Is it Croup?

Have you ever heard a cough that sounded like a barking seal or a fog horn? Once you’ve heard it, you’ll never forget it—it might be croup. Croup is not usually serious and can be treated at home. It is triggered by a viral infection that attacks the throat and upper airways, causing swelling and sometimes breathing difficulties.

Since croup is caused by a virus, antibiotics are not necessary. In more severe cases, your doctor might determine that your child needs an oral steroid.

Some children may develop croup during or just after a cold. Croup most commonly affects children younger than age 3, with younger children experiencing more severe symptoms. Some symptoms you may notice include:

• noisy, high-pitched breathing
• barking cough (can last a few hours up to a week)
• fever (can last up to three days)
• runny nose
• hoarse voice

Usually after two or three days, the cough will change from a hard, harsh, barky, dry cough into a congested cough, which typically lasts another few days. Sometimes croup can cause episodes of severe coughing followed by vomiting.

The symptoms are almost always worse at night. You may hear wheezing or stridor, which is noisy, rough-pitched breathing. Stridor is usually brief, happens with crying or coughing, and gets better when the child is calm and quiet. Continuous stridor that is heard with every breath is considered to be a serious symptom. In rare instances, croup can be life-threatening. Call 911 if symptoms include:

• episodes of turning blue or grey around the mouth, lips or nail beds
• struggling to breathe
• grunting with breathing (pushing the air out)
• drooling excessively
• inability to swallow

What can you do to treat croup? Most importantly, stay calm and comfort your child since crying can make the coughing worse. If the child is older, have him or her relax and breathe slowly. You may want to offer warm liquids to sip on, such as warm apple juice, lemonade, etc. Take your child into your smallest bathroom and turn the shower on hot to get the bathroom steamy, then remain there for about 20 minutes. Be sure to stay with your child for safety reasons. If the steamy bathroom fails to make the cough and stridor better, take your child outside to breathe in the cool night air. This can help calm the cough. If stridor is still present after trying steam and cool air, your child should be seen immediately in the emergency room.

Returning to School
Children can return to school and normal activities when their fever is gone for 24 hours without taking any fever-reducing medication (i.e., Tylenol or Ibuprofen).

Good hand-washing is the best preventive measure. If you have concerns about your child’s health, it is always appropriate to contact your doctor.

This article was written by Kathy Hotard, a nurse at the St. Louis Children’s Hospital Answer Line. For more information about croup, please call the St. Louis Children’s Hospital Answer Line at 314.454.KIDS (5437) or 800.678.KIDS.