Croup

The seal-bark sound of a croupy cough is quite distinctive … once you’ve heard it, you can recognize it from two grocery aisles away.  Of course, it usually starts in the middle of the night, so maybe you won’t be grocery shopping at that time …  Here’s a youtube video that’s a pretty good representation.  The croup cough is the first one described/labelled in detail.  In real life, the bark usually sounds deeper.

Croup is a viral illness, caused by many of the same viruses that give your child a typical runny nose and regular cough of a regular cold.  However, what makes it different is that it not only causes inflammation of the nasal passages (thus causing a runny nose), it also causes inflammation of the vocal cords, the folds of tissue that open and close the airway.  In children (infants, toddlers, preschoolers, usually not any older but sometimes also older kids) the airway is small enough that there could be significant airway blockage if the vocal cords are swollen enough.  Usually, the peak of swelling/inflammation is day 3-5, so after that the barky cough evolves into just a regular mucousy cough, and eventually by day 7-10 the cold that it has become should gradually fade.

In children young enough to be concerned about possible airway blockage, a once daily dose of oral steroids for about 2-4 days should be enough to decrease the swelling and hasten the transition to just dealing with a regular mucousy cough.  This will need a prescription.  For older children or before the steroids have kicked in, the interventions that best help with the symptoms of the barky cough and the terrifying (to the child to experience, and also to the parents, to hear) noise of breathing in between coughs (called stridor) is getting the child to breathe cool mist.  This can be from a cool mist humidifier right by the bedside or even within a “tent” in which parent and child are sitting, sitting in the bathroom with the shower running with the door cracked open, turning down the freezer to full blast and then sitting the child right in front of the open freezer door, or even going outside on a cool damp night.  If cool mist doesn’t help within ten to twenty minutes, your child may need to get a breathing treatment at the ER.  This is not the same medicine as an asthma breathing treatment, which typically does not help, but may be worth a try if your child doesn’t get too upset by it, and is not available to be prescribed as an outpatient.

Usually an individual child should only get croup a few times at most in his/her lifetime.  If it happens on a regular basis, he/she may need to be examined by an ENT (ear nose and throat doc) to see if there is an anatomic reason that he/she keeps getting croup.