Diane and Rick settled down in bed for the night. Diane cherished this quiet time in her day after her son was in bed.
All of a sudden Diane heard a strange cough and crying coming from her son’s room. Every once in a while, three-year old Michael would awaken after a bad dream, but this time it seemed different. Diane could sense real fear in her son’s voice.
Croup
Croup is an illness that affects a child’s breathing. It is caused by many different viruses. It most often occurs in the fall and winter months but can happen in any season.
Croup symptoms most often happen in late evening and at night – it starts quite suddenly.
His rattling, bark-like cough was incredibly loud. He felt hot and his coughing was causing him obvious discomfort — his eyes were watering and his body trembled with each cough.
“Mommy, mommy, I can’t breathe!” he said.
Michael’s chest was sucking in deeply with each breath. Diane became scared but didn’t want to show it.
Diane thought about the day, trying to pinpoint a cause for Michael’s sudden coughing and distress. Their day had been like any other. Michael had gone to preschool like he did regularly three times a week. He had eaten a good dinner and had gone to bed at his usual eight o’clock bedtime without trouble.
“What’s going on?” asked Rick.
“I’m not sure” replied Diane.
Croup Fact
Croup occurs most often in children between age six months and three years. This is because young children have a smaller airway. Airways become wider as children grow, and this decreases the chances of older children and adults getting croup.
Rick and Diane thought the best thing to do was call a 24-hour health information line. Diane rubbed her son’s back and sang some of his favourite songs to calm him. Already Michael’s breathing eased and he only coughed every once in a while.
“I heard two mothers talking at the preschool. They said one of the little boys was sick at home with croup. Maybe Michael has the same thing” she said.
Diane picked up the phone and dialed the health information number she had put on her fridge for health advice.
Telephone health advice is available 24 hours a day, seven days a week in Canada.
Call 8-1-1 to speak with a Registered Nurse for free.
If you live in Manitoba, call 204-788-8200 in Winnipeg or 1-888-315-9257 toll-free elsewhere in the province.
A nurse answered and asked questions to check if Michael needed emergency care:
- Has he stopped breathing?
- Has he fainted or passed out (unconscious)?
- Does he have bluish lips or fingernails?
- Does he seem very tired
If any of the above happens then you should call 911 immediately.
Diane replied no and the nurse then tried to identify the cough in more detail. “Does Michael’s cough sound like a dog or seal?” the nurse asked. “When Michael breathes in, do you hear a harsh, vibrating sound? Does it get worse when Michael cries?”
“Yes, exactly like a seal,” Diane replied. “I hear the vibrating sound right now.”
The nurse told Diane to visit the emergency room if:
- Michael does not improve after 15 minutes.
- His breathing becomes difficult (when not coughing).
- He starts drooling or having trouble swallowing.
- Michael makes a high-pitched noise when breathing, even when he is calm, and the noise does not improve.
- He begins acting very sick.
The nurse then told Diane how to treat croup at home:
- Using a cool-mist humidifier or running a cold shower may help.
- Take him into cold air outdoors or sit by a window or an open freezer door, while keeping him warm with a blanket. The cool air helps the breathing.
- Keep Michael calm. The symptoms can get worse if he is excited.
- Sleep with the window open.
- Give Michael plenty of clear fluids or popsicles when he’s awake.
- Encourage regular eating.
- Give Michael acetaminophen (Tylenol or Tempra) or ibuprofen (Advil or Motrin) for his fever or discomfort.
Medication Use
Diane and Rick walked to Michael’s room and opened the window. Diane bundled Michael in a blanket and they sat together in a rocking chair breathing in the cool air. She crossed her fingers. “Please let his coughing stop” she thought.
After twenty minutes Michael became more calm and his coughing less frequent. They no longer heard the squeaking sound when he breathed in. “Maybe that’s done the trick, he already seems a little better.” said Rick.
But soon, Michael’s coughing started getting worse again and his breathing strained.
