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Croup

By Dr Jay Gordon and Jeffry Still


Croup is a terrifying illness for parents--and kids--to suffer through. In the middle of the night, your child may sit up in bed gasping for air, often coughing like a barking seal. These symptoms are so unsettling that panic is usually the first reaction. However, most of the problems associated with croup can be safely and easily treated at home.

Croup is a viral infection that causes a swelling in the larynx (voice box), trachea (windpipe), and other airways leading to the lungs, making breathing noisy and difficult. The swelling is not visible in the tonsils and cannot be heard when a doctor listens to the lungs with a stethoscope, so you won't know your child has it until he or she wakes up with the distinctive barking seal cough.

Most common in the fall and winter in children under four, the swelling is also accompanied by increased secretions in the air passageways that become dried out. The dried, thick secretions in turn block the respiratory tract and make breathing even more difficult. Children outgrow croup as the airway passages enlarge; it is unusual after age seven.

The best treatment for this swelling and narrowing of the respiratory tract is cool, moist air. The best way to get this "dose" is by driving towards or along the beach or another body of water with the windows rolled down. Dress warmly, including a hat, and take a late night ride for 20-40 minutes and your child will probably experience almost instant relief from the frightening sounding cough. As these dried, hard secretions are dissolved and the air can again pass freely into the lungs, the child's discomfort will subside.

You may be thinking about your mother's admonition that "You'll catch your death of cold" if you go outside late at night, especially with your precious baby in your arms. Well, forget the idea that you'll catch a cold from the brisk night air. That idea is a myth--you cannot catch pneumonia or any other illness from cold air. Colds, flu and pneumonia are spread by viruses which like to stay nice and warm... and in humans.

Another option is to steam up your bathroom to create a moist, soothing environment. Close all the doors and windows and run a warm shower to create steam, but avoid really hot water as it may scald the child. To avoid slipping while holding your child, do not stand in the shower. Remember too, that steam rises, so do not set the child on the floor, but hold him or her upright in your lap. Usually after ten minutes you'll see improvement, but continue comforting the child.

You can also purchase a cool mist humidifier and place it in the child's room for several nights. Position the humidifier as close to the bed as possible so the moist air can make its way to the child's airway passages.

Croup is a "self-limited" viral illness, meaning you have to let it run its course. Unfortunately the second night is often worse than the first. There may be a few more scary nights of the barking cough, but continue with the car rides or steam treatments to relieve symptoms. The illness then changes into a long, mucousy cold which can last for another week or more. The fever rarely rises above 102 or 103 degrees and can be treated with anti-fever medications, long lukewarm baths, and light clothes to allow the body to cool itself.

Take your child to the emergency room if he or she:

  • shows no improvement in breathing with either of these mist therapies after 30 minutes;
     
  • cannot talk because of lack of breath;
     
  • has difficulty swallowing, drools, and breathes with chin jutting out and mouth open, this could be a rare infection called epiglottitis;
     
  • struggles when inhaling or appears to be in severe respiratory distress.