Background
Childhood croup is very common, especially for children younger than 5 years of age.
Classical presentation is a barking cough which is more common at night.
The cause is typically a viral infection.
Usually it can be endured at home with fluids and bed rest.
But, sometimes the peak of the infection can be scary for parents
and the airway may become so swollen that the child can not eat or drink
and can not get enough oxygen.
Acute treatment may include epinephrine and steroids to bring down the swelling
and inflammation. [1]
Croup is most commonly caused by viral infection.
For recurrent croup, it is important to rule out mechanical problems,
reflux and allergies which can also cause croup-like symptoms.
If the croup-like symptoms are not caused by mechanical problems,
reflux or allergies then they are almost certainly caused by viral infection.
Unfortunately, incurious conventional doctors are at a complete loss for anything
to do to help children who experience difficult episodes, up until the cough
becomes severe enough to merit emergency intervention.
At the point where emergency intervention is warranted,
steroids and epinephrine can be effective to reduce swelling in the airway
enough for the child to be able to get oxygen and fluids.
As a last resort, intubation can save the child's life.
Failure of conventional medicine for childhood viral croup
Parents may consider that if they could only lower the severity slightly,
then emergency intervention would not be necessary and they would be able
to weather the condition at home.
The condition usually resolves quickly and completely after the acute syndrome passes.
But, cookbook doctors will provide no hints or clues as to how antiviral and antiinflammatory early treatment could help to ameliorate the acute condition.
For preventing recurrent viral croup, the cookbook doctors have an extremely limited playbook that includes nothing useful for most children:
- We could try famotidine for reflux [2] even though we know it won't work and that the child's condition is not related to reflux
- We could do an invasive examination of the airway to see how small it is - almost
certainly to no worthwhile ends for most children who suffer from recurrent croup
Many cookbook doctors won't even consider allergies as a possible common trigger or contributing factor for croup so you will probably need to insist on allergy panel if you have a hunch that your child's croup may be caused or exacerbated by allergens.
For most conventional cookbook doctors, that's it. Once reflux, mechanical abnormalities and allergies are ruled out, there is nothing you can do for common viral croup. Go to the emergency room if your child turns blue. Good luck. Some doctors might erroneously advise an asthma inhaler. But, croup is in the larynx and the upper airway and is not related to asthma. Treatments for asthma will not help for classic viral croup.
Cookbook doctors don't look in the literature, they don't think creatively and they don't think in terms of practical things that families can do on their own. They follow the intellectual property cookbook -
better to stick with what the government and pharmaceutical industry
recommends and let children go to the ER.
We wouldn't want to incur liability by delving into the complicated world of diet and lifestyle! Most cookbook doctors won't even mention fluids and bedrest!
So, the cookbook doctors can not help us prevent or treat common recurrent childhood croup of viral etiology. But, can the scientific literature?
At Home Treatment Plan
Often the syndrome that evolves into acute barking cough can be seen early as a normal cold with a stuffy nose and low fever many hours before. There are substances that might help prevent and treat viral croup at this early stage so that the peak is not so scary or life-threatening.
Some of these substances are stimulating and some are sedative; so, the morning regimen will be different than the night.
** - be very conservative with dosing if using at all with children
Summary
Be gentle and conservative with dosing for any intervention involving children.
Don't feel the need to force these interventions on your child
even though the evidence that they can be helpful may be extremely compelling.
Some children love garlic; some will not tolerate it.
Some children may enjoy clearing their sinuses with
nasal irrigation; for others it may cause a ton of
sneezing and distress.
Adapt your program to your child's preferences
and what they can tolerate.
Consider mouthwashes, gargles and nasal irrigation.
The evidence that these interventions work is actually overwhelming (see below).
Even simple water gargle is successful in clinical trials.
There are many variations to these types of treatments.
A croupy child may not tolerate some of these interventions.
So, you may have to
experiment to find a variation that works for your child.
Though the evidence for these types of treatments is very strong,
do not overdo and do not force them to the point of upsetting your child!
Start the day off with a large glass of pure water.
Staying hydrated is generally very important for
the immune system and good baseline health.
Add green tea with citrus (lemons are good, other types of citrus can also help).
Soak the lemon, including the peel, in the hot water.
Depending on your experience and the child's preference,
the green tea + citrus decoction could be used as a gargle or a beverage,
or both. Do not consume caffeine in the afteroon, within 10 hours of bedtime.
0.5% Iodine solution as a mouthwash, gargle and nasal irrigation can be used
(especially in the morning since it can be stimulating)
to prevent and treat URTIs such
as viral croup. Use a formulation specifically meant to be
used as a mouthwash or you may dilute 10% povidone iodine
20 to 1 (example 1 tsp 10% povidone iodine to 20 tsp pure water).
If you use this technique, use with caution!
You don't want to do too much too often. Chronic use
could disrupt normal thyroid function.
Povidone Iodine Mouthwash, Gargle, and Nasal Spray to Reduce Nasopharyngeal Viral Load in Patients With COVID-19
Consume nutritious foods including allium vegetables (onions and garlic)
and mineral-rich foods. Consider liver.
