Croup

A distinctive cough in children that sounds like a barking seal or a foghorn. It is usually caused by a virus that affects the voice box (larynx). There may be a hoarse voice and sometimes by a breathing pattern called stridor. Stridor is a harsh raspy breathing sound heard mostly when breathing in.

The main concern is if the child is having difficulty breathing. The difficulty breathing may be minimal or severe. A child who is having mild or moderate distress in the day may be alot worse in the night. The physician should be seen or at least contacted if they are having moderate to severe breathing difficulty in the day. Children at most risk for getting into trouble with their breathing are usually under 3 years of age. A child may switch from having mild to severe croup several times within the course of the disease.
Croup may be caused by a virus which also causes cold symptoms such as congestion, sore throat and sometimes fever. It affects children between 6 months and about 4 or 5 years old. Symptoms are typically worse at night, or the child may awaken with the first signs of croup in the middle of the night. It peaks in severity over 3 to 5 days and then begins to resolve.
Croup may be caused by a bacteria and is then called bacterial tracheitis. This is less common and more serious. These children have severe difficulty breathing, appear quite ill and are often hospitalized for oxygen and antibiotics.
Children may get croup more than once in their life and some children seem to get it more often than others.

Difficult breathing with continuous stridor or retractions after at least 20 minutes of steam treatment (see below)
Signs of severe or moderate difficult breathing , constant noisy breathing
Signs of severe dehydration
Has excess drooling, spitting or difficulty swallowing
Lips turn bluish with coughing episodes
Unable to bend the neck forward
Unable to lie down comfortably
Is appearing listless, lethargic or difficult to arouse or acting sick

Coughing spasms are worsening or becoming more frequent
Refusing fluids or vomiting and is appearing well-hydrated or only mildly dehydrated
Fever more than 104
Signs of secondary infection - ear infection, pneumonia

Humidifier. Run a humidifier in the child’s room. Cool mist humidifiers are safer to use than the steam vaporizers because of the risk of curious toddlers burning themselves with the steam. Humidifiers must be kept clean and if possibe, distilled water is recommended.

Steamy bathroom. If the child is having frequent croupy cough or becoming stridorous and has constant noisy breathing, take him into the bathroom and run a hot shower. Sit in the steamy bathroom with him for 10 to 20 minutes. Another alternative is to bundle your child up and take him outside in the cool night air if the episode is occurring at night.

Medicines. Antibiotics do not treat viral croup, although secondary infections which may accompany croup, such as an ear infection, pneumonia or strep throat do need antibiotics. Bacterial tracheitis as mentioned above does require antibiotics, but these children are usually hospitalized. Acetaminophen or ibuprofen may be used for fever. Over-the-counter cough medicines are usually not very helpful for croup. If a child is having a lot of difficult breathing, the physician may prescribe oral or injected steroids or give a breathing treatment with a medication called racemic epinephrine.