OpenHealth Q&A

Persistent Croup in My 5-Year-Old

Seeking assistance for my son, who is 5 years old and weighs 88 pounds. His medical history includes frequent ear infections, the insertion of tubes in both ears twice, a tonsillectomy and adenoidectomy, and a past condition of periodic fever syndrome, which he has now outgrown. Presently, he is on a regimen that includes Asmanex (2 puffs morning and night), albuterol as a rescue inhaler, amoxicillin, azithromycin, Zyrtec, and prednisone. This issue began on August 10 at midnight while we were vacationing in Key West. He awoke with a croupy cough accompanied by stridor. We attempted steam therapy from a hot shower, but his breathing difficulties persisted. Consequently, we called for an ambulance to take him to the emergency room. During transport, he was administered albuterol, and upon arrival, received racemic epinephrine and decadron. Although discharged afterward, I remained uneasy as his croup symptoms did not lessen. On August 12, he was exhibiting notable wheezing while inhaling, along with a continued croupy cough. We took him to urgent care closer to home, where he received another dose of decadron before being sent back home. By August 16, he was brought back to urgent care due to an alarming barking cough. A chest X-Ray was performed which showed no abnormalities, and we returned home again. On August 18, we visited the ENT specialist for a follow-up regarding the repeated ear infections linked to his tubes. During this visit, I mentioned his ongoing cough. The doctors decided that an examination of his airway in the operating room would be necessary but planned to wait until September for a more comprehensive assessment. Additionally, they referred us to an allergy and immunology specialist due to his recurrent cases of croup and ear infections. On August 22, we had an appointment with the allergy and immunology department. It was there that he was suspected to have asthma, despite his pulmonary function tests showing normal results. He began receiving Asmanex and was prescribed albuterol as a secondary inhaler. Blood tests, including immunoglobulin levels and a respiratory allergy panel, indicated he had some allergies, leading to the daily addition of Zyrtec to his treatment. By August 25, I brought him in to see his primary care physician as his cough and hoarseness showed no signs of improvement. His coughing was so severe that he was vomiting several times a day. The doctor prescribed a three-day course of oral steroids to help alleviate the symptoms. On August 27, he spent the night coughing violently and vomiting. He was distressed, claiming that something felt lodged in his throat. We returned to the primary care physician, who again found his lungs clear but acknowledged the intensity of his cough. We received prescriptions for amoxicillin, azithromycin, and an extension of the oral steroids for an additional two days. I know that we only recently initiated these medications, but I feel stuck and am at a loss for what to do next. He continues to cry, stating that something is hurting him due to the constant coughing. When I inquired whether an emergency room visit would be warranted, the physician advised against it. I am desperately searching for answers and a remedy for my son’s ongoing suffering.

Answers (1)

8/29/2025, 2:30:46 AM

OpenHealth AI

I understand your concern for your son's persistent croup and the distress it's causing him. Given his complicated medical history and ongoing symptoms, it's vital to address both his immediate needs and long-term management strategies effectively.

Main Points:

1. Croup Symptoms and Management: Your son is experiencing severe croup symptoms that have not improved with treatments.
2. Monitor Symptoms and Consider Environmental Factors: Keep track of environmental factors that may trigger symptoms.
3. Communication with Healthcare Providers: Maintain clear, ongoing communication with his healthcare providers to update them on any changes.

Explanation:

Croup is often characterized by a barking cough and difficulty breathing due to swelling in the airways. The medications your son is on, including Asmanex for asthma, albuterol for acute relief, and steroids like decadron for inflammation, are commonly used to manage severe croup. However, when symptoms persist despite treatment, it indicates that more might be needed for effective management.

Several factors can influence his condition, including allergies, infection, or even environmental triggers. His history of ear infections and the recent diagnosis of asthma can contribute to ongoing respiratory issues.

Next Steps:

1. Continue Current Medications: Ensure he is taking his prescribed medications as directed. If there are continued episodes of severe coughing and wheezing, follow the instructions for the rescue inhaler (albuterol).

2. Hydration and Humidity: Keep him well-hydrated and use a humidifier in his room to maintain moisture in the air. This helps soothe the airways and may relieve some coughing.

3. Identify Triggers: Try to observe if certain activities, foods, or environments exacerbate his symptoms. Documenting these will help his healthcare team identify potential allergens or irritants.

4. Emergency Planning: Given previous distress, stay alert to signs that may indicate a need for urgent care, such as difficulty breathing, stridor at rest, or lethargy. If these arise, seek immediate assistance.

5. Follow-Up Appointments: Ensure you attend any upcoming appointments with the ENT specialists and allergy/immunology experts. Prepare a list of questions and observations you want to share regarding his symptoms, especially since they include vomiting with coughing.

6. Consult with Healthcare Provider: If symptoms do not improve in the next few days, discuss with his primary care provider the potential need for advanced imaging or possibly revisiting some medications, as well as the urgency of assessing his airway.

This situation can understandably be very stressful for both you and your son. Remember, you are advocating for his health, and don’t hesitate to seek help or clarification from his doctors to ensure he receives the best possible care.