You're at home, watching television. All of the sudden, you hear a seal
attacking your infant child in the other room. Yes, a seal. You get
up, and run into the room to defend your child, only to find that
what you thought was an angry seal was actually your child making
barking noises, imitating a seal, coughing trying to breathe. Shit.
Or...
You're at home, watching television, and you get up to go check in on your baby. When you
walk in, the first thing you notice is drool. Copious, copious
drooling. Shit.
What's happening to your child? Which one is more dangerous? What should you do?
The two above scenarios are not terribly uncommon in the world. In
the first scenario, the seal-barking-like-cough is a pretty tell-tale
indicator of croup. It's hard to describe the cough other than
seal-like. You'll never know the sound until you hear it, but once you
hear it, you'll know it immediately. The second scenario is most
likely a case of epiglottitis. Epiglottitis is often found in
infants, and is usually indicated by copious amounts of drooling.
Lets talk about the similarites and differences of these two
respiratory conditions that tend to affect infants to toddlers, and
what you should and should not do about them.
The Conditions
Croup is a viral infection, and tends to have a slower onset (over
a few days), and usually occurs along with other infections (ie, your
kid is already sick before this happens). Croup causes the tissue in
the larynx to swell, leading to upper airway obstruction. This causes
both a seal-like barking cough, as well as stridor (high pitched,
whistling sound) on inhalation. Croup is generally self-limiting,
and while it can be dangerous, it doesn't compare with scenario number
two.
Epiglottitis, on the other hand, is a bacterial infection, and has
a much quicker onset (hours, not days), and can occur alone.
Epiglottitis, as the name implies, is the inflammation of the
epiglottis, or the little flap that closes over your
trachea when you swallow. This swelling causes a pretty
severe sore throat: severe enough that it hurts so much to swallow, the
infant stops doing it, leading to copious drooling. Being an
infection, it often presents with fever, and the epiglottis' swelling
can cause the same stridor from above. Your child will very likely be
having respiratory distress with this condition. The epiglottis also,
for lack of a better word, becomes irritable. A wrong move, and it can
snap shut over the trachea, and shit hits the fan. Epiglottitis is a
medical emergency by any standard, and a hospital trip is mandatory.
The Treatment
Should you suspect your child to have either of these conditions (or
any major respiratory distress, for that matter), call 911. Explain
the symptoms to the operator- a call for an infant with respiratory
distress with copious drooling will get you a paramedic with lights
and sirens.
The above is very important. That being said...
For croup, weather permitting, there is a very simple, short term
cure. Cold air. If the fit is happening at night, or if it is cold
outside where you live at the time, take the child outside. You will
likely notice improvement very quickly. However, this improvement is
only temporary, and the distress will eventually return when taken out
of the cold weather. While a case of croup will earn you and your child a
trip to the hospital, you likely won't get to experience a
lights-and-sirens ride.
For epiglottitis, the "treatment" is very different. You need to
keep in mind that this is a very dangerous condition, and it should be
handled carefully. The best advice I have to give regarding treating a
child with epiglottitis is to not piss them off. Really, that's one of
the most important things. Don't irritate the child, and stay calm. Putting
anything in the child's mouth, or trying to look inside of the child's
mouth is very dangerous, and is something you should never, ever do if
you suspect this. I cannot stress the above enough. Don't go
poking around an epiglottitis patient's mouth. One wrong move, snap, the epiglottis goes down, and your day just got a lot
worse (it won't be coming up on its own). The EMTs and paramedics,
when they arrive, will be very calm; don't accuse them of not working
hard enough or not taking it seriously enough- nobody considers
epiglottitis more important than the EMS system. They will try to
sooth your child, be very slow in their movements around him or her,
and very quick with movements away. They will insist you ride in the
ambulance with them, and insist for you to move quickly, but not to
hurry. Again, its hard to describe, but the epiglottis just gets
irritable.
When you get to the hospital, you'll likely run into more than a few
doctors or nurses, depending on how big the hospital is. Epiglottitis
is taken very seriously in the ER, and they will likely try to get an
advanced airway in as soon as possible (the paramedic/EMT's will not
attempt one in the field).
If you have any questions about either of these conditions, please
send a message. Both are serious respiratory distress conditions, and
should be treated as such. I hope you learned something.