The Cough that Barks:  What to Know when your Child has Croup

by Stuart Slavin, MD, FAAP

One illness that we see a lot in young children, especially during the fall and winter seasons, is that dreaded disease that we call “croup”. Croup is notorious for coming on suddenly, without warning, often in the middle of the night, or in the early morning hours. Here’s what you should know about this common, but scary, disease of childhood.

The term “croup” refers to the illness caused by a type of cold virus that specifically affects the upper part of the airway, right below the vocal cords.  Although croup can occur at any age, young children (usually under the age of 3 years) are the most likely to be affected, since their airways are small to begin with, and so a little inflammation, swelling, and narrowing of the airway can cause a lot of problems. When your child has croup, in addition to the normal symptoms of the common cold (fever, runny nose), he will also start to show – often very suddenly, and at night – signs of irritation and swelling of the vocal cord area. The symptoms you will notice include some or all of the following: a hoarse voice (like “laryngitis”), a characteristic barky cough (which sounds more like a seal barking than a normal human cough), and, in more worrisome cases, the child’s breathing might become very noisy and labored, as he struggles to breathe through a narrowed upper airway. This breathing noise is called “stridor”, and is a husky throaty noise. This stridor, which is a specific sign of croup, is very different from “wheezing”, which is a high-pitched whistling sound on exhalation which comes from the lungs of children with asthma and other lung infections.  The typical sounds of croup can be heard by clicking on the audio file above this paragraph.

Since croup is caused by a virus, not a bacteria, antibiotics are not at all helpful, and the illness ultimately runs its course on its own, like other viruses. However, since the illness can cause trouble breathing, it is something we take seriously, and for the more severe cases, after examining your child, we might prescribe a short course of oral steroids for your child. Steroids are medicines that reduce inflammation and swelling, and so they are very effective in “opening up the throat” of children with croup. This can be very helpful at getting a child through the first few nights of croup, which are usually the worst. After that time, the cough will “loosen up”, the breathing will become more comfortable again, and the illness typically turns into a bad cold with a loose cough, which then resolves on its own like any other cold, usually within 7-10 days.

Not all cases of croup need to be treated with steroids. For the milder cases, there are several things you can do to make your child more comfortable. Humidifying the air (such as with a cool mist vaporizer) or putting your child in a steamy bathroom might make him more comfortable. Often, breathing cold air can help open up your child’s airway pretty dramatically. On a cold night, bundle up your child and sit with him outside quietly for 20 minutes, and often he will improve. Keeping your child calm is especially important, because with agitation or crying, he will attempt to breathe more heavily, which causes the stridor to get worse.  Or you can bring him to the kitchen and stick his head in the freezer, which can be soothing as well. Of course, at any time, if you are concerned about your child’s labored breathing, the best course of action is to call us or bring him to the emergency room. In addition to steroids, there are special breathing medicines your child can receive in the ER to open up his airway in a hurry.

Like most other viruses, croup is contagious. Other children can catch croup from a child with croup, and adults can catch a nasty cold (often laryngitis) from a child with croup. Handwashing is always the best way to keep respiratory illnesses from spreading.