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Post by AlleyRose on Mon May 12, 2014 6:34 pm

Key points

  • Caused by any number of viral infections.
  • Starts with cold symptoms which progress to a barking cough. Symptoms usually worsen as night falls.
  • Usually lasts three to four days.
  • Seek medical attention immediately if your child is short of, or fighting, for breath when they are resting.

Any one of a range of viruses which commonly circulate in the community can cause croup.
Children get croup when the lining of their voice box (the larynx) and their windpipe (the trachea) becomes inflammed by the viral infection. This inflammation narrows their airways, making it harder for them to breathe - they usually have particular difficulty breathing in. It usually affects children aged under five years.
Signs and symptoms
There are several stages to croup: it often starts as a 'cold' but then it develops into a high pitched 'barking' cough.
Children with croup usually make a barking or crowing noise when they breathe in.
You may also notice the following symptoms in your child.

  • They may have a hoarse voice and experience difficulty breathing.
  • In particular, you may notice they are having to work hard to breathe or are breathing more rapidly.
  • Not uncommonly they will wake up distressed in the night having gone to bed well.
  • You may see that the tissue in between their ribs is 'sucking in' as they breathe.
  • Children with croup sometimes have a mild fever.

It's worth remembing that croup usually worsens as night falls so moderate croup in the afternoon will be severe croup by the mid evening.
Course and duration

The condition usually lasts about three to four days and it responds well to medical treatment which may help the illness clear up more quickly.
Spread of infection
Croup occurs more often in younger and smaller children, and is partly due to the age and size of the child. The same virus might cause croup in one child but not another.
Unfortunately, as with the usual coughs and cold in the community, it is not possible to avoid the viruses that cause croup.
In general, complications from croup are rarely seen these days. Severe untreated croup was occasionally fatal in days gone past unless it was treated in hospital with an operation to open the wind pipe. With moderate treatment this is rarely necessary.
There are things you can do to help a child with croup.

  • Sitting up may be the most comfortable position for them.
  • Ensure they are given adequate fluids.
  • Paracetamol may help if they are uncomfortable from a fever.

If both you and your child are relaxed, then it is likely the croup is mild and can be managed at home. But, remember, croup will get worse as night falls.
Children who are at all distressed in relation to their breathing need to see a doctor as soon as possible.
A short course of oral corticosteroids such as prednisone quickly relieves symptoms by reducing the swelling in your child's airways, making it easier for them to breathe. Occasionally in hospital nebulised (misted) adrenalin is given through a mask particularly for more severe distress.
Since croup is caused by a virus, antibiotics are not required.
Humidified or moist air used to be considered helpful, but we have discovered more recently that it does not help children with croup and it is no longer recommended.
There is no way to prevent croup, but if your child has a history of it they will eventually grow out of it as it is partly related to the small size of a young child's airways.
Medical intervention
Do seek medical attention if you are concerned about your child at any time with this illness. Immediate medical intervention is however essential if your child is showing any of the following signs:

  • shortness of breath
  • rapid rate of breathing
  • working hard to breathe
  • a jerky see-saw movement between chest and abdomen
  • a sucking-in of chest wall tissues between the ribs

ANY child that appears to be short of, or fighting for, breath when they are resting should receive urgent medical assessment.
A child with croup who has blue lips and is unexpectedly drowsy needs URGENT hospital attention
Reviewed by Dr Peter Vine. A former rural paediatrician with more than 20 years experience, Dr Vine is head of campus and senior lecturer, UNSW Rural Clinical School, Albury Wodonga.
Your story: croup
Lauren Angove, Cody, 4

Cody and Lauren
My son Cody had just come home exhausted after a birthday party. Seeing that he was so tired, I quickly got him to bed, but around midnight, I heard a gasp and then, what sounded like a bark.
I raced to his room to find him sitting up in bed and coughing – the noise sounded like a dog barking. I could see he was having some trouble breathing, so I called the health advice line Health Direct immediately.
I was in the middle of explaining his symptoms to the nurse on the helpline, when Cody vomited. I could also see that he was sucking in his ribs while he was trying to breathe and the point of the neck near his Adam's apple was quite depressed as well.
The nurse was pretty sure that it was croup by this time and advised us that we should try to keep him calm. This was quite difficult as Cody was panicking when trying to catch his breath and all the crying didn't help either. It was at this point that we decided to take him to the emergency department of the local hospital.
The doctor examining him was pretty quick to diagnose his condition as croup and administered oral steroids. We waited for about an hour to give the steroids time to work. When the barking subsided, we returned home and Cody was able to go back to sleep. By 10am the following morning, the cough was gone. So even though we all had a difficult night, the impact on the family was minimal as, the following day, he was back to normal.
Cody had croup a few times after that, but the symptoms were mild in comparison and we were able to manage it at home.
Lauren Angove spoke to Lakshmi Singh.

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