Dr Phil: What can I do to ensure my two-year-old doesn't get croup?

Asthma and croup are two breathing issues that make up a large percentage of the children’s consultations I see over the winter and spring months.

Although they often happen at the same time, they are unrelated conditions with specific symptoms and treatments.

Croup is a condition in which the vocal cords become swollen due to viral infection. This can cause a distinctive, seal-like barking cough.

It tends to last approximately five days, with the symptoms getting worse over days one to three and then starting to resolve. I

It tends to worsen at night, which can be exhausting for everyone.

As it is a virus, antibiotics will do nothing to help.

We used to recommend steaming as a home-based treatment, but now we know that cold air is much more beneficial to children with croup — so opening a window can provide relief. 

It is also important to try to remain calm as if your child becomes stressed, breathing will become more difficult.

Even though a croup cough sounds terrible, it is not a symptom that we treat.

We advise parents to look out for difficulty in breathing. This can cause a symptom called stridor, which some patients describe as “like Darth Vader breathing” and is usually loudest when breathing in. 

If this is happening, or if you notice your child is struggling with breathing, it’s a good idea to seek medical attention.

We may give the child steroids, which will reduce the swelling and make breathing easier. This course of medication doesn’t settle the cough, but helps the breathing — the cough has to settle on its own.

Asthma is caused by the muscles on the smaller airways in the lungs tightening and obstructing breathing.

This will cause a wheeze (loudest when breathing out). Asthma can be made worse by infections, viral or bacterial, allergens, and exertion or emotion. Asthma is relieved during an attack by a reliever inhaler (the blue one), but the consistent use of the preventer inhaler (often brown) is far more important. If asthma is well controlled, your child will not be at a higher risk of developing chest problems than someone who does not have the condition.

Well-controlled asthma is when you do not need to use the reliever inhaler more than twice weekly. 

If you are using it more, we need to increase the use of the preventer. Over-reliance on the reliever increases the frequency and severity of asthma symptoms.

Children with breathing difficulties, such as asthma, recurrent croup, or allergies, should be more careful to get all vaccines. 

This would include the whooping cough vaccine, which they should get as part of their childhood vaccines, and the flu vaccine.

If you have a question for Dr Phil Kieran, please send it to parenting@examiner.ie.