Your child wakes you up in the middle of the night with a barking cough and high-pitched inhale. Do you know what to do?
Dr. Michael Rizkalla, medical director of the Mastroianni Family Pediatric Emergency Department at Jupiter Medical Center, says those are telltale signs of croup, an inflammation and narrowing of the upper airway. It is commonly caused by the parainfluenza virus, most prevalent in spring and fall.
“Croup can be scary for parents because most kids are fine throughout the day,” Rizkalla says. “Then suddenly, in the middle of the night, they’ll wake up with a harsh, barky cough and a high-pitched sound when they breathe in, and can often have trouble breathing. It’s one of the more common causes for little children to come into the emergency department in the middle of the night.”
Unlike asthma, which is inflammation in the lower airways thatcauses a wheezing sound when breathing out, croup creates a loud, high-pitched sound when breathing in.
If the child is struggling to breathe, it’s time to go to the emergency department. “If they’re obviously in a lot of distress, it would be reasonable to call 911,” he says. “If they’re not in distress—they can catch their breath—but the barking cough is just not stopping, you can bring them in by private car to the hospital.”
When it’s croup season, Rizkalla often sees three or four croup cases each night. Patients are usually 6 months through age 6. “Parainfluenza can infect anybody at any age, but it tends to cause croup only in those younger children that have narrower airways,” he says. Non-infectious spasmodic croup can be triggered by allergens.
For mild cases, home remedies can ease the cough and high-pitched inhaling noise known as stridor. “The first thing you should do is put them in cool, humidified air,” Rizkalla says. “The one caveat I have is that if it’s asthma, this remedy will have the exact opposite effect. Cold air is great for croup but very bad for asthma.”
That is also what Rizkalla does for mild croup in the ER. Some children are kept for a few hours and given racemic epinephrine nebulizer treatments through a mask for immediate relief until the steroids take effect. If the treatment isn’t helping, an X-ray will confirm whether a physical obstruction is instead the culprit and the child will be transferred to a hospital with pediatric surgery.
There is no vaccine for the parainfluenza virus, but a flu shot can prevent against croup caused by that virus. Other ways to try to prevent croup include avoiding contact with sick people and handwashing. “It’s very common in kids who are either in school or daycare,” he says.
Dr. Michael Rizkalla is employed by Nicklaus Children’s Pediatric Specialists and serves as medical director of the Mastroianni Family Pediatric Emergency Department at Jupiter Medical Center. Nicklaus Children’s Health System is proud to partner with JMC to provide pediatric emergency and neonatal (newborn) intensive care (NICU) services.