Croup is an illness that causes swelling around the vocal cords. This gives the child a classic "barking" cough. It sounds like a seal barking - a deep "bark bark" or "honk honk" sound. Once you hear it, you can't miss it! If the swelling gets bad enough, it can make it hard to breathe, and the child will make a harsh sound (called "stridor") especially when breathing in. The child may also have a low fever and sore throat.
WHO GETS CROUP AND HOW IS IT PASSED?
Croup is usually caused by parainfluenza virus, which makes its rounds in fall and early winter. It affects infants and toddlers the worst. Daycares may have little epidemics of croup, as it's passed like any other cold - by sharing personal items, unwashed hands, and sneezed- or coughed-upon surfaces. Older kids and adults can get (and spread) this infection, but symptoms are more like laryngitis - mild sore throat and hoarse voice, without the breathing issues.
IS THERE A PATTERN THE ILLNESS USUALLY FOLLOWS?
Infectious croup often follows a very predictable pattern. The illness starts with a minor cold that progresses overnight into a very barky, honking cough and stridor (that harsh breathing sound mentioned above) that wakes everyone up. Most parents are savvy enough to have the child sleep upright or put them in a steamy shower for 20 minutes or so, which usually abates the symptoms for the night. The next morning, the child may seem better, with a milder cough and maybe just a little hoarseness.
The problem is that in most cases the SECOND night is much worse, with a return of the barking cough and much worse stridor, which may cause real difficulty breathing or swallowing and require an evaluation in the local emergency department. The younger the child is, the higher the chance this could happen.
WHAT CAN BE DONE IN THE OFFICE TO PREVENT A POSSIBLE BAD SECOND NIGHT?
Usually we like to see the child the morning after the first night - that is, BEFORE the much worse second night. If it seems the child's symptoms were bad enough, we may give an injection of a medicine called dexamethasone. This is a steroid which improves the swelling around the vocal cords, so the child won't have such bad breathing problems the second night. We may also recommend using ibuprofen, sleeping more upright, and using a steam shower or a humidifier to soothe the airway.
WHAT HAPPENS AFTER THAT?
Dexamethasone gets the child over that second night hump, and the croup generally starts improving on its own by the third day. The cough may persist for several more days, but after the dexamethasone it shouldn't sound nearly as painful or have any of that scary sounding stridor. Once the fever is gone and the cough starts to improve, the child can return to daycare or school. Older kids, who we don't usually give dexamethasone to, will also start getting better after the first 2-3 days of illness. All symptoms of simple croup should be pretty much resolved after a week.
WILL MY CHILD EVER GET THIS AGAIN?
Children can get croup several times, but usually it's not as bad as the first time. This is partly because as kids gets older, the symptoms become less severe. As mentioned, older kids infected with parainfluenza virus usually just get a sore throat and hoarse voice. We call that "laryngitis", but it's the actually the same disease process as croup.
WHEN SHOULD I CALL THE OFFICE?
You should contact our office any time you have concerns, especially if your child:
Of course, you can call us any time you have questions or would like to be seen!