How is croup treated?
1. Mild croup – home treatment
Most instances of croup are mild enough that no medical intervention is entirely necessary. Although a child will be in some degree of discomfort and quite miserable while the infection is active, symptoms will resolve and he or she will be well again within at least a week. It is important to monitor a child closely while they are unwell with croup, particularly during the initial few days when normally feeling at their worst, and encourage as much rest as possible.
Things a parent or caretaker can do to help alleviate symptoms while infection clears include:
- Making an effort to keep a child as calm as possible: Discomfort will make a child fussy, agitated and quite unhappy. This aggravates crying and will in turn cause a child’s airways to narrow even more and worsen inflammation. The knock-on effect is that a child will then find it increasingly difficult to breathe. As much as possible, although it may be difficult and challenging, a parent or caretaker should do their level best to calm an ill child. Some read stories, cuddle, play quiet games, offer soothing objects such as blankets or toys, or sing lullabies to their child as a way to soothe their agitation and discomfort. The more a child is agitated, fussy and in tears, the worse symptoms will be.
- Moistening dry air: A cool-mist humidifier can help to open up the airways and alleviate a bothersome cough. If a humidifier is not on hand, running a hot shower in the bathroom and sitting in the steam for about 10 minutes at a time can also help. It may be best to avoid hot water vaporisers so as to prevent any risk of accidental burns. Allowing cool air to circulate in the child’s environment (nursery or bedroom) is also helpful for a few minutes at a time to alleviate symptoms. Some parents have found some relief by taking their little one for a short car ride (10 to 15 minutes) with the windows rolled down.
- Maintaining sufficient hydration: A child can quickly dehydrate when unwell with croup. It is thus important to ensure that he or she is kept well hydrated with warm, clear fluids to loosen mucus, alleviate discomfort of the vocal cords and avoid dehydration. Small amounts of fluids (such as water, breast milk or baby formula) may be regularly fed to a very young baby or child using a spoon, medicine dropper or syringe. Frozen fruit juice cubes may also be helpful for older children.
- Keeping the child’s head elevated: Propping up the affected child’s head with an extra pillow can also help in alleviating symptoms (if a child is older than 12 months), especially during the night when at rest. It is also best for a parent or caretaker to sleep in the same room as a child suffering from croup in case he or she struggles with breathing during rest / sleep. Holding a child upright, or placing them in a chair, also helps to make for easier breathing.
- Over-the-counter medications: In the event that a doctor has recommended the use of medications for treatment of symptoms (usually for children older than 2 years of age), such as for fever, over-the-counter pain relievers can help to soothe discomfort, particularly in areas affecting the head, throat and chest. Care must be taken, however, as many have proven to be ineffective for treatment of croup and can also cause more side-effects. It is thus advisable to use only what is recommended by a treating doctor. Aspirin-based medications should never be used for treating illness in children with a viral infection as it can lead to severe complications, such as a life-threatening condition known as Reye’s syndrome. Saltwater nose drops may help to alleviate nasal congestion and allow for easier breathing. Any cough medications recommended will normally be prescribed, as over-the-counter variations are not known to alleviate symptoms associated with croup.
2. Severe croup – medical intervention
Treatment will depend on severity. Breathing difficulties will be treated in an emergency capacity and a child may be given steroid medications (glucocorticoid or an oral cortisone) to alleviate narrowing, reduce inflammation and open the airways. A breathing tube (inserted down a child’s windpipe) may also be used in severe instances to assist with receiving more oxygen. If a child is dehydrated, intravenously administered (IV) fluids will be given for rapid hydration.
On occasion, severe respiratory difficulties may be treated in hospital with inhalation therapy using epinephrine (adrenaline), which will be carefully monitored. Inhalation therapy provides a rapid but temporary period of relief (approximately 2 hours).
Side-effects of this treatment can include:
- Elevated blood pressure
- A rapid heart rate
It can happen that symptoms recur following treatment (these are often severe). This is known as ‘rebound phenomenon’.
Prescription medications administered in the treatment of croup are normally fast acting and have lasting effects, and may also be prescribed for continued use once a child is allowed home for further recovery following hospitalisation.
In the event of any bacterial causes (appropriate laboratory tests will have been ordered to determine the infecting bacterium) or an infection becoming superimposed with a viral cause, a doctor will prescribe antibiotics, both while a child is in hospital and / or at home.
If hospitalisation is necessary (this is rare), a child may be monitored and treated for a short stay and then discharged for further recovery at home once symptoms, especially breathing, are under control.
Outlook for recovery
A mild case of viral croup generally runs its course and will resolve within a week. All instances of croup are treatable and a child can make a full recovery without further complication.
A life-threatening instance, or cases of croup which require hospitalisation are a rare occurrence. It is best to treat an infection appropriately by following the guidance of a medical doctor, so as to avoid potentially dangerous complications, especially when it comes to breathing. It’s important to watch for warning signs of complications and take action quickly, as is necessary. The sooner a potentially life-threatening situation can be avoided, the better.