Fast forward to this past Tuesday (February 12th). As usual, I got home from work at about 5:15p.m. Peggie brought me up to speed on Ryder's after-school status (i.e. his mood, how much he ate for dinner, whether he seemed tired, etc.). I also reviewed the summary sheet that his teachers send home from school each day. From these sources, I confirmed, as usual, that Ryder had eaten well, taken his typical nap, pooped like a pro, and generally been in a good mood that day. Peggie did make one casual comment, mentioning that Ryder's nose was a tad crusty that afternoon. I asked whether she thought he was coming down with a cold, and she said something along the lines of "it's possible, but he's certainly in a good mood today." She left and I played with Ryder until Blake got home. Then we both played with him until his bed time. We saw no indication that he was feeling even remotely under the weather. We changed him and put him to bed at about 7pm, and he fell right asleep.
Blake and I were both asleep by 11:00 p.m. At midnight, I woke up to sounds from Ryder's monitor. I strained my ears and heard Ryder crying softly (or at least I thought that is what I was hearing). I could see on the video monitor that he was still laying down, so I figured that he would fall back asleep on his own. I did think it was odd that he was crying so softly. Ryder doesn't usually wake up during the night anymore, but on the rare occasion that he does, he makes himself heard. I waited 5 or 10 minutes and then begrudgingly rolled out of bed to go check on him. I never expected to find what I found when I entered his room.
The instant I opened his door, I could see that something was very wrong. Ryder was gasping, and I mean GASPING, for air. Each breath that he took was insanely loud, labored and accompanied by a bizarre whistling sound. My first thought was that he was having an asthma attack. He'd never had an asthma attack before, but he's had mild issues with asthma so it seemed like a reasonable assumption. Dr. Friedman had explained to me in the past that babies who get RSV are often prone to ongoing respiratory issues, including asthma. We were given a nebulizer machine to administer breathing treatments during the course of Ryder's bout with RSV, and it had not been uncommon for Ryder to need nebulizer treatments whenever he came down with a cold ever since that bout with RSV. I scooped Ryder up and ran to the bedroom to wake Blake. I semi-calmly ordered Blake to come help me set up the nebulizer. If Ryder was having an asthma attack, I knew that I needed to get nebulized albuterol into his system as quickly as possible to open his airways. It took Blake a couple of minutes to fully wake up and process what was going on, but as soon as he zeroed into his surroundings, I saw a bit of fear creep into his eyes. Often times Blake thinks I overreact when it comes to Ryder's health, but this time, there was no question that we were dealing with something very serious. Within three or four minutes of scooping Ryder up from his crib, I was sitting with him in his glider and administering the breathing treatment. While doing so, Blake and I began debating what to do. Ryder's breathing was unlike anything either of us had ever heard before, and it wasn't improving or changing as I was giving him the breathing treatment. I had no clue whether I needed to call 911 or rush him to the hospital or simply call the after-hours nurse's line at the pediatrician's office or perhaps none of the above.
I called the after-hours line first. The operator took my information and told me that a nurse would call me back within the hour. I knew that I couldn't wait an hour, or even ten minutes, to make a decision, but I just prayed that I'd get an immediate call back. I then decided to call my mom. I hated to wake and scare her if the situation wasn't truly as emergent as it seemed, but she has experience with asthma and asthma attacks. My older brother Aaron has asthma, and I knew that my mom had taken him to the ER on multiple occasions for asthma attacks when Aaron was a kid. My mom picked up the phone right away, correctly assuming that something was wrong. I started to explain the situation and ask for advice, but she interrupted me before I could finish. She could hear Ryder's respiratory distress in the background (yes, it was THAT loud), and she told me I needed to take him to Cook's right away. As I was hanging up the phone with her, the nurse's call came in. Again, I did not need to offer much explanation because the nurse could hear Ryder's breathing in the background. In a nutshell, she told me to take him to Cook's ER as quickly as possible but to run a steaming hot shower and take Ryder into the bathroom to breath in the steam for a few minutes before loading him up in the car (as long as his lips weren't turning blue yet, which they weren't, and as long as Ryder was fully conscious, which he was). While Blake ran Ryder into the bathroom and cranked up the hot water in the shower, I threw on my clothes and grabbed Ryder's diaper bag. I'd say that we were out of the house by 12:25a.m., approximately twenty-five minutes after finding Ryder in respiratory distress.
Although I had seen no improvement in Ryder's breathing after the nebulizer treatment, I did notice marked improvement on the way to the hospital, which I assumed was from the steam shower. The whistling and wheezing was quieter, and his breathing, although noisy and unnatural, wasn't nearly as labored as it had been before.
One time before leaving for the hospital, and once during the car ride to the hospital, I heard Ryder cough. The cough sounded like a seal bark. It was very different from a normal sounding cough. Somewhere back in the cobwebs of my brain, I remembered hearing that a bark-like cough is a sign of croup. So during the ride to the hospital, I definitely began to wonder whether Ryder had croup. However, he literally had only let out two of these strange sounding coughs, and I had thought that croup was all about coughing, so I just wasn't sure.
