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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.

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