Croup
The illness
A hacking “croupy” cough, like a barking seal, that usually gets worse at night is the most typical feature. Often the first sign of croup is the distinctive cough that wakes the child up in the early hours. There maybe a hoarse voice, sore throat and fever and it can be severe enough to cause gagging and vomiting. Sometimes a harsh crowing sound (“stridor”) is heard with each inward breath. (This is often mistaken for a wheeze). The worst of the illness lasts for 2 or 3 days; however, a wet mucous cough may linger for another 1 or 2 weeks.
When to call your doctor
You should seek help if you are concerned about your child’s breathing. Croup is often worse at night time and the child will wake coughing and quite distressed and may have a stridor. Often this settles over a 15 minute period, but sometimes the breathing will worsen and if there is sucking in of the chest wall with each breath and your child having breathing difficulty you will need to call an ambulance. You will also need to seek help in the following circumstances.
- difficulty breathing
- continuous stridor
- drowsiness
- very sick appearance
Treatment
Croup can be very scary to children and parents. Often the most important treatment you can provide is to hold your child in your arms for comfort and reassurance. Steroids given orally lessen the stridor and lessen hospitalisation. In Australia the medication is called redipred and it’s dosage is about 1mg per kg given daily for three days. Note that the onset of action is 1-3 hours.
Using mist from a shower or vaporiser was a traditional treatment but there is no studies that have shown any benefit. Hospitals have abandoned this treatment.
Panadol or nurofen may help with throat pain and discomfort and also will calm some children. However if your child is not good at taking medicines do not force these as the best treatment is to keep him/her calm. Because croup is almost always caused by a virus, antibiotics are of no help. Forcing fluids is unnecessary.
How Contagious?
Children with croup are most contagious during the first days of fever and illness. Little can be done to prevent spread of infection in a household; it is likely that other youngsters in the family will also develop a sore throat or a cough.
Return to group actitivites
Infants and children may return to school or day care when their temperature is normal and they feel better. A lingering cough is no reason to keep them at home.
What complications can occur ?
Being a viral upper respiratory tract infection the child will often have a runny nose, and during the day a ‘more typical’ cough and cold. This may cause middle ear infection. Those children that are prone to either asthma or wheezy respiratory illnesses may start wheezing around day two to three of the illness, so make sure asthma plan is followed.
Common concerns
Coughing is the way the body eliminates infected mucus from the airways. Overly vigorous use of decongestants or cough suppressants can interfere with this defence by making secretions thicker and more difficult to bring up.Rarely, sudden onset of stridor or barking cough is due to a foreign body stuck in, or just below, the vocal cords. If you believe your child may have been playing with a small object (e.g. soda can tab, metal foil, safety pin) right before the illness began, let your doctor know.
