Croup is a swelling or inflammation of the upper part of the airway involving the larynx (voice box) and trachea (windpipe).

Croup usually begins as a mild respiratory infection. The cough sounds like the bark of a seal. The development of the cough can be gradual or sudden, often occurring in the middle of the night 1-3 hours after your child has gone to sleep or during the early morning. Other symptoms associated with croup include a hoarse voice and fever.

If your child has croup he may also experience difficulty breathing because croup is caused by a swelling in the airway. The difficulty in breathing is accompanied by a sound called "stridor," which is a harsh noise that occurs when your child takes in a breath. The development of difficult breathing can be gradual or quite sudden, occurring with the development of the cough. Most commonly the difficulty in breathing is mild and responds readily to home therapy.

Occasionally, the difficulty in breathing is more severe.

Croup tends to be most severe in the middle of the night and usually improves in the morning, regardless of therapy. The average duration for symptoms of croup is about 3-5 days.

Croup is most common in the fall and spring, but may occur any time during the year. It usually affects children between ages 6 months and 3 years, because their airway is smaller and swelling in this area is more likely to interfere with breathing or produce a cough. Older children also occasionally get croup.

While croup is very frightening for both you and your child, it is rarely serious. It is important to try to stay calm while treating croup and to try to keep your child as calm as possible, as croup will worsen when your child is excited.

If your child should awaken in the middle of the night with the barking cough of croup or with the difficulty in breathing associated with croup, the best treatment is the mist from a warm shower. Take your child into the bathroom and turn the shower on the hottest setting possible. Close the bathroom door so the room fills with steam. Allow your child to breathe in the steam, which should improve the symptoms within 15-20 minutes. If shower steam does not improve your child's symptoms, a walk outside in the cool night air may help alleviate the swelling of the windpipe so that he can breathe more easily.

Once you know your child has croup, setting up a cool mist humidifier in his room may help him to be more comfortable through the night.

Call our office IMMEDIATELY if these symptoms are present:

• Unresponsive to the shower mist or cool night air treatment;
• Significant retractions (caving in between the ribs or of the top or bottom of the rib cage);
• Excessive sleepiness or lethargy;
• A high-pitched whistling sound with each breath;
• High fever (greater than 104°F);
• Absence of a cough; or
• Inspiratory stridor.

If your child is worsening in spite of therapy, seems to be struggling to get a breath, is not able to swallow his saliva or cannot speak, you should take him to the nearest Emergency Room immediately.

If your child goes to the Emergency Room, he may be given medication to open the airway and improve breathing. He may also be given oxygen. X-ray studies may also be performed to confirm the diagnosis of croup.

Antibiotics are not helpful in the treatment of viral croup. Occasionally, in more severe cases of croup, we may prescribe cortisone or a steroid preparation for a short period of time.

If you have questions about your child's condition or the treatment of croup, please call our office.