Croup

There will be many parents familiar with the seal-like bark of croup and its alarming tendency to hit children in the early hours of the morning. While unpleasant for both child and parent, it usually isn’t serious, lasts only for a few days and is in most cases treatable at home. It is most common in young children, particularly those between the ages of 6 months to three years – with their naturally smaller airways, this age group is more susceptible to symptoms.

Croup is a viral upper respiratory infection that causes inflammation and swelling of the voicebox and airways. With narrowed airways breathing becomes more difficult and children can sound like they have a raspy voice. Sometimes when the child breathes in there will be a high-pitched whistling noise, called stridor. Croup often begins with cold-like symptoms such as a runny nose, sore throat, fever and irritability with the hoarse voice and harsh barking cough developing later. The cough and noisy, laboured breathing can often be worse at night. Crying and coughing aggravate the symptoms, as does anxiety, so sometimes the child can end up in a cycle of worsening symptoms.

The virus that causes croup is easily picked up from contaminated surfaces or breathing in infected droplets from a cough or sneeze. The best prevention measures are all the things we have learnt from our Covid experience – frequently wash or sanitise hands, keep your child away from sick people (and vice versa), and encourage your child to cough or sneeze into their elbow to avoid spreading germs.

Because croup is caused by a virus, antibiotics wont work. The best home treatment for croup is similar to that for colds – lots of rest, fluids and keeping your child comfortable. During a bout of coughing keep the child upright and try to keep them as calm as possible because getting upset and agitated can worsen any airway obstruction. Soothe them with cuddles, stories, music, whatever works. It may pay to sleep in the same room as them for a few nights so you can keep a close eye out for any worsening of symptoms. The cough may seem to be ok during the day but will often worsen at night in the early hours of the morning as this is the time when the body’s own natural steroids are at their lowest. Taking your child outside into the cold air (wrapped up warm!) can help to ease a bout of coughing. Steam therapy such as using a room vapourisor or taking the child into the bathroom and turning the shower on to create warm, moist air is no longer recommended.

Only a small number of children will need hospitalisation but it is not uncommon for a doctor to prescribe a short course of steroid treatment to reduce the inflammation in the airways. Steroids will show their benefits within a few hours and can dramatically improve the night time cough. Some children will need to be admitted to hospital for observation or further treatment with inhaled adrenaline. Adrenaline is given via a face mask and helps to relieve coughing spasms and airway swelling until the steroids take effect.

While usually the worst part of croup is the accompanying lack of sleep for both parents and child there are some danger signs that people need to be aware of so they can seek medical help. You need to get your child to a doctor immediately if your child:

  • is struggling to breathe
  • has a breathing rate faster than normal
  • has the noisy, high-pitched sound on both inspiration and expiration
  • finds swallowing difficult
  • is fatigued or listless
  • has blue or grey skin around the nose, mouth or fingernails.

This blog provides general information and discussion about medicine, health and related subjects. The information contained in the blog and in any linked mate­ri­als, are not intended nor implied to be a substitute for professional medical advice.

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