Croup is a common respiratory illness in which the vocal cords (larynx) and the area below them in the windpipe (trachea) are inflamed. Croup is usually caused by a virus, such as the parainfluenza virus, adenovirus, or respiratory syncytial virus (RSV).
Croup is associated with a harsh, barking cough and noisy breathing, and occurs most often in late winter, particularly in children between the ages of 3 months and 5 years. Spasmodic croup is a croup-like cough without any signs of infection present, usually the result of an allergic reaction in the windpipe or trachea.
Croup usually begins as a common cold with a stuffy or runny nose and fever. After a few days, the child's voice will seem hoarse and he or she will develop a harsh cough, described as sounding like a seal's bark. They may also have problems drawing air into the lungs because of inflammation in the airway; the whistling noise that results when breathing in is called stridor. The cough and difficulty breathing occur most often in the evening after bedtime or in the middle of the night. In cases of spasmodic croup, the child may not have cold symptoms before the coughing begins, but the cough and breathing symptoms are the same as in children with infectious croup.
Children who are born prematurely or those with known asthma may develop more severe signs of croup. In general, however, croup goes away within a few days, though symptoms can occasionally become severe. Sometimes a child who is having difficulty breathing may have rapid, labored breathing or wheezing combined with a barking cough. The child's skin color may be pale and blue around the mouth due to lack of oxygen. If you notice this serious symptom, call 911 or a doctor immediately as your child may need hospitalization.
It is difficult to prevent your child from developing croup, as a number of common cold viruses can cause the condition. Frequent hand washing and avoiding close contact with people who are sick may reduce the risk of infection.
Once someone has croup, antibiotics are not helpful since it's usually caused by a virus, not by bacteria. If your child has croup for the first time, contact a doctor immediately if there are signs of difficulty breathing, dehydration, high fever, drooling, and an inability to swallow saliva. This may be a sign of acute epiglottitis, a rare but potentially life-threatening infection of the epiglottis.
If your child has had croup before and you recognize the symptoms, try these measures:
Sleep near enough to your child so you can follow the course of the illness. Croup symptoms may improve during the day, but worsen again for two or three nights. Always try to stay calm: It is important to comfort your child. If you're anxious, your child will quickly sense this and become anxious and afraid herself. This may make her breathing worse.
Contact a doctor immediately if your child does not start breathing more easily with the treatments. Your child may need treatment in a hospital to receive oxygen, medication to open the airway, and intravenous fluids.