Croup

Croup is a common childhood illness that can cause a bark-like cough. It can also cause difficulty breathing which can be frightening for both you and your child.

Croup is caused by a virus which affects the airways including the voice box (larynx),
windpipe (trachea) and lungs (the bronchi) causing them to swell and become
narrower.
Some children have croup two or more times in their childhood.

If your child has any of the following:

Breathing very fast or breathing that stops or pauses
Working hard to breathe, drawing in of the muscles below the rib or unable to talk
A harsh noise as they breathe in (stridor) present all of the time (even when they are not upset)
Drooling more than normal and struggling to swallow their own spit
Becomes pale, blue, mottled and/or unusually cold to touch
Difficult to wake up, very sleepy or confused
Weak, high-pitched, continuous cry or extremely agitated
Has a fit (seizure)
Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red or amber features)
Has a rash that does not go away with pressure(see the 'Glass Test')

You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

Breathing a bit faster than normal or working a bit harder to breathe
A harsh noise as they breathe in (stridor) only when upset
Dry skin, lips or tongue
Not had a wee or wet nappy in last 8 hours
Poor feeding babies (less than half their usual amount)
Irritable (unable to settle them with toys, TV, food or hugs even after their fever has come down)
Is 3-6 months old with temperature 39 o C or above (unless fever in the 48 hours following vaccinations and no other red or amber features)
Temperature of 38^oC or above for more than 5 days or shivering with fever (rigors)
Temperature less than 36°C in those over 3 months
Getting worse or you are worried about them

You need to contact a doctor or nurse today.

Please ring your GP surgery or call NHS 111 - dial 111

If symptoms persist for 4 hours or more and you have not been able to speak to
either a member of staff from your GP practice or to NHS 111 staff, recheck that your
child has not developed any red features

If your child has none of the above

Watch them closely for any change and look out for any red or amber symptoms
Additional advice is also available for families for help cope with crying in otherwise well babies
If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you.

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111

This guidance has been reviewed and adapted by healthcare professionals across North East and North Cumbria with consent from the Hampshire development groups.

What are the symptoms of croup?

A cough. The cough is usually harsh and barking. This ‘croupy cough’ is due to inflammation and swelling of the vocal cords in the voice box (larynx).
Noisy breathing. The infection can narrow the voice box (larynx) and windpipe (trachea) and cause an extra noise called a stridor. This noise is normally heard on breathing in.
Breathing may become difficult if the narrowing becomes worse.
Your child may also have a runny nose, hoarse voice, sore throat, high temperature (fever), general aches and pains and be off their food. Croup may follow a cold but can also appear without any earlier illness.
The symptoms of croup appear worse at night. A mild but irritating cough may persist for a further week or so.

How can I help my child?

Stay calm. This will help keep your child calm. Children with croup may become upset. Crying may make their symptoms worse.
Sit your child upright on your lap if their breathing is noisy or difficult. Let them find the most comfortable position.
Encourage your child to drink cool drinks regularly (little and often) to help soothe their throat and keep them hydrated.
If your child seems to be in pain or discomfort, you can give your child paracetamol or ibuprofen , following the instructions on the container.
If their temperature is high, dress them in cool, loose clothes (if any) and don’t use anything warmer than a sheet to cover them in bed.
Stay with your child or check him or her regularly. You need to know if the symptoms are getting worse.
Some people find that taking their child outside in the cool, fresh air helps to relieve their symptoms
There is no evidence that steam inhalation helps. There is a risk of scalds if steam is used.
Do not give cough syrup. It is not recommended for children under 6 years. It can make children sleepy and does not help croup.

How is croup treated?

Your child may be given a steroid medicine called dexamethasone or prednisolone which can reduce airway swelling
As croup is caused by a viral illness antibiotics are not needed.

Where should you seek help?

If it is non-urgent, speak to your local pharmacist or health visitor.
If your child has any of the above features, urgently see your GP. For an urgent out-of-hours GP appointment, call NHS 111.
You should only call 999 or go to your nearest A&E department in critical or life threatening situations.

Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.

Sound advice

Visit a pharmacy if your child is ill, but does not need to see a GP.
Remember that if your child's condition gets worse, you should seek further medical advice immediately.
Help your child to understand - watch this video with them about going to the pharmacy.

For information on common childhood illnesses go to What is wrong with my child?

Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.

Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns or to the Community Paediatricians or to the child and adolescent mental health services.

Contact them by phoning your Health Visitor Team or local Children’s Centre.

Sound advice

Health visitors also provide advice, support and guidance in caring for your child, including:

Breastfeeding, weaning and healthy eating
Exercise, hygiene and safety
Your child’s growth and development
Emotional health and wellbeing, including postnatal depression
Safety in the home
Stopping smoking
Contraception and sexual health
Sleep and behaviour management (including temper tantrums!)
Toilet training
Minor illnesses

For more information watch the video: What does a health visitor do?

Midwives provide advice, care and support for women and their babies during pregnancy, labour and the early postnatal period. They provide health education and parenting advice until care is transferred to a health visitor. This usually happens when your baby is about 2 weeks old.

Sound Advice

A midwife is an expert in normal pregnancy and birth.

GPs assess, treat and manage a whole range of health problems. They also provide health education, give vaccinations and carry out simple surgical procedures. Your GP will arrange a referral to a hospital specialist should you need it.

Sound advice

You have a choice of service:

Doctors/GPs can treat many illnesses that do not warrant a visit to A&E.
Help your child to understand – watch this video with them about visiting the GP or going to a walk in centre

For information on common childhood illnesses go to What is wrong with my child?

If you’re not sure which NHS service you need, call 111. An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.

Sound advice

Use NHS 111 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services.

For information on common childhood illnesses go to What is wrong with my child?

A&E departments provide vital care for life-threatening emergencies, such as loss of consciousness, suspected heart attacks, breathing difficulties, or severe bleeding that cannot be stopped. If you’re not sure it’s an emergency, call 111 for advice.

Sound advice

Many visits to A&E and calls to 999 could be resolved by any other NHS services.
If your child's condition is not critical, choose another service to get them the best possible treatment.
Help your child to understand – watch this video with them about going to A&E or riding in an ambulance

School nurses care for children and young people, aged 5-19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and/or emotional health needs.

Contacting the School Nurse

Primary and secondary schools have an allocated school nurse – telephone your child’s school to ask for the contact details of your named school nurse.

There is also a specialist nurse who works with families who choose to educate their children at home.

Sound Advice

Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.

They all have a role in preventing disease and promoting health and wellbeing, by:-

encouraging healthier lifestyles
offering immunisations
giving information, advice and support to children, young people and their families
supporting children with complex health needs

Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.