Consume tea of ginger, turmeric to taste.
These measures are safe to do as prophylaxis, in early stages,
and in the acute phase of illness.
Add medicinal mushrooms to the diet - preferably as food that
the child enjoys rather than supplements.
In general, avoid concentrates for children.
Consider a mild, whole-food vitamin so that your child
has near-optimal intake of all essential nutrients.
Consider high-quality omega-3 fatty acid supplementation.
Upon the first sign of respiratory infection,
use zinc lozenges.
To help the child sleep and fight infection,
consider occasional melatonin supplementation,
particularly as an infection becomes evident in the early stages.
Chronic consumption of melatonin is not advised.
As with everything, use the minimum dose necessary
and do not overdo it!
Green tea
Warm water gargle with salt and green tea has a long tradition of
of apparently successful use in children and has been shown to be worthwhile
in a modern human trial.
#
Given the robust
pre-clinical experimental confirmation of antiviral activity
#,
it's not surprising that green tea is effective against viruses
in convincing clinical trials with adults.
#
An observational study of 2663 children in Japan (age 6-13) found that
children who consumed green tea were significantly less likely to
get influenza.
#
Another study found that green tea consumption
was associated with lower rates of influenza in adults.
#
A review of the available literature found:
Our analysis suggests that green tea consumption is effective in the prophylaxis of influenza infections - #
Other plant materials
Green tea to prevent and treat viral infection in children has a robust rationale.
Other plant materials are supported by similar experiments and peer-reviewed science.
Other plant-derived substances may be beneficial in preventing and treating croup.
From a quick review of the literature, the above list seems to be most promising and very low risk.
Revealing the Potency of Citrus and Galangal Constituents to Halt SARS-CoV-2 Infection
Medicinal Mushrooms
Medicinal mushrooms are widely studied for their antiviral, anti-inflammatory and
immune-modulating potential. However, there are a multitude of different species
with different active ingredients and clinical data are sparse or non-existent
for most varieties. A further complication is that different substances are
thought to have different, even opposite effects at different dosages.
A substance that increases some cytokine at low doses may increase the
same cytokine at high doses. This makes medicinal mushrooms an incredibly
interesting and promising source of medicinal compounds but also makes
it almost impossible to produce a confident recommendation about how they
may be used in current practice.
As a rule of thumb, one might try moderate, low dosages of mushrooms which
have a long record of safe consumption and traditional use. These genera may include:
- Ganoderma
- Cordyceps
- Lentinus
- Grifola
- Flammulina
- Fomes
- Pleurotus
- Hericium
Mushrooms in general are thought to be healthful foods and,
in addition to many novel potential antivirals and anti-inflammatory substances,
are very nutritious in Zinc, Magnesium, Selenium and other
essential nutrients that are thought to play important roles in immunity.
There are many reviews of the literature that can provide hours of
reading.
Here is one such recent publication.
Zinc and other essential dietary constituents
In a Cochrane review of the literature, the authors
looked at 15 clinical trials and concluded:
Zinc administered within 24 hours of onset of symptoms reduces the duration and severity of the common cold in healthy people. When supplemented for at least five months, it reduces cold incidence, school absenteeism and prescription of antibiotics in children. There is potential for zinc lozenges to produce side effects. In view of this and the differences in study populations, dosages, formulations and duration of treatment, it is difficult to make firm recommendations about the dose, formulation and duration that should be used. - Zinc for the common cold
There is no firm consensus that zinc is useful for recurrent viral croup.
One rational approach would be to give zinc lozenges at the first sign of
respiratory infection. But, as with all interventions for children,
don't overdo it! Too much zinc is not good for children.
Other essential dietary constituents that may have beneficial effects
include vitamins C, D, E, selenium and omega3 fatty acids.
Key dietary components such as vitamins C, D, E, zinc, selenium and the omega 3 fatty acids have well-established immunomodulatory effects, with benefits in infectious disease. Immune-boosting role of vitamins D, C, E, zinc, selenium and omega-3 fatty acids: Could they help against COVID-19?
These results suggest that vitamin D3 is a promising intervention for the prevention of URTI. Vitamin D3 significantly reduced the risk of laboratory confirmed URTI and may reduce the risk of clinical infections. #
Dietary Iodine
Dietary iodine is essential for good health. But, the optimal amount of iodine
is a very small amount. Consider getting foods rich in iodine such as seaweed.
A small amount may be supplemented, especially in the absence of iodized salt.
However, it's important not to supplement too much.
There is no overwhelming evidence that dietary iodine supplementation can
ameliorate recurrent viral croup in young children, although theoretically tantalizing.
Gargles, mouthwash, nasal spray and irrigation
Regardless of what the pharmaceutical industrial media tell us
in erroneous, dumbed-down, lying "fact checks",
there are a lot of things that parents can do to treat upper-respiratory
infection in children that are supported by the scientific literature.
These simple interventions will not result in windfall profits;
so, they are not studied as intensely as the data suggest that they should be.