Our experience at the Cook's ER this time around was excellent. Thank god. The moment I walked in, I was met by a staff member who asked me a few questions and escorted us into a back room. We were in the waiting room for a grand total of 20 seconds, at most. Hospital techs began taking Ryder's vitals and asking questions. I heard them throwing the term "stridor" back and forth, but I had no clue what that word meant. We were shown back to a private ER room within five minutes of our arrival. The remainder of the ER visit proceeded in the same fashion. We were seen by a nurse immediately and a doctor followed only minutes later. The doctor listened to his breathing and instantly diagnosed Ryder with croup. When I told the nurses and doctor that Ryder's breathing was ten million times better than it was when I went into his room at midnight, they were surprised. I guess they thought he still sounded pretty bad.
The doctor explained that the nebulizer treatment that I gave Ryder at home wouldn't help for croup-related breathing problems because albuterol operates to open airways in your lower respiratory system, whereas respiratory swelling from croup affects the trachea, larynx, etc. In other words, respiratory complications from croup cause your throat to close up and normal asthma medication doesn't help. The doctor ordered a breathing treatment with a different type of medication (epinephrine) and a dose of long-lasting oral steroids to help the inflammation go down. The doctor explained that we'd need to wait in the ER for two hours after the breathing treatment to make sure that Ryder's breathing remained stable once the epinephrine started to wear off. He cautioned that Ryder would have to be admitted to the hospital if he was still having breathing difficulties after the two hours were up. I got the impression that the doctor felt that we wouldn't be going home any time soon. The primary concern was that Ryder's breathing was as bad as it was while he was in a calm, relaxed state. Apparently, breathing problems usually arise with croup when a child is agitated and crying (which makes sense), but Ryder was calm (and perhaps even listless) during the entire ordeal.
A nurse brought in the steroids and nebulizer as soon as the doctor left the room. Ryder is typically pretty good when I administer nebulizer treatments at home, but I guess the fact that he was sleep-deprived and not feeling well did not lend itself to an easy administration of the medication. Ryder screamed and flailed during the entire five minutes that it took to give him the treatment. It took me, Blake and the nurse to hold him down, which was awful. But within a half hour of giving him the treatment, I felt pretty confident that we'd get to go home after our wait. Ryder's breathing had improved dramatically. Indeed, after our two hours were up, the doctor came in and was very pleased with Ryder's progress. We were discharged from the ER at about 3:30 a.m.
It really was such a "good" ER experience. I automatically associate ERs with looooong miserable waits, and we simply didn't encounter that at Cook's (at least on this occasion). I think the expediency of our visit resulted from a combination of three separate factors: (1) we lucked out and the ER wasn't crowded upon our arrival, (2) respiratory distress takes high priority, and we probably would have been seen right away even if there had been a crowd, and (3) Cook's is just a really great children's hospital that is run like a well-oiled machine. I hope that I never have to take Ryder to the ER again, but if I do, I won't have the same sense of added fear/dread that I had after the pre-NICU emergency room visit (but before this recent croup visit).
Ryder was also pretty well-behaved while we were in the ER (other than during the breathing treatment, when he acted as if he were possessed by demons and miraculously demonstrated the strength of a two-ton gorilla while fighting off both of his parents and the nurse). His relatively good behavior was impressive given the fact that he obviously wasn't feeling well. He isn't the type that will sleep while there is any type of action going on around him, so he was awake and even a bit slap-happy once the breathing treatment took effect and he began feeling better, which definitely wasn't fun for me and Blake to deal with at three in the morning... But still, he wasn't crying or fussing, so we really couldn't complain. He finally did pass out in Blake's arms... ten minutes before the doctor walked in and discharged us.
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| The sweaty, exhausted, heap-of-a-mess baby finally passed out. |
As always, I've jabbered on and on and turned a simple story into a long-winded saga. However, for any of you who made it all the way through this blog entry and are left with questions about croup, I'm going to include some medical information. My thought is that anyone with a baby/toddler who doesn't already have first-hand knowledge about croup will likely head straight to Google after reading this post to find out more information (since this post makes it sound like such a scary, sudden thing). Hopefully the following excerpt will reassure you that croup is relatively common, usually not a terrible ordeal, and rarely ends up requiring a hospital visit (Lucky us). The following summary is thorough and easy to understand. I even highlighted the parts that I thought were reassuring (i.e. croup is usually fairly mild) and also the parts that specifically applied to Ryder. Interestingly, Ryder never had a fever and only emitted a barking-like cough a handful of times even though both of those symptoms typically accompany croup.
