Croup

Published in the St. Louis Post-Dispatch, Nov. 19, 2009

With so many kids coughing, it can be hard to determine when it is something other than the much-talked-about flu. A barking cough that makes your child sound like a seal at the zoo could be croup (kr-oop), a common childhood condition affecting children ages six months to six years old.

Croup – caused by flu viruses – usually occurs during the fall and winter months and begins with typical cold symptoms such as a runny nose, fever, and/or some hoarseness with talking or crying. Over the course of several days, these symptoms may develop into that distinctive barking cough caused as the air tries to move through swollen and narrowed breathing tubes leading into the lungs. It may worsen at night or when your child cries or gets upset.

In severe cases, you may hear a high-pitched squeaking sound - called stridor - when they try to take a breath in. Other signs of breathing trouble can be a fast breathing rate or more noticeable use of belly muscles to breathe. Also, check for skin that pulls in between the ribs and skin that pulls in by the neck above the shoulder blades when breathing in. If you see these signs, call your doctor immediately.

Most children have mild cases of croup and get better at home when you try some simple things. Create a steam room by turning on the hot water in the bathtub or sink and closing the door. Sitting with your child for about 10 minutes in this moist air is enough to help ease the barking cough.

Breathing cold air is another way to reduce swelling in the breathing tubes. Dress your child in warm clothes and go outside for about 10 minutes. Many parents tell stories about driving to the hospital emergency room in the wintertime only to get there and their child sounded fine.

If your child does need emergency care, medicines may be given to reduce the swelling in the breathing tubes. One medicine, called racemic epinephrine, works quickly to bring down the swelling but only lasts about two hours. A respiratory therapist will help your child breathe in this medicine. The doctor also may order another type of medicine, steroids, either to be given as a breathing treatment or a shot. Steroids do not work quickly, but will last longer to keep the swelling down. Often, parents will be able to take their children home if the barking cough and breathing stays better after being watched for two hours.

Holly Dodds, RRT, M. Ed, is a pediatric respiratory therapist at St. John’s Mercy Children’s Hospital and a clinical assistant professor at University of Missouri-Columbia. For more information about St. John’s Mercy Children’s Hospital, please visit www.stjohnsmercychildrenshospital.org or call 314-364-3825.