Croup

Recently, lots of children that we know have been diagnosed with croup. They are all toddlers which is not surprising since croup is most common between children aged six months to three years old. One of my friends said that her two year old son said, "Mummy, I can't breathe," and it absolutely petrified her.

Croup is a relatively common respiratory infection which usually starts with a cold. It is usually caused by infection from a virus, but can also be due to a bacteria. Like colds, it is spread in droplets via sneezing or coughing or touching a surface which has been contaminated with the virus.

Croup is basically an inflammation of the airways which makes it difficult to breathe. The reason it affects children is that they have narrower airways than adults, so any further restrictions on these airways can be quite serious. It is more likely to occur when it is cold, particularly during the night. The symptoms are a barking cough, a hoarse voice, a noisy high-pitched sound when breathing (this is called stridor) and can progress to difficulty breathing.

In severe cases, croup can cause your child to stop breathing so you should see a doctor urgently if you are concerned (go to the Emergency Department of your nearest hospital if it is after hours). Some symptoms which warrant immediate medical attention include:

• Difficulty swallowing.
• A sudden attack of coughing.
• Unusual noises while breathing. This can include stridor or a snoring sound when breathing out.
• If you notice a 'caving in' of the chest when trying to breathe in. 
• An increase in the rate of breathing or any difficulty breathing (especially if they stop breathing for more than ten seconds at a time).
• A bluish tinge to the lips or fingernails.
• A rapid heart rate.
• If your child is restless, anxious, sweating, abnormally drowsy and can't be woken, or has a high fever (38.5 degrees celcius or higher).

If the croup is mild and none of the above symptoms are displayed, ensure your child keeps well hydrated with frequent drinks, try and keep the room reasonably warm and offer lots of cuddles and reassurance to your child. You can also give paracetamol, but ensure you give the correct dose for your child's weight. Mild croup will usually go away on its own within 48 hours, but may last up to a week.

If the croup is more severe, your child may require medication. Croup is usually caused by a virus so giving antibiotics won't help the infection or the symptoms. Your doctor may prescribe a few doses of a corticosteroid such as dexamethasone or prednisolone, which will help reduce the swelling of the airways and make it easier to breathe. These can be given either in tablet or liquid form. If admitted to hospital, doctors may prescribe adrenaline which is breathed in via droplet form through a mask and nebuliser. This will also help with the breathing.

The best way to prevent croup is via good hygiene, but like colds and other infections, this is not easy and often even the cleanest children contract croup. Wash hands with soap and water regularly, and especially before preparing or eating food and after coughing, sneezing or blowing your nose. Discourage the sharing of cups and eating utensils. Cover mouths after coughing or sneezing. Keep hands away from eyes, nose and mouth. Keep children home from school or childcare if they are unwell.

Croup can be very scary, both for the child and the parents or carers. If you are at all worried or if your child has any of the above symptoms, seek medical attention from your family doctor or a hospital immediately. You are always welcome to give the pharmacists at Berwick Pharmacy a call to discuss any concerns about your family's health.

References and further reading

• Croup Fact Sheet, NPS, published 4 May 2012 (accessed online 9 May 2012)
• Croup Fact Sheet, Better Health Channel, published February 2012 (accessed online 9 May 2012)