About Croup
Croup is a condition that causes an inflammation of the upper airways — the voice box (larynx) and windpipe (trachea). It often leads to a barking cough or hoarseness, especially when a child cries.Most cases of croup are caused by viruses, usually parainfluenza virus and sometimes adenovirus or respiratory syncytial virus (RSV). Viral croup is most common — and symptoms are most severe — in children 6 months to 3 years old, but can affect older kids too. Some children are more prone to developing croup when they get a viral upper respiratory infection.
Most cases of viral croup are mild and can be treated at home. Rarely, croup can be severe and even life threatening.
The term spasmodic croup refers to a type of croup that develops quickly and may happen in a child with a mild cold. The barking cough usually begins at night and is not accompanied by fever. Spasmodic croup has a tendency to come back again (recur).
Treatment of symptoms is the same for either form of croup.
Signs and Symptoms
At first, a child may have cold symptoms, like a stuffy or runny nose and a fever. As the upper airway (the lining of the windpipe and the voice box) becomes more inflamed and swollen, the child may become hoarse, with a harsh, barking cough. This loud cough, which is characteristic of croup, often sounds like the barking of a seal.
If the upper airway continues to swell, it becomes even more difficult for a child to breathe, and you may hear a high-pitched or squeaking noise during inhalation (called stridor). A child also might breathe very fast or have retractions (when the skin between the ribs pulls in during breathing). In the most serious cases, a child may appear pale or have a bluish color around the mouth due to a lack of oxygen.
Symptoms of croup are often worse at night and when children are upset or crying. Besides the effects on the upper airway, the viruses that cause croup can cause inflammation farther down the airway and affect the bronchi (large breathing tubes that connect to the windpipe).
Contagiousness
Outbreaks of croup tend to occur in the fall and early winter when the viruses that cause it peak. Many children who come in contact with the viruses that cause croup will not get croup, but will instead have symptoms of a common cold.Diagnosis
Doctors can usually diagnose croup by listening for the telltale barking cough and stridor. They will also ask if your child has had any recent illnesses with a fever, runny nose, and congestion, and if your child has a history of croup or upper airway problems.If a child's croup is severe and slow to respond to treatment, a neck X-ray may be done to rule out any other reasons for the breathing difficulty, such as a foreign object lodged in the throat, a peritonsillar abscess (collection of pus at the back of the mouth), or epiglottitis (a inflammation of the epiglottis, the flap of tissue that covers the windpipe). An X-ray of a child with croup usually will show the top of the airway narrowing to a point, which doctors call a "steeple sign."
Treatment
Most, though not all, cases of viral croup are mild. Breathing in moist air helps most kids feel better, and ibuprofen or acetaminophen (only in children over 6 months old) can make them more comfortable. As with most illnesses, rest and plenty of fluids are recommended.The best way to expose your child to moist air is to use a cool-mist humidifier or run a hot shower to create a steam-filled bathroom where you can sit with your child for 10 minutes. Breathing in the mist will sometimes stop a child from severe coughing. In the cooler months, taking your child outside for a few minutes to breath in the cool air can ease symptoms. You also can try taking your child for a drive with the car windows slightly lowered.
Consider sleeping overnight in the same room with your child to provide close observation. If you cannot break your child's fast breathing and croupy cough, call your doctor or seek medical attention as soon as possible.
Medical professionals will evaluate your child if the croup appears serious or there is a suspicion of airway blockage. Doctors often treat croup with steroids to decrease airway swelling. For severe cases, doctors will give a breathing treatment that contains epinephrine (adrenalin). This reduces swelling in the airway quickly. Oxygen also might be given, and sometimes a child with croup will remain in the hospital overnight for observation.
Duration
Croup symptoms generally peak 2 to 3 days after the symptoms of the viral infection begin. Viral croup usually lasts 3 to 7 days.Complications
The vast majority of children recover from croup with no complications. Rarely, a child can develop a bacterial infection of the upper airway, or pneumonia. Dehydration may follow inadequate fluid intake.Children who were born prematurely or who have a history of lung disease (such as asthma) or neuromuscular disease (like cerebral palsy) are more likely to develop severe croup symptoms and often require hospitalization. Still, croup rarely causes any long-term complications.
Prevention
Frequent hand washing and avoiding contact with people who have respiratory infections are the best ways to prevent spreading the viruses that cause croup.When to Call the Doctor
Immediately call your doctor or get medical attention if your child has:- difficulty breathing, including rapid or labored breathing (*Ryder had this)
- retractions: when the skin between the ribs pulls in with each breath (*Ryder had this)
- stridor: high-pitched or squeaking noise when inhaling (*Ryder had this)
- a pale or bluish color around the mouth
- drooling or difficulty swallowing
- a fatigued appearance (*Ryder had this)
- signs of dehydration (including a dry or sticky mouth, few or no tears, sunken eyes, thirst, no urine or only a little dark yellow urine for 8-12 hours, extreme tiredness)
- a very sick appearance