Still, some clinical trials on various solutions have somehow found their
way to publication without financial incentives.
Saline nasal spray and irrigation
A small trial found that saline gargle and nasal irrigation reduced the
duration of the common cold and also reduced household transmission.
A pilot, open labelled, randomised controlled trial of hypertonic saline nasal irrigation and gargling for the common cold
A Cochran review found hint of benefit for saline nasal irrigation
but the included studies were too small to authoritatively confirm benefit.
Saline nasal irrigation for acute upper respiratory tract infections.
A more recent review of four clinical trials found nasal irrigation to be safe and to
have modest benefit for rhinosinusitis in children. Saline nasal irrigation for acute upper respiratory tract infections in infants and children: A systematic review and meta-analysis
Warm water salt gargle and nasal irrigation have a long tradition
of use and can be considered safe and moderately effective
intervention for upper-respiratory tract infections such as the ones
that cause croup.
Similarly, nasal saline spray may be considered moderately effective
to reduce the nasal symptoms of the common cold.
A Daily Nasal Spray with Saline Prevents Symptoms of Rhinitis
Saline nasal irrigation and gargling significantly reduced
the duration, severity, chest congestion, hoarseness, scratchy throat,
runny nose, sneezing and subjective experience of illness in an
adult SARS-COV2 trial.
Hypertonic saline nasal irrigation and gargling should be considered as a treatment option for COVID-19
Gargling
Gargling water, saline solution and medicated solutions has a very long
history.
In Japan, gargling is a generally accepted way of preventing upper respiratory tract infection (URTI). #
Surprisingly, US cookbook doctors are never interested in these
interventions although they have been proven by modern science.
Even water alone can be helpful. But, perhaps adding some combination
of salt, green tea or iodine can make this simple intervention even more powerful.
Simple water gargling was effective to prevent URTIs among healthy people. This virtually cost-free modality would appreciably benefit the general population.
Prevention of Upper Respiratory Tract Infections by Gargling: A Randomized Trial
Our findings suggest that tea gargling and tea catechin consumption may have preventive effects against influenza infection and URTI
Povidone Iodine Gargle, Nasal Irrigation
You can find some moronic fact-checks sponsored by
the pharma-industrial complex warning that iodine
can not help for SARS or other respiratory infections.
But, scratch the surface a little and you might find:
The Japanese Clinical Respiratory Guidelines recommend gargling with
[Povidone Iodine] as an effective antiseptic against pandemic influenza and prevention of hospital‐acquired pneumonia.
Povidone‐iodine gargle as a prophylactic intervention to interrupt the transmission of SARS‐CoV‐2
Iodine, a preventive and curative agent in the COVID-19 pandemic?
Maybe the powers that be assume that lay people are too
stupid to gargle with povidone iodine solution.
Using too much could be harmful, after all.
You also don't want to swallow it.
Swallowing a large amount of concentrated iodine
could be catastrophic for your health.
In most clinical trials (there are quite a lot actually),
the concentration used seems to be between 0.5% and 1.0%
povidone iodine.
The problem of concentration could be solved by using products
specifically designed to be used as mouthwash and gargle. Common commercial products use 0.5% povidone iodine
and you can likely buy them at your local pharmacy
betadine sore throat gargle.
Melatonin
Melatonin has been shown to have dramatic and profound
antiviral effects in several clinical trials. Perhaps I'll do another page reviewing its potential and proven efficacy.
For now, as this article is running longer than I initially
intended, I invite you to
do your own research
As far as recommendations - don't use too much and don't use
it too often for children in particular. BUT, feel free
to use 0.25-5mg at night at the first sign of illness.
A very strong night's sleep the first night of a viral illness
could be the difference between barely noticing the infection
and having an emergency episode with in the next 72 hours.
Try it and see how it works for you and your child. Sublingual
administration is far superior to pills that you swallow.
0.5-1 mg should have a profound effect on most children and
give them a solid night's sleep. Melatonin has profound
antiviral and anti-inflammatory actions and should help
your child's nighttime barking cough.
Morning
- Green tea **
- Gargle (green tea or salt or povidone iodine 0.5%)
Night
- Melatonin **
Neutral, all day
- Citrus
- Onion, Garlic
- Turmeric, Ginger
- Zinc
In addition to dietary interventions, oral and nasal lavage can be helpful to prevent and treat upper respiratory viral infections. If you do it at all, don't overdo it! Your child's nasal passages are gentle and sensitive. A little irrigation goes a long way. Follow trusted directions and don't do it too often or use too much iodine or silver.
Topical, ear nose and throat
- Silver **
- Iodine **
- Warm salt water
Conclusion
You can prevent and treat your child's recurrent viral croup
so that it doesn't result in an ER visit.
Consult a doctor and make sure that
nothing mechanical is wrong with your child's
throat and that they are not suffering from allergies or
reflux. Once you know that you are dealing with classic
viral croup, try some of the remedies in this article,
proceeding carefully with minimal dosages.
Let me know if you try any of the above and how
it works for you and your child. My expectation is that most
people reading this article will never again have
a dramatic episode of viral croup in their families.