Croup is a very common childhood illness that generally occurs during the fall and winter, and most often affects children three months to five years of age. Croup is usually caused by a virus (most often parainfluenza, influenza, or adenovirus), which produces swelling of the vocal cords, voice box (larynx), and windpipe (trachea). A croup episode usually lasts about three to five days.

The illness usually begins like a cold, with runny nose, dry cough, and low-grade fever. Children then develop the characteristic odd-sounding cough, which is often described as tight, low-pitched, and “barking.” This barking cough usually first develops at night, several hours after the child has gone to sleep. It may be accompanied by a harsh, high-pitched sound while breathing in (inspiration). This is called stridor. This inspiratory noise occurs when the opening between the vocal cords becomes narrowed. As a result, children with croup may work harder to breathe and may also develop a hoarse voice due to the swelling of the vocal cords.

Breathing warm, moist air can help your child to relax the vocal cords and liquefy accumulated mucus, thereby increasing the size of the airway and reducing the stridor and barking cough.

• Turn on the hot water in the bathroom shower and sit with your child in the steamy bathroom for about 15 minutes.
• Then bundle your child up and take him or her outside into the cold night air, which will further help to reduce airway swelling.
• Stay outside for a few minutes. If it is not cold outside, you can stand with your child in front of the open refrigerator freezer instead. These two actions, in combination, often work very well to alleviate the airway swelling that is the hallmark of croup.
• Additional strategies for relieving the symptoms of croup include using a humidifier in the bedroom and providing warm, clear fluids to drink.
• Antibiotics are not helpful, since croup is a viral process.

If stridor persists after the steam/cold-air treatment, or if your child is drooling or having difficulty swallowing, please call the office, whatever the time of night. If your child turns blue, becomes unconscious, or stops breathing, call 911 immediately.

Once your child is breathing comfortably, you may put him or her back to sleep. A dose of acetaminophen or ibuprofen can help to relieve the fever and sore throat that often accompany croup and reduce inflammation further. Upright positioning in the crib or bed may also help to keep symptoms at bay. Some parents prefer to sleep in the same bed with a croupy child in order to monitor the breathing. If the stridor and barky cough return, repeat the steamy air/cool air process.

Please call our office in the morning if your child has had a difficult night or continues to have stridor or a barky cough during the day. Often the second and third nights are worse than the first, and croup can last up to a week. We will evaluate your child’s airway and breathing and may give a dose of oral steroid in order to speed the reduction of airway inflammation. Rarely, a child with croup may require a short hospital stay for monitoring and supportive care.

Croup is contagious for about the first three days of the illness and until the fever is gone. Once your child feels better, he or she may return to school or daycare. Most children with croup can be cared for at home without our help, but we are always happy to speak with you by phone or see your child in the office if you are concerned.