House Calls runs every other Saturday. Today’s column is written by Aleen Huston, respiratory care practitioner and certified respiratory therapist at Sutter Coast Hospital.
Your child goes to bed with a runny nose and a fever. In the middle of the night he or she wakes up, crying. It’s not so much the tears that worry you, but the loud and barking cough that is coming from the child’s room. This is called croup, which is a viral infection of the upper airway. Children get croup most often between 3 months and 5 years old. It is mostly seen from late fall through the early winter months. It is more common in boys than in girls.
Croup is an infectious illness that involves the respiratory system, mainly the vocal cords, the windpipe, and the upper airways of the lungs. The majority of the symptoms reflect involvement of the vocal cords.
It is contagious and it is usually spread by the sneezing or coughing of infected children. When a healthy child inhales the droplets, symptoms will start developing within two to three days. The infection can also be spread by droplets on objects like doors, toys, furniture and other objects. Once healthy children touch an object, they will accidentally touch the droplets and put it in their mouth.
Usually croup starts with a cold. Your child goes to bed not feeling well, then wakes up with the classic harsh, barking cough that sounds like a seal or the “Darth Vader” sound. This can be scary to parents who don’t know that most cases of croup are mild. The condition can get worse if a child is tired and upset. Luckily, though, the symptoms are usually gone within a week after a couple restless nights.
Other symptoms are a runny nose, low fever (although temperature can be as high as 104 degrees F) and hoarse voice.
A croupy cough can sometimes come on suddenly without any cold symptoms and without fever. This is called “spasmodic croup.”
If croup gets worse, breathing can become difficult. In addition to a croupy cough, a child with worsening croup could start having stridor. That’s a harsh, raspy, whooping sound when breathing in. A severely sick child will refuse to lie down and want to be in the upright position. They will have chest retractions when they inhale and may develop facial blueness (cyanosis). Call 911 if you think your child has stridor or trouble breathing.
Again, croup is very frightening to children and the parents, so remember to comfort and reassure the child as the first step. Breathing difficulties can develop and worsen rapidly. Close monitoring of the child is important during the early phases of the illness.
To help he or she breathe more comfortably, a cool or warm mist vaporizer can be places near the child. The humidification helps prevent the vocal cords from swelling and lessens the symptoms. When cough or stridor worsens at night, 10-15 minutes sitting or driving in the cool night air can also help the child to breathe.
In infants or children, mucus in the nose block the nasal passages so using a bulb suction with a little saltwater (1/4 teaspoon of table salt in 1 cup of water) can be helpful in opening the nasal passages.
If a child develops a fever, give acetaminophen (such as Tylenol) or ibuprofen (such as Motrin, Advil) for the fever and pain relief. Avoid giving aspirin or Ecotrin since it is suspected as being related to Reye’s syndrome. Reye’s Syndrome is a serious illness that causes kidney, liver and brain damage, which may lead to a rapid onset of coma.
Even though plenty of fluids are encouraged to avoid dehydration, forcing fluids is generally unnecessary. Popsicles are great for providing fluids. Activity should be limited during the first days of the illness.
Children with croup are contagious during the first days of the fever and illness. Once their temperature is normal and they feel better, they can return to school or day care.