Croup is a viral disease that we usually can tell kids have by the way they "bark." Now, lots of people tell me their kids have a "croupy cough" but the real croup cough is a seal bark, not a dog one. Once you've heard a croup bark, it's hard to forget.
Croup is an inflammation of the trachea right underneath the vocal cords (that's what makes the bark.) Lots of viruses can cause croup symptoms, RSV and influenza among them. It can be associated with nasal congestion, sore throat, fever, and hoarseness. As you get older, your trachea gets bigger, and the amount of obstruction that the inflammation causes gets smaller. So, little kids, ages 7 months to about 6 years, are the ones who get this. It gets worse over about 3 to 5 days before starting to get better. And as usual, it's usually worse in boys.
Probably scarier than that bark is that the symptoms usually are worst in the middle of the night and the kids can look and sound as if they are really having a hard time getting air in. If your child starts using muscles they normally wouldn't to breathe, specifically, if you notice that the skin above their sternum or over their collar bones is pulling in with each breath, then we need to have your child seen.
Most kids with croup never need to be seen by a doc. We need to see them when there are worsening problems with breathing. At home, probably the best thing to do is to try to keep the kids calm-- if they get anxious, the obstruction below the vocal cords and therefore the breathing difficulty gets worse. We'll often tell parents to take the kids into the bathroom and get the shower on and steamy, so that the mist decreases the swelling. (Many studies suggest that this may not help at all but I'm all for it. I think it makes everybody feel better to do something!)
If that doesn't work, and the kids are acting as if they are having a hard time breathing, then we have to have them seen. This usually involves a ride in the car in the winter night air and by the time you get to the ER, the cool air has helped the swelling and the kids are acting and feeling much better. If the cold air didn't work, we can use nebulizers of epinephrine and steroids to help. Very few kids will need hospitalization.
So...come in if you are worried that the kids are working too hard to breathe, if they are acting sick, if they are drooling as one of their symptoms, if they aren't drinking well or if you just want me to check them out.
updated April 16, 2007