Our children’s hospital gave me a list of things to watch for with croup. I don’t remember the whole list, but the main points I remember were:
-
cold is better than warm. So, fog up the bathroom by running a COLD shower for a longer time, rather than running a hot shower. I’ve found this does make a difference, though depending on the relative humidity at the time, I’ve sometimes alternated between hot and cold to get more moisture. Also good is the drive in the car with windows open, or just taking them outside in the middle of the night (if it is cold out - no help if the coolest spot is in the A/C!).
-
wet is better than dry. The wetter the better. We used a cool mist humidifier on high enough to leave puddles of condensation on the floor. An evaporative humidifier won’t get things quite as wet, the electronic kind seems to push the humidity more (though they are harder to keep clean). Warm mist isn’t recommended. We’ve also let the A/C and humidifier fight it out, to get as cold and wet in combination as we can. More blankets needed, and everything needs to get dried/aired out to keep it from molding, but for three days, it is worth it.
-
Stridor is not in itself the way you identify how bad it is. Stomach cave-in on breathing (how severe), and the child’s behavior (how far from normal) are the main determinants of ‘enough to go to the ER’. Listless behavior plus caving stomach = ER visit, where they may give you meds you can take home.
I don’t remember if there was any commentary on the ‘breathe out vs. breathe in’ thing, but I’d go with MsWhatsit’s info on that.
Something that I’ve observed myself, not sure whether it is just coincidence (microscopic data pool, here) is that laughing while in the wet cold seems to reduce the symptoms faster. Not sure if laughing is just more forceful than breathing, so gets the cold/wet where it needs to go, or if it releases endorphins that help, or what, but sitting in the croup tent, Gabe improved fastest once I started being silly and making him laugh.
Gabe has spasmodic croup. That is, he got croup once, and while the vast majority of kids never get it again, now whenever he gets any kind of esophageal irritation, he goes croupy. Dust, allergens, virus, post-nasal drip, anything, and only in the last year (5) has he been big enough for the reaction to not make for utter misery. He was hospitalized once at 18 months old (overnight) with epinephrine treatments, despite having a blood ox level of 98%. (the other measures, like the anti-inflammatories, had zero impact, but the epinephrine did at least help.) He was acting like normal (getting into the speculum tray in the ER), and his stomach was barely caving at all, he just sounded awful. But they still kept him overnight.
Bad hospital ER - we’ve since learned to go straight to the Children’s Hospital. First they diagnosed pneumonia (it took them two teams and 30 minutes to get the IV into him for what turned out to be unnecessary antibiotics), and were still wondering about asthma when the head of pediatrics finally diagnosed croup. I find out later that the children’s hospital won’t keep you overnight on a 98% blood oxygen level (after taking him to their ER the next time and getting sent home).
Scary as all get out, though. Since then, we’ve treated with Advil (takes down the fever, plus somewhat anti-inflammatory), cold wet air, and keeping him more vertical (seems to help with the breathing comfort) when he slept. Which meant me sleeping on a chair with him sleeping sitting up leaned back against me. But it helped.
I’ve long since lost count of the number of three-day stints we’ve had, doing croup-watch. It is usually worst on the second day for Gabe, and lasts three days in the severe form (some tail-end barking, but not severe). And it is worst around 3 AM, just when you are too bleary to make great decisions. Not sure if that is the usual pattern, but it held true for Gabe’s brother Brendan, who got croup last fall.
Hang in there! Your instincts provide valuable info. Combine your child’s behavior with your instincts, and you usually have a sound diagnostic tool, at least for a yes/no call on an ER visit.
Also, if breathing is in serious crisis, our Infant/Child CPR class suggested calling 911 rather than transporting yourself - remember that they can usually get to you faster than you can get to the ER, and they can start treatment when they arrive at your house, which gives you a jump on the treatment.
