Prevent and prepare

• Caregivers and parents of young children should be aware of croup, including how to recognise it and what to do.

Early recognition

The child may have:

• shortness of breath
• a hoarse cough
• noisy (rasping or squeaky) breathing (stridor)
• croaky voice.

The caregiver or child may be alarmed by the sound of the child’s breathing.

First aid steps

1. Calmly reassure the child and help them into a comfortable position (usually sitting).
2. Measure the child’s temperature. If they are running a fever, treat it (see Fever).
3. Breathing in warm, humidified air (e.g. being near a running shower, or hanging over a bowl of hot water) may help to calm down and distract the child. Make sure the water is not too hot to avoid burns.
4. Monitor their breathing and level of response closely. If the episode of croup is severe or persists, access emergency medical care.

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NOTE

A child with croup may find their condition alarming. Remaining calm may help them to be calm and ease their symptoms.

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 Access help

• If the child is having severe breathing difficulty (they are sitting up, bent forward, mouth open, using accessory muscles for breathing such as their neck and shoulders, moving their nostrils, or a hollow forms at the base of their neck), access emergency medical services immediately. Be aware that symptoms can worsen from mild to severe within a few hours.
• Epiglottitis is a croup-like condition which can cause a small flap in the throat to swell and block the airway. A child with epiglottitis needs urgent medical care. If in any doubt access medical care.

Recovery

After the first episode of croup, carers of children may recognise the signs of a recurrence more quickly and act accordingly.

Context considerations

• In some contexts, treatment has included putting the child in a steamy bath or encouraging them to inhale the steam. In doing this, there is a risk of burning the child if hot water is used, so this treatment should only be recommended in contexts where it can be done safely.
• Words or expressions to describe the hoarse cough that accompanies croup vary in different countries and regions. Programme designers should base the learning design on the common words used by local learner groups.

Learner considerations

• Parents and people who care for young children would benefit from learning about this topic.

Facilitation tips

• Talk about the different words that may be used to describe the sounds of coughing and breathing during an episode of croup (e.g., barking cough, hoarse, squeaky, stridor). Create a glossary and mutual understanding of what these mean.
• Use audio clips to help learners identify the specific kind of cough that accompanies croup.
• Many parents have experienced croup, so using storytelling, scenario-based learning and sharing experience with other parents can be both reassuring and a useful way to learn about this topic (Hartgling et al., 2010; Luckie, 2019).
• Emphasise the importance of seeking medical advice if the condition does not subside.
• Learners may like to see a simple diagram of the upper and lower airways to understand the mechanics of what is happening in the body during an episode of croup.
• Talk about how learners might be able to create a safe, warm humidified environment and the associated dangers of using water that is too hot.

Facilitation tools

• Some facilitators use the acronym CRY to support education on croup (or learners could make up their own that they find easy to remember):
  >    C: cough and cry in a hoarse voice
  >    R: respiratory distress (shortness of breath)
  >    Y: young child.

Learning connections

• Connect with differences in recognising other conditions like stridor, Choking, Sore throat, Breathing difficulties and Asthma attack. This could be done with the support of a diagram to show the relationship between the upper airways and the mouth and food pipe.
• Link to the risk of Burns if the method to create humidity uses water that is too hot.