Croup can be a very scary time for parents not to mention the young child who can feel miserable & anxious.
Croup is caused by a virus that attacks a young child’s upper airways & vocal cords at a point where the airways are at their narrowest & susceptible to infection & swelling from inflammation. The most common age group for croup is between 18 months & 3 years. It becomes rarer after 3 years of age as a child’s airways becomes bigger & wider & not so vulnerable to infection, inflammation & swelling.
It is very rare for croup to start suddenly. In almost all cases there is a 3-4 day history of a child being unwell. The most common symptoms include a low grade fever & a classic history of a “barking” cough for a few days. This is often referred to as a “croupy” cough. That is why it is generally an easy diagnosis to make.
Unfortunately the severe symptoms of croup almost always occur at night. The typical symptoms are rapid, shallow breathing & stridor. Stridor is a high pitched sound that children with croup make when they breathe in. This can be distinguished from a wheeze which occurs almost always when children breathe out! If the symptoms are left untreated the stridor becomes softer. This is not good news as it means that the airway is becoming completely blocked. In this case the child becomes drowsy from lack of oxygen to the brain. This is a medical emergency. Fortunately most parents & doctors recognise the signs & symptoms long before it becomes so dangerous.
If a child presents to the emergency department we look to see if the stridor is at rest or when the child is running around. We are much more concerned about stridor at rest as it tells us the airways obstruction is more significant. Treatment consists of adrenaline in a nebulizer which off course all young children hate! We also prescribe oral steroids for a few days. In some cases the croup does not respond to a first dose of nebulized adrenaline & we have to use multiple courses of adrenaline. These children will always require admission & observation for minimum of 4-6 hours.
If you have any concerns that your child may have any of the symptoms of croup described above- don’t hesitate to take them to your nearest emergency department for review. We definitely want to treat croup early not late.