The little girl with Croup...

I remember the most challenging time since becoming a mum was when Alyvia had Croup.

I had witnessed it before, when I observed children come into the emergency department, but I later learned that the symptoms had always reduced by 50% by then. I never really witnessed Croup at its worst in live action. That’s because it typically occurs in the middle of the night, when the child is sleeping. By morning, symptoms are usually MUCH better.

Alyvia’s croup experience occurred around the end of September 2016 and we were approaching my birthday. I was looking forward to celebrating my first birthday with Alyvia. I had so many plans but it just wasn’t meant to be.

She was 8 months old, and I was 2 months pregnant.

She had one of her usual colds…a runny nose and difficulty breathing as her nose was blocked. Her appetite was reducing by the day and we just hoped she would naturally increase her oral intake as she got better.

She then started to get a temperature overnight and after 7 or so days of regular Calpol and Ibuprofen, we started a course of antibiotics. Although we weren’t convinced this was a bacterial infection, we hoped the treatment would improve her somewhat. After 5 days of antibiotics, things didn’t change at all. Alyvia was back to eating purees (if we were lucky) but she only really wanted water and milk. The only way she could get any sleep at night was if she slept upright on us, but that too was disturbed sleep and she was tired throughout the day as a result.

Every night her breathing became worse and she began drooling a lot. By the morning, she was better and we put things aside thinking she was getting better. At night, she would go downhill again. Her breathing became loud and laboured and there were frequent pauses. This carried on for a few days.

One night, CD and I discussed our concerns with each other. We knew what the GP would say if we took her for a routine appointment, something along the lines of wait and watch, look out for worrying signs etc. I decided to call my friend who was a paediatrician. She suggested we look for sources of infection, send in a urine sample, let her have some blood tests etc. We also happened to mention that she had a dry cough. Croup was suggested and we kept it in the back of our minds.

The following night, Alyvia barely slept at all. Her breathing was difficult. It was painful to watch her struggle. She couldn’t breathe and had her mouth open, tongue sticking out and drool coming out just so that she could try and breathe. She was literally gasping for breath. There were seconds where she would stop breathing altogether. It was 3am. I remember CD saying to me ‘Why are we letting our daughter go through this??’. A few minutes later, we called the ambulance. As doctors, we knew it was time (in fact, it was time a few nights ago), to get her taken into the hospital…we both feared she would stop breathing very soon. She was tiring, desperate for air and drowsy. It was the worst day of my life.

After answering some basic questions over the phone and staying on the phone with the first responder, we managed to get dressed and pack a basic bag for Alyvia as we knew an ambulance was on its way. 3 minutes later, our doorbell rang and the paramedics came in to assess Alyvia. They took one look at her and decided that she needed to go into hospital urgently. In the ambulance, they agreed this was and sounded like Croup and gave her some steroids to take orally.

By the time we reached the emergency department, Alyvia’s breathing was much better and she was beginning to behave like herself again. When the doctor finally came to see her, she was much better and we could only describe how bad things were a few hours earlier. He agreed this was most likely Croup and didn’t want to take any bloods in case she became distressed and had difficulty with her breathing again. They decided to monitor her for the day and review again later on. Alyvia was fine during the day, she was her usual bubbly self despite what was going on but we were exhausted. When the doctor returned, he reassured us that things looked better and that we needed to give her a second dose of steroids at home before she slept and things would settle in a few days to a week. We were happy to take her home and look after her. It was my birthday the following day and I wanted to spend time with her in our own environment.

Later that night at around 4am, things got very bad again, despite giving her the steroids earlier on. She was gasping for breath again and her lips were looking blue. We called the ambulance again and this time took a video of how she was. The crew came immediately and she was taken into hospital again. She was given more steroids in the ambulance and by the time the doctor came again, she was her usual self and breathing much better. This time around, we showed the doctor the video we took and he looked a little surprised but did say that Croup is at its worse in the middle of the night and by the time the children reach hospital, they are usually much better. We certainly didn’t want to take the risk again.

She was monitored for the rest of the day and this time discharged with a longer course of steroids. The next few days were a blur for us. With little sleep, and immense worry we managed to slowly get over the severe episode. Alyvia’s appetite slowly returned and after about a month, she was back to her usual self again and gaining weight.

From then on, we decided we did not want her to sleep in her own room anymore and brought her into our bed. Sleep training was postponed for the time being (and never actually happened with Alyvia). I had no time to think about the little baby growing inside me. As harsh as it sounds, I didn’t care about anyone else other then Alyvia.

Although my birthday was spent in hospital with Alyvia, I was happy that things eventually settled and when she was better, we went out for a little belated birthday dinner.

Some things you need to know about Croup

It usually occurs in the winter months and is caused by a viral infection that affects the upper airways resulting in inflammation of them. The symptoms are a barking, raspy cough and difficulty in breathing. The airways become so inflamed, they start to narrow, causing it to become difficult to breathe (which is what happened to Alyvia).

Your child may start off with the usual symptoms of a cold with a runny rose and temperature but then things may escalate quickly with a barking cough, difficulty in breathing and swallowing (worse in the middle of the night). Mild croup is usually managed as per any viral infection with conservative management. In severe cases, you may hear a harsh noise when your child is trying to breathe in. This is called stridor and is a dangerous sign, in fact it is a medical emergency. Their airways have become so narrow, that breathing can stop altogether imminently. If this occurs, call the ambulance straight away, your child may need to have a tube inserted into their throat for them to breathe properly.

If your child has recurrent croup, exposing them to fresh air in the early morning is usually good for their airways and recognizing the symptoms early allow you to monitor symptoms better. Alyvia’s case was her first episode and ever since then, during the winter months, we are very careful with her and tense up with every small cold.

Most children manage very well without needing hospital admission but I would advise seeing your GP or seeking some medical attention in order to ensure things are going in the right direction.

So what have I learnt from this episode? Croup can manifest in varying severities. What I see as a doctor in hospital, may not be what was actually happening when the initial 999 call was made and I need to be aware and trust parents’ accounts of what they saw. Many parents have experienced croup with their children, but not all episodes of croup are the same and one must treat each case individually.

Being a doctor does not mean that I know it all and know what to do if my children are unwell. In some cases, it is quite the contrary. Yes my children DO get unwell too, some may even say possibly more then non medic parents’ children, so please don’t assume we don’t experience the same emotions as you do. We are ALL parents at the end of the day and are on this journey together.

I have included an audio adjacent to this post (it appears on the home page) of how she sounded when she had breathing difficulty...you can hear her stopping and then starting again.

Lastly, if you happen to ever read this Alyvia, I love you very very much.

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