As the temperature outside drops, we often find the number of cases of little ones experiencing croup increases. Croup can come on quickly, and to the untrained parent, can be quite alarming because the cough is so distinctive and different to your usual run-of-the-mill cough from the common cold. To save you Googling your heart out at 3 in the morning when your little one wakes with croup, we've got all the answers you're looking for right here.
What is croup?
Croup is when the upper airway [the voice box, called the larynx and the windpipe, called the trachea] swell in response to bub catching a virus. As the swelling causes the airway to become narrower, it is often harder to breathe.
Is it contagious?
No. You can't catch croup, but you can catch the virus that caused the croup to occur, so while the croup isn't contagious, the virus that caused it may be. You can also develop croup multiple times a year in response to various different viruses.
Who can develop croup?
Anyone may develop croup, but it's most common between the ages of 6 months and 5 years, although I have personally witnessed older kids also develop croup up to the age of 12.
Signs + symptoms
The first thing to know about croup is that it ranges in severity, from mild to life-threatening. It often begins with your little one catching a virus and showing symptoms of being unwell with a viral infection, such as a runny nose, sneezing, fever or being irritable. Then, once you've put your bub to bed, they'll often wake with croup, as it almost always comes on during the night. Nights 2 + 3 of croup are usually the worst, with it often resolving within 3-4 days.
Overall symptoms of croup:
- Initial symptoms of a virus
- Harsh barking cough that's often described as sounding like a seal barking
- Hoarse voice
- Fast breathing Stridor [squeaky noise when breathing in and out]
-Difficulty breathing, such as recessions [sucking in around the ribs, base of the chest, base of the throat etc.]
Symptoms of mild croup:
- Harsh barking cough
- Hoarse voice
- Viral symptoms
- No difficulty or noisy breathing
Symptoms of moderate croup:
Mild croup symptoms, plus:
- Noisy breathing at rest
- Some signs of difficulty breathing, like breathing faster than normal or chest recessions
Symptoms of severe croup:
Mild and moderate croup symptoms from above, in addition to one or multiple of the symptoms below:
- Bub is looking very unwell
- Difficulty breathing
- Bub becomes pale, drowsy or lethargic
- Bub's lips appear blue Bub is drooling or can't swallow
- You are seriously concerned for any reason about your little one – you know your bub best!
When + where to get help
If bub has a case of mild croup, you can keep them at home. Continue to closely monitor them throughout the night, and check-in with your GP in the morning if it's bub's first case of croup or their croup is lasting more than four days.
If bub has a case of moderate croup, take them to the Emergency Department [ED]. In ED they may give bub a dose of steroids to help reduce the swelling and monitor them closely for improvement or deterioration.
If bub is showing signs of severe croup, or you are seriously concerned, call 000 for an ambulance and follow the call taker's instructions while waiting for the ambulance to arrive. In hospital, they may give bub nebulised adrenaline through a face mask +/- oxygen.
Treatment for croup
When it comes to croup, there are usually two treatments depending on the severity: steroids and nebulised adrenaline.
Steroids
This refers to an oral, liquid medication given to bub. It may be a drug called 'Prednisolone' or 'Dexamethasone', which both work to reduce inflammation in the body [i.e. reduce the swelling in the upper airway]. If bub is given Prednisolone, they may require another dose the next day. They'll usually begin to work within 2 hours of being given.
Nebulised Adrenaline
-Nebulised adrenaline is for little ones with severe or life-threatening croup, with improvement often seen within 10-30 minutes. It's given in a mask, and all bub has to do is continue breathing as best they can. Following the adrenaline, oxygen may also be given via mask if the croup is severe enough.
Why not antibiotics?
A common misconception is that antibiotics will treat or improve croup; however, this is not the case. That's because croup is caused by swelling, and croup itself is triggered by a virus, both of which antibiotics make no difference in treating.
Care at home
If your little one has mild croup, it's reasonable for you to care for them at home. Here's what you can do to keep your little one comfortable:
- Keep your little one as calm as possible; the more worked up they get, the worse the croup often gets.
- Treat the fever from the virus with paracetamol + ibuprofen if they are miserable.
- Snuggles + distraction with activities that will keep them calm like watching TV, playing on the iPad, reading books, playing with toys + colouring-in or drawing pictures.
- Monitor your little one closely for signs of respiratory distress or worsening croup and escalate as needed.
How can I prevent croup?
Unfortunately, there's no way to prevent croup. But you can try to prevent catching and spreading viruses that cause croup by things such as regular hand washing, not sharing food or drinks, staying home when unwell and avoiding those who are unwell.
Is steam or humidified air still recommended to treat croup?
No. Steam and humidified air haven't been proven to change the severity of croup, and there's no research that suggests they are beneficial. Plus, there is a risk of burns if you're placing bub near a source of very hot water, which creates steam.
What about cold air?
Sources report mixed things on this, with some saying yes, it can improve the stridor, others reporting it makes no difference, and some saying the cold air can worsen already irritated airways. In my personal experience, my little one had croup on two occasions during winter in Canberra, and he did improve both times during the walk from the car park into the ED. So while it did work in my experience, I can't confidently recommend this as a treatment option without research-based evidence.
Important things to know:
- You should always assess your little ones when they're at rest. This means not when they're up or running about. You want them lying down calmly to get a true picture of how they're breathing.
- Upsetting bub can make the croup worse, so it's important to keep your little one as calm as possible.
- Bub may be required to stay four hours at minimum post adrenaline nebuliser or 30 minutes post oral steroids as long as their stridor has settled for observation.
- Paracetamol + ibuprofen makes no difference to croup but may help reduce discomfort from the virus.
- If bub is under 6m and has croup or the stridor returns after already being treated, they need medical attention.
- Croup is more common in winter.
- 1 in every 50-100 kids will develop croup before their first birthday.
- Sitting bub upright may help them to breathe easier.
- Croup symptoms may disappear during the day and return at night.
As a parent, I know how stressful croup can be. I hope this blog helps, and if you've got any questions, leave them in the comments section on our original post on Instagram or Facebook.
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