Janet woke up in the middle of the night to a strange noise. It was 3 a.m., and it sounded like someone's dog was running loose outside. This dog was rather bizarre-it had more of a seal's bark than a dog's bark. As she listened closely, Janet realized the dog was actually INSIDE the house! Quickly waking her husband, they ran toward the source of the noise, which was coming from their 18-month-old son's room. Bursting in, they discovered the cough was coming from… their toddler. He had croup!

What Is Croup?

Croup is a condition caused by inflammation of a child's trachea. In almost all cases, croup is caused by a viral infection. It usually affects children from 3 months to 5 years of age and tends to happen mostly in the winter. It begins as a simple cold (runny nose, congestion, fever, etc.), but over several days it worsens into a unique-sounding cough. The child will have a "seal" or "dog" bark-like cough, which becomes worse in the late hours of the night (2 or 3 a.m.) and gets better or even goes away during the day. By the second or third night, it has usually hit its peak, and the child will start to get better. The most common cause of croup is the parainfluenza virus, though other viruses like RSV and "cold viruses" can also cause this.

WHAT TO DO

If your child develops croup, try taking him into the bathroom and running the hot shower water until steam fills up the room. If that doesn't work, dress your child up in warm clothes and sit outside of the house for 5 to10 minutes (if it's a cold night). The mist or cold air will hopefully reduce some of the swelling in your child's trachea. For cases that don't respond to home treatment, I usually recommend a trip to the local emergency room for medical treatment. The emergency room doctor will use a combination of inhaled, oral and IV meds to treat the condition. The goal is to do whatever it takes to reduce the inflammation in the trachea. In severe cases, the child may have to spend a few days in the hospital for more specialized treatment.

Symptoms

The good news is that croup, in most cases, will get better on its own. It is important, however, to be able to tell if the child really has croup or some other, more dangerous, illness.

Typical croup symptoms include:

  • Slow onset of symptoms over a few days

  • Low-grade fevers (100-103)

  • Cold symptoms

  • Laryngitis

  • Some irritability

  • Lack of appetite

Other illnesses to consider include: epiglottitis, foreign body aspiration, asthma, pneumonia and bronchiolitis.

  • Epiglottitis is the most dangerous and needs immediate attention in a hospital. This is an infection of the tissue flap that protects the airway in humans. Epiglottitis is usually a bacterial infection that can happen at any time of the year in older children and with more severe and rapid symptoms.

  • Foreign body aspiration happens when a child accidentally inhales an object into his trachea. The child usually starts out gagging and coughing, but then can have trouble breathing. He may make loud wheezing noises. This is also considered an emergency and requires immediate E.R. attention.

  • Asthma is a reaction in the lungs that causes wheezing, cough and shortness of breath. In essence it is an allergic reaction in the lungs. Many children suffer from asthma, and the symptoms can vary from person to person. Treatment usually calls for inhaled asthma medications and regular evaluations by a pediatrician.

  • Pneumonia is an infection of a portion of the lungs, and at first may seem like a bad cold. Patients tend to have high fevers, chest pain and difficulty breathing. Treatment requires antibiotics and other medications, depending on the severity.

  • Bronchiolitis is a generalized viral infection of the small breathing tubes in the lung. Its symptoms are similar to asthma. Since complications can occur due to bronchiolitis, a visit to your pediatrician is important.

Once a family member gets croup, it is very hard to prevent others from getting it too, because it is a viral infection. The symptoms-at least for adults-are pretty mild. It is best to isolate the sick child from other children until his fever goes away. Lots of hand washing and keeping the toys clean may also help. If you believe that your child is coming down with croup, contact your pediatrician to discuss what steps you need to take.


William "Dr. Bill" Incatasciato is a pediatrician at Capital Area Pediatrics in the Countryside Shopping Center in Sterling. For more information about Dr. Bill and/or his practice, visit capitalareapediatrics.com.