Croup turned into a chest infection :-( Ds quite poorly. Advice needed please

[alibobins]

Went back to gp this morning as ds has been stuggling to breath He put him straight on nebuliser and hes on abs aswell as steriods said its turned into a nasty chest infection.

The thing is ds is quite lathargic and just lay on settee wheezing away

Should I go back to gp or see how he goes.

He's upped his ventolin to 5 puffs every two hours.

Do you have a spirometer? Or an asthma action plan?

when I get chest infection (which sets off my asthma - nebulised, steroids etc) I tend to go back to gp if I can't talk.

If he can talk/eat/move I would think it is ok.

HE's gonna be lathargic for a while if he was bad enough to be nebulised this morning and it may be enough that the steriods haven't balanced it out yet (is he on prednislorone (sp?))

But that is for an adult so not sure about child.

Yeah he's on prednisolone.

Is their anything else the hospital could do other than observe him cos hes got all his medicine here.

He hasn't got an action plan- who does them me or his consultant?

Sorry how old is your ds?

Your Gp should have formulated an action plan with you, using the spirometer readings.

This is normal for ds's age......

If it drops to this....increase ventolin

Drops to this....increase becotide

drops to this.......contact GP/go to A&E etc.

Also are you using a spacer?

He's 2.6.

Don't quite understand

If what drops??

His spirometer readings. But given he's 2.6 prob wont be able to take them. You should still have discussed with GP other 'signs' that should indicate he need to be seen like a doctor. Like sternal recession (breast bone dipping in (with each breath) or over use of the muscles in the neck.

With young children I would always see a Dr if you are concerned. Always. drs don't mind examining & reassuring you when it comes to poorly children.

He seems to have calmed down and seems a bit happier. Although he is constantly coughing

He's in bed now buy all I can hear is him coughing it is none stop

Shall i give him tixylix or will it make things worse

and not buy

Has your son still got croup? Or has he juts got a chest infection now?

How is his breathing in bed? If he's finding it difficult I'd get in touch with a doctor. Is he meant to be taking venrtolin that regularly all night?

He will be lethrgic because he is having to work so hard to breathe.

Is he pulling his stomcah in just under his ribs, or is the skin over his throat being really pulled in when he breathes ??

If so, we were always advised to go to a&e when d did this, and were always glad we had.

Never said anything about what to do at night.

He only had the stridor part of croup sunday night and spent the night in hosp

Gp said its a chest infection his chest was really wheezy and his breathing was shallow.

He is breathing really fast but does seem to have a gap of about five mins in between coughing.

I've got a nebuliser at home do you think i should try that.

I think you shoudl call a doctor/NHS 24 myself.

IS it you whose son is asthmatic?

Cold followed by chest infection is the trigger for my dd2's asthma. Might be for your boy?

Better to get him properly comfortable if you have not been able to do that at home

Ok my advice is:

Look for signs of respiratory distress others have mentioned here; indrawing above the breast bone, between or below the ribs, using neck muscles in breathing, sitting up to breathe, finding it difficult to talk in sentences.

Count respiratory rate.

If you are worried, ie signs of respiratory distress plus fast resp rate then give 10 puffs of salbutamol/ventolin via spacer. If no better after this or if gets better but gets worse again within 1 hour then go to A+E.

Do not give nevuliser as there is no evidence that they are better than spacer if a child doesn't need oxygen and if your child needs oxygen then they need to be in hospital.

Poor LO, sounds like many episodes we've had.

If he vomits easily I would not give chesty cough tixylix (or any other?) as it contains expectorant and can make them more inclined (this advice from my GP as mine vomit with coughing)

We always return to ward with any signs of intercostal recession - skin being pulled between ribs.

My be lethargic if shallow breathing/wheeziness due to low oxygen sats.

Can you make the room steamy? Put the end of his bed up on some very thick beeks to prop him up, works better than pillows for lo's.

My GP says to use the ventolin as much as needed during acute episodes - none of the 4 times a day - up to 10 doses an hour. Which if you use a nebuliser in hosp this is a similar dose. Obviously GP will have their own advice for each individual and that rate may not be appropriate for all.

My DS is now 2yrs and 11 mths and he has not been admitted to hosp for chest infection for over 3 months (although it was touch and go in Cyprus 2 weeks ago!) which is a minor miracle, so perhaps things may improve for your LO as he gets older. My DS had max yearly dose of predniselone between 1-2, he's small enough already! Also his teeth have white patches due to all medication.

Hope he feels better soon.

Pointydog- yeah he has got severe asthma and usually i can control it at home

I'm rubbish at deciding if he needs seeing again.

well I agree with dudley.

Give 10 puffs ventolin now. If no better within 10 mins, phone and get him seen to. He may well need oxygen

We were always told that if we needed to give 10 puffs then dd needed to be seen.

I have taken Dd in for less worrrying symptoms and have never been told that I shouldn't of.

Really not wanting to scare you at all, but I took dd2 in once with similar but not as severe symptoms and sat there thinking i shouldn't have taken her as she ran around the waiting room. Within 2 min of her being seen, she was almost unconcious and on a very high level of oxygen, she had pneumonia, and was in hospital for a week.

I really would take him in.

Have a look at his lips and around his mouth - if they appear dull/ blueish then he must be seen - it means his oxygen is low. My ds had this at 9 mths and ended up going to hospital in an ambulance and kept in for 4 days.

Also count how fast he is breathing - I think over 100 was the danger sign.

All the other advice on here is sensible too - especially a steamy atmosphere.

Good luck, and call NHS direct if you are at all worried.

Thanks for all the advice

Ended up taking him to A&E who admitted him for the night. Ds was on 2 hourly nebs but managed without oxygen which was really positive. He has managed on 2 hourly inhalors today so have let us come home again. He is still very up and down and they have given us open acess for 48 hours.

Glad you got that reassurance from them, ali. Hope he does get better soon.

Sorry he is poorly, I hope he feels better soon.

His temp has shot back up this morning Do you think I should take him back in or give him chance to fight it?

alibobins,

My son has really bad asthma as was previously mentioned an asthma plan is a good idea. But that is not going to help you now. Take him back to the doctor and ask for an oral steriod. Everything gets inflamed and swollen and the inhalent steriods become less effective.

Prednizone is heavy duty but it works fast. It is on my sons red plan and I have had to use it a couple of times.

A couple of other tips...Cold foods and drink tend to cause severe coughing fits so try warm or room temp fluids. Steamy showers are good and cool air can work wonders. Oooh and most important lots of love, hugs, and back rubbing.

I hope he feels better real soon!

Leati- Thanks for the advice Ds is already on prednisolone 4 tablets a day for 5 days.

He is eating some toast at the min but is getting really out of breath