Croup: Symptoms and Management (Pediatric Nursing)

00:01 Now let's talk about the signs and symptoms of croup.

00:03 It typically starts as a mild cold, but it can progress quickly.

00:08 The cough associated with croup is very characteristic, and the parents will often say that their child has a croupy cough when they bring them in for care.

00:16 It sounds like a barking or a seal-like cough, and you'll know it when you hear it.

00:22 Signs and symptoms of the respiratory tract include difficulty breathing, fast breathing or tachypnea, noisy breathing, shortness of breath, wheezing, and stridor.

00:33 As the respiratory status worsens and the work of breathing increases, the child may become anxious or agitated as they become air hungry.

00:41 They may also have a lot of secretions to clear and also have a sore throat from all of the coughing and the irritation in their airway.

00:49 Their nose may have clear nasal congestion, and the child may have a hoarse voice or laryngitis.

00:56 Symptoms of croup are always worse at night and when children are crying or upset.

01:01 The clinician will want to limit their agitation during the exam to minimize exacerbating these symptoms even further.

01:08 Croup is a clinical diagnosis.

01:10 There's not an actual lab test to diagnose this.

01:13 It's based on the history.

01:14 Has the patient had any recent colds, including a fever, runny nose, nasal congestion, a sore throat or cough, and the physical exam.

01:24 The clinician's going to interpret the vital signs and will perform a full physical exam, including the head, eyes, ears, nose, throat, cardiac, respiratory, and skin systems.

01:37 The child will also have usually a barking cough during the visit, and have a hoarse voice and some inspiratory stridor.

01:45 The child may have a low-grade fever and typically, with croup, there's an absence of wheezing.

01:50 This is different than children with asthma or a reactive airway.

01:56 How do you manage croup? Well, most cases are a mild viral illness that can be managed at home, but rarely, croup can be severe or life threatening.

02:05 Unfortunately, we don't have any medications that will make the inciting virus go away any faster.

02:10 So the focus on croup is on making the child more comfortable while the virus can run its course.

02:15 Remember, antibiotics do not treat viral infections.

02:21 The first step in managing croup is to administer corticosteroids.

02:24 This could be dexamethasone or prednisone, and this is a mainstay treatment to help decrease the swelling in the upper airway.

02:32 Unfortunately, these medications take a while to work.

02:34 They can take 4 to 6 hours, so you want to give them early in an outpatient setting so they can get on board before the symptoms worsen that night.

02:43 Another option in more extreme cases is racemic epinephrine.

02:47 This is when the patient's airway is being acutely compromised and the patient does not have hours to wait on their steroids to work.

02:54 This is administered via a nebulizer treatment.

02:57 It will very quickly decrease the airway swelling and should be done in a hospital setting because any patient that requires racemic epinephrine is at risk for airway compromise due to the severity of their croup.

03:09 Here's a child receiving racemic epinephrine nebulizer treatment, and you can see they also have a nasal cannula with some supplemental oxygen.

03:17 Another management technique is to administer acetaminophen or ibuprofen.

03:21 This can help decrease the sore throat associated from the coughing, and can also make the child just generally feel better.

03:28 Remember, ibuprofen can only be administered in >6 month olds.

03:32 A controversial management technique is humidified air.

03:35 It has debatable efficacy.

03:37 It used to be the mainstay, but delivery devices have been evolving and humidifying crib tents are no longer used.

03:44 In studies, they found that the particle size created by blow by humidifiers is not optimal for deposition in the larynx.

03:51 And also, they've studied warm and dry or cool and dry air, and that actually produced the greatest reduction in airway resistance, whereas there was no reduction in the moist air group.

04:02 Some countries have completely abandoned this treatment regimen, although in the United States, the standard for inpatient and outpatient management of croup still includes humidified air.

04:12 In the primary care setting, you're going to want to create a steam-filled bathroom or bundle the child up and take them outside into the moist air.

04:19 If it's cool outside, the parents can also roll the windows down in the car.

04:25 Complications of croup are rare.

04:27 They can include secondary bacterial infections after the viral infection has passed.

04:32 This includes ear infections, sinus infections, and pneumonia.

04:38 Dehydration can develop, and this can be because the child's breathing faster, they're going to lose more fluids through their insensible water loss with their breathing.

04:47 In addition, they may feel really lousy and they just might be napping most of the day, missing out on opportunities to drink, and they may also have a sore throat.

04:55 And all of these factors can put the child at risk for dehydration.

04:59 Encourage the parents to push fluids and encourage water-rich foods such as Jell-O, applesauce, pudding, fruits, and popsicles.

05:08 Respiratory distress can also develop with croup.

05:12 Some children are going to develop complications that need additional respiratory support.

05:17 It's important for the clinician to perform frequent and thorough respiratory exams to watch for signs of decline.

05:24 The child may need additional support including oxygen, IV fluids, and racemic epinephrine.

05:30 Children with increased risk factors include those with a history of lung or neurologic disorders, such as asthma, and children who are more likely to develop severe croup symptoms may require hospitalization.