The Nurse’s Tool Box: Helping Parents to Calm Croup
By Marci Lawing, RN
There are not many conditions that a triage nurse is able to identify by sound alone, Croup happens to be one that is fairly easy to recognize by its characteristic barky sounding cough. Many parents and healthcare professionals will say “once you have heard it, you will never forget it.”
What : Croup is a viral infection of the upper airway, mainly the larynx and trachea.
Who is at risk : Most at risk for developing Croup are children between the ages of 6 months and 3 years with the peak incidence around age 24 months.
Cause : Croup is a viral illness, normally the parainfluenza virus.
Contagiousness : Croup is contagious and is spread by airborne droplets. It is spread by sneezing, coughing or coming into contact with infected droplets left on doors, furniture, toys or other objects.
Symptoms : Croup often begins as a typical cold, with nasal drainage and a cough. Croup has a distinct barking cough and harsh, raspy sound with inspiration.
Incubation : 24-72 hours between exposure to virus and development of symptoms.
How is it diagnosed : Diagnosis is usually made by the physician listening to the characteristic barky sounding cough, hoarse voice and stridor during inhalation. An x-ray of the neck will often show an elongated narrowing of the region called a “steeple sign.”
Complications : Most cases of Croup are mild and will resolve without prescription medications, however a major concern is complications related to severe airway swelling interfering with breathing.
Home Treatment : Warm mist humidifier or allowing the child breath in steam from a hot shower will often relieve respiratory symptoms. Using saline drops can help clear nasal mucus, and drinking lots of fluids can prevent dehydration. In moderate to severe cases where stridor is present, the child may require a steroid.
Did you know ? Studies suggest that acid reflux may be a contributing factor in children with recurrent croup.
When triaging a patient with a barky cough, it is important that the triage nurse rules out other causes such as ingestion of a foreign body and allergic reactions. Asking the right questions at the beginning of the triage will enable the nurse to accurately determine next steps. Next, the triage nurse can focus on giving the parent the home care needed to lessen the child’s symptoms and ease the parent’s anxiety. As with any respiratory ailment, the parent should be advised to monitor respiratory symptoms and seek emergency care if the child develops increased respiratory rate, cyanosis, extreme irritability, abdominal or intercostal retractions, or nasal flaring.