GENERAL INFORMATION
Croup is an inflammation and swelling of the larynx (vocal cords) and of the surrounding tissues. The infection is usually caused by viruses. Sometimes, bacterial infections follow a "common cold" or other seemingly minor upper respiratory infection. The cough that is present with both types of infection is a "croupy" cough. Anyone who has heard a child with this type of cough knows its characteristic and frightening sound. When croup is severe, the patient must be treated in the hospital. Continued treatment after hospitalisation, or home treatment of less severely ill patients, is outlined below.
The major symptoms of croup are laboured breathing, sucking in of the chest, hoarseness, a hacking kind of cough, and an unmistakable bark-like noise with each intake of breath. Croup often comes on at night. If the breathing is very laboured, both you and your child may be frightened. Don't panic! You will be able to help your child more if you stay relaxed. There are some definite steps you can take to ease matters.
Simple croup, although frightening, is usually not too serious. In this type the child, usually under six years of age, appears perfectly well at bedtime but awakens later at night with a barking cough and noisy, difficult breathing. Certain children are prone to croup. It does run in families.
Any croup associated with high fever is usually more serious. Croup associated with difficulty in breathing during the daytime is also more serious. If there is breathing difficulty and the child cannot swallow his own saliva or water, this is extremely serious. Take him to the hospital immediately.
General Measures. First, take the child immediately into the bathroom. Close the door. Turn on the hot water of the sink, tub, or shower to steam up the room. The shower is best. If hot water is not available, open up the windows to let in the cold air. These measures will almost always relieve the breathing in several minutes.
If someone else is available, have that person call us while you are taking the measures just described. In any event, don't leave the child alone.
If after 10 minutes of steam or cold air your child's breathing has not improved, make arrangements to take the child promptly to the nearest emergency room. Stay in the steamed-up bathroom until you are ready to move. Don't be afraid to take the child out into the cold night air. Not only is this air not harmful, but it may actually ease breathing difficulties. Don't wait for the doctor's return call if your call is not answered promptly. Alert the hospital that you are coming, but move right along.
If the child's breathing does improve, you can remove him from the bathroom and take him with you while you call the doctor or wait for a return call. Use something to moisten the air, preferably a cold steam vaporizer. The child may be more comfortable in a semi-sitting position. If this is the case, prop him up from behind with pillows. Try to distract him so that he can relax. Television, radio, or a good story will help. Above all, stay calm yourself. Your child will quickly sense anxiety and is then likely to become more tense himself. If at any time his breathing worsens so that he becomes short of breath and frightened, take him back into the steam-filled bathroom.
Most children with croup do very well and can stay at home. If difficulty with breathing persists, it is sometimes necessary to have the child enter the hospital for more extensive treatment. Contact us if the croup returns, even if the croup seems relatively mild.
If you do not own a vaporizer, buy or borrow one that manufactures "cold steam". Use it every night for a while. If a vaporizer is not available, place warm compresses on the child's chest and put wet towels on a radiator.
Simple croup often recurs the next 2-3 nights, so even if everything seems all right, run the vaporizer for several nights after your child has stopped having attacks.
Diet. Your child is likely to have a diminished appetite while the croup lasts. Offer small quantities of fluids frequently. Any fluid, except milk, is all right. We prefer water, ginger-ale, tea, fruit juice, or cola drinks. The cough may lead to vomiting, so it is best not to feed solids.
Medications. Medicines must be fitted to your child's own particular needs. Do not give any medicine (not even medicine you buy without prescription) without telling your doctor. If drugs are prescribed, carefully follow the instructions on the label.
Since croup is usually caused by viruses, antibiotics don't help. If bacterial infection is present, antibiotics may help. Sometimes, the doctor may put the child on antibiotics for reasons other than the croup. Another medication that is often used are steroids (such as prednisolone, dexamethasone). Theoretically, these steroids may reduce and ease the swelling but they are usually reserved for more severe cases of croup.
Activities of Daily Living. When croup is occurring in your child, have him decrease activity and come into the house before dark. Obviously, it is important to limit activity since the faster breathing with increased activity only serves to dry out the trachea (windpipe) and possibly aggravate the swelling.
SPECIAL NOTES
If croup is a recurring problem in your family, try to add moisture in the heating or ventilating system of your home. In the very mildest attacks of croup, the laboured breathing and barking noise may be apparent only when the child coughs or cries. The treatment is similar to that of colds. Discuss even these mild cases with us within 12 hours.
Save your energy to care for your child instead of being anxious. If two adults are at home conserve your collective energy by "tag teaming" in observing/caring for your child through the night. A little rest is better than none at all! With time, the appropriate humidification and medication (if prescribed), you and your child should weather this common illness of childhood.