The Bark May Be Worse Than The Bite

In the cooler weather months, those of us with children tend to worry about runny noses, coughs, colds, long nights staying awake with the miserable feeling little kiddo, etc.

When your little one has been running a low grade temp, having a runny nose and presenting with cold-like symptoms for a few days and then start up with a cough that sounds like a seal barking, it's time to pay attention as things can get serious. I speak from experience as this happened to my little girl when she was 3 and I don't want any parent to have to worry like my wife and I did.

Soft tissue x-ray showing narrowed airway that looks like a steeple.

Typically, croup is a viral infection (it can be bacterial) and like all viruses, is self-limiting, meaning it's usually gone in 7 days or less and unfortunately means that you and the little one are going to be up for a few nights. Usual treatment is comfort measures--Tylenol, Motrin, lots of fluids to prevent dehydration and cool, moist air. However, what croup does to cause that barking cough is inflame the tissue surrounding the vocal cords and in children (usually hits 5 and under group) who have naturally narrow airways, this inflammation can become life-threatening and require emergency treatment.
How do you know it's time to go in or call 911? If your child has progressed from a barking cough to having obvious difficulty breathing and making a high pitched wheezing sound when breathing (this is called "stridor" and comes from a very narrowed airway), then it's time to seek help as the inflammation can shut down the airway, causing respiratory arrest and then cardiac arrest. Look for them sitting almost bolt upright with hands on their knees in the “tripod position”. Look for use of “accessory muscles” in the respiratory effort. (muscles around the collar bones) Observe for any sternal retractions (the tissue will be ‘sucking in’ and forming around the sternum) All of these are signs of respiratory distress. So, at the first sign of ANY difficulty breathing or abnormal sounds when breathing, seek help without delay.
Keep them calm and in a position that’s easy to breathe in. Try to remain calm yourself as the child will also feed off of your emotions. Once in the ER, the staff will administer several medications designed to reduce swelling and improve oxygenation, take some x-rays and depending on the severity, you may spend the night for observation.
The X-Ray in this picture shows the extreme narrowing of the airway right below the opening to the trachea due to the inflammation from croup. It forms an inverted "V" called the "Steeple Sign" because of it's resemblance to the spire or steeple of a church. The black lines on either side represent where the airway should be open.

Keep an eye on them, comfort them, listen to their work of breathing and get them in if needed!

-Pocket Doc