Dr Chiara Hunt is a General Practitioner at the Sloane Street Surgery in London. A mother of two, she is a co-founder of The Bump Class, London’s go-to antenatal class for discerning mothers-to-be who want impartial, practical and sensible advice before the birth of their baby.
What is croup?
I see a lot of children with croup at this time of year. Croup is an infection of the voicebox and windpipe, which is commonly caused by a virus. It can be caused by various types of virus. It is usually mild and most children recover fairly quickly. In some cases a steroid is prescribed to ease the symptoms and very rarely a child is admitted to hospital to be monitored until the symptoms have eased.
How does croup differ from a normal cough?
Croup is different because the infection causes swelling of the windpipe and can lead to breathing problems. Croup is most common in 1-3 year olds because their windpipe is particularly small in relation to their size so even a small amount of inflammation can restrict the breathing. After about six years, their windpipes become firmer and wider making croup much less common.
What are the symptoms of croup?
Thy symptoms are fairly unique but can be somewhat alarming for parents. They include:
- A distinctive, barking cough, like the ‘bark’ of a dog or a seal, not like a normal cough
- Breathing Difficulties: The infection causes an inflammation of the windpipe and there may also be a lot of thick mucus. This combination may cause the windpipe to narrow which may result in noisy breathing or difficulty breathing. If you’re worried, undress your child and look at his chest. If you can see the skin pulling in between the ribs as he breathes or that he’s straining his tummy to breathe, you need to see a doctor.
- A child is usually unwell with a fever and cold like symptoms
- Symptoms are usually worse at night. I often see a child who is coping fine during the day but whose cough and breathing deteriorates at night, which sometimes can result in a late night dash to the hospital.
How long does croup last?
Symptoms usually peak between 1-3 days but tend to get better after that. The child often has a cough and mild cold like symptoms for a week after that.
Is croup contagious?
The virus that causes croup in contagious but will not necessarily cause croup in every child. Some children, particularly if they are a bit older, will just experience cold like symptoms.
Is my child more prone to croup if he’s had it once?
Children who have had croup once tend to be the ones who get it again and parents will often recognise the symptoms immediately.
What treatment is advised for croup?
In most cases, the symptoms are mild and children do not need to go to hospital. If you are not particularly worried about your child there are various things you can do at home to ease their symptoms:
- Keep calm and reassure your child: Children quickly pick up on panic and if they are agitated their breathing will become faster and harder. Give your child lots of cuddles and distract with something calming such as a favourite book or game.
- Let your child be in whatever position they are comfortable in, particularly at night. Don’t force them to lie down if they’re happier sitting up or being propped up in bed.
- Reduce the fever and alleviate the cold symptoms: Give Calpol and Nurofen every 4 – 6 hours and make sure the child is not over dressed.
- Take them outside: Often the cool winter air eases the symptoms of croup and at the least, a walk is a good distraction.
- Encourage your child to continue drinking but if they’re unwilling don’t force it. Cool drinks often ease the swelling in the windpipe.
- Steam has been thought to ease symptoms although recent studies have struggled to prove it has any positive effect. If you do want to put a humidifier in your child’s room, make sure it is suitable for children’s rooms and not likely to burn or harm your child. Never use boiling water.
- Don’t give your child cough medicine or anything that will make him drowsy: cough medicines will not alleviate the symptoms and should your child develop breathing difficulties, a medicine that might make him drowsy is dangerous.
Should I see a doctor?
The virus that causes croup will pass on its own in about 3-5 days but if your child is struggling to breathe he might need some steroids to reduce the inflammation and make it easier to breathe. As it’s a viral infection antibiotics will not help. If you are worried about your child, you should call your doctor but always call your doctor if your child:
- starts finding it harder to breathe
- is unusually pale
- has a fever that does not go down with paracetamol or ibuprofen
- becomes particularly restless or agitated
- Is “just not right” – trust your instinct!
The doctor or hospital will assess the child and if necessary will give a steroid medicine orally. The steroids should reduce the swelling in the windpipe rapidly, allowing the child to breathe easily again. Occasionally the hospital will want to keep the child in to be monitored. As a parent, you can always stay with your child.
Croup can be stressful and worrying for the parent. Do remember to trust your instinct and if you feel that you would rather have your child checked, do see your doctor. No doctor will berate a parent for bringing a child in unnecessarily. If your child is unusually sleepy, really struggling to breathe or blue, you need to call an ambulance.
By Dr Chiara Hunt, The Bump Class