Rick and Diane decided that Michael should go to the emergency department. Diane threw on a winter coat and bundled up Michael, carrying him to the car. Rick stayed home with their other child who was well and sleeping. He watched by the door hoping that Michael would be okay.
As she raced along the empty streets, Diane nervously kept a close eye on Michael by regularly looking in the rear-view mirror. She rolled down the window to clear the windshield and within a few minutes, Michael’s coughing got a little better. Though he was breathing very loudly and his voice sounded scratchy, he seemed calmer and happier.
Just before midnight they walked through the emergency department doors. Within minutes of being in warmer air, Michael’s breathing got worse.
Diane described what happened to the nurse, who then made notes on a chart and checked Michael.
The nurse gave Diane some Tylenol to give to Michael for his fever. He then asked them to have a seat in the waiting room.
The emergency department was very busy and the wait seemed endless. Finally after three hours, Diane and Michael were led to an examination room.
The doctor read Michael’s chart. The nurse had noted the classic symptoms of croup: mild fever, hoarse-like voice, and a seal-like barky cough that started that night.
“Another case of croup” thought the doctor. She had seen several cases lately, as it tends to cluster in the fall and winter months. As she entered the room, the doctor noted the mother looked tired and stressed. She realized that though this was another case of croup for her, it was an intense and worrisome event for the parent and child.
The harsh barky cough that can rouse parents from their sleep often causes fear and alarm. The coughing is startling, especially when it is heard for the first time, and often sounds much worse than it actually is.
“What brings you here tonight?” asked the doctor.
Diane explained to the doctor what brought her to the emergency department. The doctor examined Michael and confirmed what she suspected — Michael was suffering from a moderate case of croup.
Croup is an infection that is caused by a virus. This can make the vocal cords, windpipe and voice box swell — it’s the swelling that causes the hoarse voice and the barky cough. Croup tends to affect younger children 6 months to 12 years of age. Children 2 years of age are most commonly affected.
The doctor told her that they would watch Michael for a few hours and if all was well, Diane and her son would be on their way home.
“I recommend giving Michael a steroid called dexamethasone.” said the doctor. “It will help with the swelling one or two hours after taking it. The medicine is sweet tasting and there are no serious side effects.”
Sure enough several hours later when the doctor returned, Diane appeared much calmer and Michael was resting comfortably in her arms.
“What if the coughing gets worse again?” asked Diane.
“In most cases the cough is worse the first night and should be gone completely within 2 to 5 days.” replied the doctor.
Diane thanked the doctor and left the room. As she walked through the emergency doors, she remembered the doctor’s advice for managing Michael’s croup over the next few days: to give Michael acetaminophen (Tylenol or Tempra) or ibuprofen (Advil or Motrin) if he feels uncomfortable.
Other medications such as cough syrups, decongestants, or antibiotics will not help with croup.
Medication Use
Read the instructions on any medication bottle before giving it to your child. If you have any questions or concerns, talk to your doctor, nurse or pharmacist.
When Diane arrived home, Rick was on the computer researching croup. He asked how Michael was doing and Diane updated him on the experience.
“Apparently kids can get croup more than once because there are many viruses that can cause it.” said Rick. “Kids can get croup when they become infected with each of these viruses. I have found a lot of useful information on here.”
Causes and Prevention
Your child may get croup by coming into contact with another person with the virus. It is spread through coughing, sneezing or contact with the mucous on tissues, toys or hands. Good hand washing technique can lower the spread of infection among children and adults. For more information, please visit echokt.ca/croup
Rick and Diane tucked Michael into bed and he fell asleep right away. They hugged at the doorway looking at Michael — they were extremely relieved.
“It’s been a long night.” said Rick. “Let’s go to bed.”
As they made their way to their bedroom, they paused for a kiss and savoured the quiet that had settled over the house.
This croup e-book is based on the following booklets, which were sponsored by CIHR Team In Pediatric Emergency Medicine:
Managing Croup at Home
A Late Night Trip to the Emergency Department
Things We Take for Granted
For more information about croup, please visit echokt.ca/croup
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