able to breathe in the middle of the night with no prior symptoms. Doctors say he will grow out of it. ??

    • My daughter is 18 months and has had croup 5 times since birth. She has seen an ENT who did a scope and said she has reflux. She wants my daughter to have a bronchoscopy and laryngoscopy at the hospital which is an outpatient procedure but she has to have anesthesia so I am putting it off because my husband and I are to nervous to have her under like that. Has anyone had their child have any of these procedures? My daughter had croup again last night and it’s the first time she’s had it that she didn’t end up at the hospital im hoping it gets better but we will se what tonight brings.

      • Gina, I’m sorry your family has been dealing with this issues. As I note in the Morsel, “recurrent croup” really should make us think of other conditions that are not croup. Often this evaluation involves bronchoscopy and endoscopy. These procedures are done commonly. Make sure you discuss your questions and concerns with your doctors.

      • My son is getting it done this Friday. I’ll let you know how it goes. I’m so nervous. He needs it done just to rule out any abnormalities.. I’m praying we get some answers soon. My son is 3 and he started getting croup episodes at 15 months old, 2 a year. Everytime had to be treated at the hospital.

    • My son is 11 and 120lbs, they finally quit telling me that he will just grow out of it since he’s the size of a small adult! They are treating it like classic asthma, has shortened episodes and severity but they are still occurring just as frequent. 🙁

  21. My 5 year old son has had Croup 26 times and Strider 6 times in the past 30 months. We have treated him with prednisolone, sometimes decadron. He had a bronc scope in January, which did not reveal any anatomical issues. He was on Amoxicillin for a year to attempt to ward off any sinus infections. He was also on Prilosec for a year to treat any possible reflux. He is currently taking Delura (maintenance), Zyrtec, Abuterol when needed, Flonase, and Saline rinses. We have seen countless Pulmonologist, GI, Pediatrics, Holistic medicine doctors yet he still experiences Croup on a monthly basis. The only response I have received is “Hopefully he will grow out of it.” One over the counter medical that seems to help is Zarbee’s mucus reducer. Our next step is nutrient testing, retesting for allergies and attempting to start a gluten free diet.

    • We are in the same boat. Specialist says son doesn’t have asthma, yet we have this ‘croup like cough’ about 1x month. Horrific coughing at night, usually triggered by a virus/ croaky voice. Treated with a one off prednisolone dose. Inhalers used but don’t always show improvement. Specialist thinks it’s just the aerosol asuch as anything giving relief. Had adenoids and tonsils out but nothing has changed.
      Specialist says he will grow out of it, fingers crossed. Interesting as he (doctor)does not believe that ‘cough variant asthma’ exists. Just a term that evolved.

  22. My son just turned 5 he has croup 3 times a year October ,February and march. Almost to the date since he has been 1. It’s appear to be when the weather switches from hot to cold and back to cold and hot drastically. Doctors can’t figure it out. Doesn’t appear to be asthma cause it only occurs in certain seasons. Same thing happens he has no symptoms and in the middle of the night starts barking and can’t breath. Do steroids and nebulizer for 3 days and than he’s good till the next season change.

    • That’s what happened to my son every year they want me to see an specialist. I’m so scared. I feel like happens every winter.

  23. My daughter is 11 years old and still gets recurrent croup requiring steroids, with many episodes each year. She is currently having an episode and had another about 3-4 months ago. It doesn’t appear to be seasonal as we live in Australia and summer is just ending with most days still in the high 30’s (degrees C). There is bushfire smoke in the air at the moment though, so I wonder if that has anything to do with it. This post has been very helpful and informative. It is clear recurrent croup at 11 is not normal and time we got it investigated properly. Will ask our doctor to refer to an ENT specialist.

    • I also live in Australia and find my sons croup doesnt just happen in winter. Hes 4 now but has had several episodes. Everytime he gets taken to the ER and is given steriods.

  24. My child is 7 years old. 8 years old n January. She has recurrent croup since birth. Is now having a bought. Treated with prednisoline.

    • My daughter is 7 years old. She was diagnosed with asthma at age 3. She has had recurrent croup since the age of two and now her pediatrician wants to have her evaluated by an ENT to make sure there is nothing structurally wrong with her airways. Fall and winter are peak months for the episodes of croup. Usually in the spring and summer months she does very well. Her doctor seems to be perplexed with her condition.

      • My son is 4 and has had reoccurring croup for several years. He has been to the ENT for airway test which came back fine. He has it all different seasons. His doctors are perplexed as well and have mentioned that he may have the type of asthma that demonstrates as purely cough (he doesn’t wheeze)

        • I hope your son begins to feel better very soon. Cough-Variant asthma is another good example of how not every illness is just like it is depicted in the medical text books.

          • My son has been having this sort of
            croup.. 4/3 and a half years and he gets it sometimes two or three times in a month which basically is the whole month because it takes three to four days to clear… I’ve become an obsessive clean freak thinking it was something I could protect him from right now it’s 3 in the morning and my son is fighting for air but every time I go to the emergency room or a pediatrician that are nonchalantly and say oh yeah it’s just that still, he’ll be fine we can’t do anything for him and I don’t know if that’s because of my insurance because they just don’t care thank you so much for this article I’m going to have to learn on my own how to help him

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