Croup

The term croup often refers to a type of cough (a croupy cough) or the actual illness caused by a family of upper respiratory (cold) viruses. What makes for this distinct seal-barking cough sound is that the family of parainfluenza viruses that cause this infection likes to go straight for the upper airway and throat. The swelling at the top of the airway causes a steeple-like appearance to form. Air traveling out of this steeple will then create the classic seal-barking cough. The big issue is that if you are a wee one, your upper airway isn’t that big to begin with, and any moderate amount of swelling in that area can cause more problems than just the barking cough. Younger kids with croup can also get stridor, which is this gasping for air sound as the air rushes down the swollen upper airway, or in some severe cases, get so swollen that air has trouble getting in altogether. This swelling can sometimes cause a weird cough for older kiddos but more often presents as a hoarse or lost voice (laryngitis) than the classic barking cough or stridor. 

Most treatment for croup is supportive. We try to “apply an ice pack” to the throat to decrease swelling if the cough is barking or if we start to hear stridor. How do we apply an ice pack to the throat/airway? We go outside. If you run a really hot shower and let the bathroom get really steamy and let little Johnny or Janie play in there for 5-10 minutes and then immediately take them outside to breathe in the cold night air, this can act like an ice pack to the throat and decrease the swelling and subsequent stridor and croupy cough for the little kiddos. There are also a few medicines in the steroid family that we can give in short bursts to decrease swelling in the upper airway for 18-36 hours. We often reserve the steroid treatment for those kids demonstrating this stridor sound at rest. 

The super annoying thing with croup is that it always gets worse in the middle of the night. When a kiddo is infected with croup, they can go to bed with a mild cough but as they are lying down and nice and warm in their bed or crib the inflammatory fluid goes to the gravity-dependent areas, like the throat, and we get the classic case of a kiddo with mild cold symptoms early in the night then waking up sounding like a seal or making that distressing stridor sound. If taking little Johnny or Janie outside to breathe in the cold air does not cause a decrease in the stridor or barking cough, they may need to make a late-night trip to the emergency room to get that dexamethasone (steroid) treatment, or if it is really bad, a breathing treatment of racemic epinephrine which decreases swelling immediately.