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Imagine you have just gotten the kiddos in bed and you are about to start on your own to do list, when you hear what sounds like a seal’s bark coming from your child’s room.  Your first question might be, “Is there a sea creature in our house?”  When you verify that the answer to that question is “No” and find that the sound is, in fact, coming from your child, it can be quite unsettling if you haven’t heard it before.  The next thing that may pop to mind is, “Why in the world does my child sound like an 80 year old smoker?” and the most likely answer is croup.

“Because of this swelling, kids often have a very hoarse sound to their voice as well as a deep, barking, type of a cough.”

Croup is caused by a virus (typically the parainfluenza virus) and can start out like any other virus with stuffy nose, congestion, and fever.  This particular virus causes infection and swelling of the voicebox, usually in children under 6 years of age.  Because of this swelling, kids often have a very hoarse sound to their voice as well as a deep, barking, type of a cough.  A quick anatomy lesson…the area by the voicebox is typically the most narrow part of the airway, so swelling from a virus will narrow this area even more.  It is the flow of air through a more narrowed passageway that gives the change in the sound of the cough as well as their voice.  Stridor, which is a noisy, harsh sound when breathing in, can occur in some children who have more significant narrowing of their airway and is a more concerning sign of croup.

“If your child has ever had croup, you know the sound of the cough from a mile away.”

As with all viruses, antibiotics will not help with croup, and for milder cases, croup can be managed at home with hydration, rest and a few of the tips below.  However, for those children with more significant croup symptoms, steroids may be used as they help to decrease the swelling at the voicebox.  These steroids can be given either as a single oral or injection dose in your pediatrician’s office or can be given orally at home for 3-5 days.  It is important to bring your child into their pediatrician’s office for evaluation if you suspect croup so that the doctor can listen to their breathing and make sure they are not having stridor.  In more severe cases of croup, especially in children who develop stridor, a special type of breathing treatment that can only be done in a doctor’s office or in the emergency room may be required.

If your child has ever had croup, you know the sound of the cough from a mile away.  For those parents who haven’t had the croup experience yet, check out the clip below to hear what a croupy cough plus stridor can sound like.

Croup is almost always worse during the night (of course when the doctor’s office is closed), so here are a few ways to manage croup at home:

  • First, keep your child as calm as possible.  The more agitated and worked up your child is, the more significant the cough and stridor can become.
  • Have your child breathe cold air.  Just as ice helps to reduce swelling on a sprained ankle, breathing cold air can reduce the swelling at the voicebox.  If it is cold outside, then wrap your child in a blanket and step outside for several minutes.  If you are lucky enough to live in the South and your average nighttime temperature in the middle of “winter” is above 50 degrees, then stand in front of the open freezer with your child.
  • Breathing steam or warm mist can also be helpful.  Make the bathroom like a mini sauna by turning on the hot water in the shower and closing the bathroom door.  If trying the steam route, make sure that your child is not too close to hot steam as it can cause burns.

If constant coughing or noisy breathing doesn’t improve within 15 minutes of trying the above things, then immediately call your child’s doctor and get ready to head to the closest ER as your child will need urgent medical evaluation and treatment for a severe case of croup.

While the cough of croup can be quite terrifying to hear, the great majority of children will not progress to more severe cases.  Croup is another example of how having knowledge and a game plan ahead of time can really prove beneficial, especially when the symptoms start at 3AM!