What can you tell me about croup?

Q1: My two-year-old has a very harsh cough. What can you tell me about croup?

Croup is a very common infection in young children under four. It generally refers to a harsh, barky, high-pitched cough that some parents describe as a “seal bark.” It is usually caused by a viral infection that produces some swelling and infl ammation of the upper part of the windpipe (trachea) and voice box (larynx). Because of this swelling, a child may also tend to have a hoarse voice. If the swelling becomes more severe, breathing will be noisier, and they will make noise every time they take a breath.Treatment for croup depends on how signifi cant the degree of the symptoms. A harsh cough can be treated with a little extra humidity. If the breathing becomes noisier, then a warm steamy bathroom or even bringing them out into the cooler outside air should help. Finally, if your child appears to be struggling every time he or she takes a breath, then they will likely need to be seen right away, even to the point of needing to go to the emer-gency room.If they become bad enough to be seen in an emergency department, they may be given a mist treatment containing adrenaline (epinephrine) to breathe in.  Occasionally a child will get a short course of steroids to help reduce the swelling and infl ammation of the trachea. It is import to remember, there is no "cure" for croup.

Q2: My six-week-old newborn is starting to cry more and more each day, usually in the early evening. Is this colic and what can I do to help my baby?

Crying is a very normal behavior of newborns during the fi rst two to three months. Your baby is making a huge transition from birth to becoming a smiling, verbal, and interactive three-month-old. They are getting used to all of the external stimulation as well as their own body’s internal workings.Normal babies can cry up to three hours per day by three months of age. If they cry much more than three hours per day, then they are generally considered “colicky.” There may not be a lot that you can do to reduce the amount of crying. Some soothing techniques that are worth a try include trying to feed them, even if they ate just an hour ago. They may need a little more stimulation and that is where walking with them, while gently patting his or her back is very helpful. If that has not worked after 10 to 15 minutes, then you need to try something else. Sometimes an infant just needs to be in a quiet room and allowed to try to go to sleep—but that may take 10 minutes of undis-turbed fussing. Ten minutes at this point will seem more like two hours, so check your clock as you start.Finally, some babies do have more signifi cant medical issues going on. If your baby is crying around the clock, is crying more than three hours per day, has signifi cant spitting up or any sort of stomach distension, is breathing in a “funny” manner, looks pale or seems cool to your touch, please contact your own clinician.

Q3: It can get really cold in January and February in Minnesota. What do I need to do to protect my kids?

There are two main injuries related to the cold. The more common and usually less serious one is frostbite. This is where some portion of the body becomes so cold that the tissue will actually freeze. Most often this tissue will eventually recover, but it will be a very painful experience for your child as the tissue rewarms—much like how a burn will hurt. If it is severe enough, blisters can form on the frozen tissue. Fingers, toes, ears, and exposed skin on the face tend to be affected most from frostbite episodes. Prevention is the best treatment, so children should wear hats, good gloves/mittens, and dry boots. Staying indoors when the windchill factor is below zero is also important. –If your child does develop frostbite, gently warming the area with warm water, not rubbing the affected area, and protecting from further frostbite is important. It is likely that area will be much more sensitive to the cold for quite a while after recovery.Hypothermia is a more serious cold-related condition, and happens when the entire body becomes chilled and the person can no longer keep up with heat loss. The core body temperature begins to fall below 95 degrees—much lower than the normal 99 degrees—and the body’s normal metabolic functions begin to malfunction. Very cold temperature, damp clothing, or exposure to open water in subfreezing conditions are risk factors for hypothermia. It is critical that if you feel your child (or anyone) is experiencing this, you seek immediate medical attention.

This column is intended to provide general information only and not medical advice. Contact your health care provider with questions about your child. Dr. Peter Dehnel is a board-certified pediatrician and medical director with Blue Cross Blue Shield of Minnesota. Send questions to drdehnel@mnparent.com.