Martin D Rudloff, MD.

Respiratory Problems

Shortness of Breath at Night (Spasmodic Croup)

Occasionally a child will be put to bed well or mildly ill and awaken at night very scared and short of breath.  He/She may  have difficulty breathing and  make a sound when he breathes in that many parents call "wheezing" but is actually something called stridor.  Sometimes there will be a barky cough.  This is called spasmodic croup.  Often a family dashes to the emergency room only to arrive with a well appearing child  who no longer has symptoms.  Treatment consists of the following:

• Calm the child as much as possible
• Offer sips of a clear cool liquid
• If the symptoms persists have the child sit in the cool night air for a few minutes 
• A bathroom full of water vapor from a steam shower or warm tub is another way to try to break the spasm
• Call 911 or go to the ER if the shortness of breath is accompanied by high fever or seems progressively worse.

Croup 

Typical viral croup comes on more slowly than above with runny nose, hoarseness, a cough that initially sounds productive and then becomes more brassy developing into a seal or dog like bark.  Treatment consists of

• Tylenol or Advil for  discomfort or fever
• Encourage liquids, do not worry about solids
• Increase humidity using a vaporizer or humidifier.
• Frequent baths or showers  especially before bedtime will offer some relief
• For more some cases physicians sometimes prescribe oral steroids
• Severe cases may require hospitalization and oxygen
• Go to the emergency room if your child is listless, a bluish tint to his lips, or has great difficulty breathing using  extra muscles just to breathe.

Wheezing (See Also Croup and Bronchiolitis)

Many people mistake the stridor of croup for wheezing.  Stridor is a noise that is more predominant when breathing in.  Wheezing is a higher pitches musical noise  that is more predominant on exhalation.  Generally  children who wheeze have a frequent chesty chough and the chest may seem to rattle.  Follow the treatment suggestions for croup.  If you have albuterol available this can also be used. (See Medication doses).   Seek emergency care if:

• a child under one year is breathing faster than 60 times a minute
• a toddler is breathing over 50 times a minute
• your child is grunting with respirations
• your child is listless and uncomfortable with the wheezing
• your child choked on something and wheezing began immediately after choking

Pneumonia

Think about pneumonia in the following circumstances

• a young child with wheezing who also has high fever--particularly if this occurs several days into the illness
• grunting respirations and high fever
•  high fever and chest pain or pain in the back in an older child

Sore Throats

Children may complain of pain or a raw feeling.  Children less than 2 years of age usually don't know how to complain about a sore throat and may refuse to eat or drink.

Most sore throats are caused by viruses that will resolve in a few days. The is particularly true in the summer.

  How do I tell whether it is strep?  (See  Strep). 

Treatment of sore throats:

• Give Tylenol or Advil for pain
• A young child's sore throat can be helped with warm broth or apple juice
• Children over age 4 can  use throat lozenges or sprays.
• A child who is old enough may gargle with salt water or swish chilled benadryl or antacids around and then spit it out.