It’s 11 pm on a Thursday night, and I’ve been dispatched to a code 1 (bells and whistles) to a four-year-old with difficulty breathing. As soon as I walk through the front door, I can hear the tell-tale barking cough of a child with croup.
The poor little fella is sitting on his Mum’s lap, tired, lethargic, creating a whistling noise when he breathes in and out (stridor) and has a nasty barking cough – he sounds like he’s swallowed a seal. This is the fourth job of the night responding to a child with croup. It’s winter, it’s cold and the cold and flu season is running amuck with our little one’s airways.
I’ve been a paramedic and paediatric nurse for six years, and there is not a week that goes by in winter where I don’t respond to an emergency call out for a child with croup. Croup is so common and can range from mild to severe. It can be incredibly scary if you don’t know what is going on or how to help your little one. With that in mind, let us impart some tips and tricks to help you out on those winter nights!
The important facts about croup:
- Croup is a viral infection of the upper airways (the voice box and windpipe)
- This infection causes swelling, which makes the airways narrower and therefore making it harder to breathe
- Croup often begins as a typical cold and then develops into the harsh barking cough due to narrowed airways
- Croup is usually worse at night - when the air is cooler and will reach its peak on the second or third night of the illness
- Croup generally lasts 3 to 4 days
- Croup normally affects children up to the age of 5 years
What does croup look and sound like?
Your child may show one or all of the below symptoms:
- Harsh barking cough
- Hoarse voice
- Squeaky noise when breathing in (stridor)
- Signs that your child is having difficulty breathing (see below)
Signs that your child is having difficulty breathing:
- Your child has a stridor (noisy breathing) when at rest
- Your child appears to be struggling to breathe
- Your child becomes abnormally drowsy and lethargic
- Your child is abnormally agitated
- Your child seems very unwell and pale
- Your child’s lips are blue
- Your child’s breastbone or space in between the ribs suck in when they breathe
What should you do if your child has croup:
- Your child may be managed at home if they do have the harsh barking cough but do not have any difficulty breathing or stridor at rest.
- Keep your child calm; breathing becomes more difficult when they are distressed. Sit quietly, read a book, watch a movie, stay with them at night if they become unsettled without you
- If your child has a fever and is distressed or irritable due to the fever – treat with children’s paracetamol
When to seek help:
When to see your GP
- When it is the first time your child has developed croup. It is best to follow up with your GP in the next 24 hours.
- Your GP may sometimes prescribe a steroid liquid which helps to reduce the swelling in the airway and make breathing easier.
- This is a viral infection – antibiotics will not be prescribed as they do not work for viral infections.
When to go to the emergency department
- When your child’s breastbone or space in between the ribs suck in when they breathe
- When your child has difficulty breathing
- When your child has stridor at rest
- When you as a parent are worried for any reason about your child – you know your child best!
Call an ambulance straight away if:
- Your child looks very unwell and becomes pale, drowsy or lethargic
- Your child’s lips are blue
- Your child has had noisy breathing which suddenly goes quiet (their stridor decreases)
- When you as a parent are worried for any reason about your child – you know your child best!
When you go to the emergency department or call for an ambulance, your child may be treated with adrenaline via a nebuliser mask (this looks like an oxygen mask that vaporises the adrenaline) if the croup is severe. The adrenaline works to reduce the swelling in the airways. It’s a safe and very effective medication to treat severe croup and works absolute wonders.
Croup really does range from mild to severe, and it is entirely reasonable to be worrying like crazy about your little one if they develop croup.
I hope this gives you some confidence and direction for when to see your GP, when to go to the emergency department or when to call an ambulance if your little one develops croup.
Always remember you’re an amazing parent, you’ve totally got this and always go with your gut instinct.
References:
The Royal Children's Hospital Melbourne, Kids Health Info: Croup
