son had a bit of a cold and it seemed to get better; however, last night he started
coughing and breathing different. The cough seems dry, rough, and sounds bark-like.
Could this be croup? How common is croup among children and do adults ever get
Croup is caused by an inflammation (swelling) of the upper airway (larynx or
voice box and the trachea or windpipe). The inflammation is usually due to a
viral infection, and is a common condition in young children. Typically, viral
croup begins with a cold that slowly develops into a characteristic "seal-like"
barking cough and a high-pitched, raspy noise when breathing in, known as stridor.
The stridor often gets worse with physical activity. Most children with viral
croup have a low-grade fever.
The potential problems of croup depend on how much the upper airway is blocked
by the swelling. The more the airway is blocked, the more the child's breathing
is labored and in general the less active the child becomes. Additionally, an
important sign of difficulty breathing is that the child may stop eating or
drinking. Croup usually worsens at night, lasts for three to four days, and
usually subsides on its own.
In children with mild croup, the treatment approach is simple: exposure to
cold, humid air. You can do this in two ways: open up a window or simply bundle
the child up and take him outside. Another way is to let the shower run, preferably
with cold water, and let the child sit in the bathroom to breathe in the cold,
humid mist. Usually, children start to breathe more easily within 15 minutes
of exposure to cold, humid air. During the rest of the croup illness, a cold-water
humidifier or vaporizer in the room during the night can also help.
The cough and stridor of croup may be quite scary, but fortunately most cases
are mild and need no other treatment or medical intervention. However, in the
most serious cases, a child may have so much difficulty breathing that he is
not getting enough oxygen into the blood. In this situation, the child will
need to go to the hospital.
Signs that a child needs immediate medical attention include: stridor that
is getting louder with each breath, inability to speak because of lack of breath,
labored breathing, pale or bluish mouth or fingernails, stridor at rest, and/or
drooling. At the hospital, the child will be evaluated and given oxygen if necessary.
Although there are no specific medications for croup, steroid injections and
adrenaline-like inhaled preparations are used to help children with severe croup.
These medications act to decrease the swelling of the upper airway.
Another type of croup is called spasmodic croup. In this case, the child
gets a cold, rarely with fever, and then the typical "croup" begins. In some
cases spasmodic croup may begin suddenly without any preceding cold symptoms.
Unlike viral croup, spasmodic croup usually recurs, can occur in older children,
and is thought to be related to allergies. Viral croup is more common in children
less than five years of age. Croup is very rarely seen in adults.