SUMMARY: Croup is a virus that attacks the vocal cords, causing sudden onset of a seal-barking cough, raspy breathing, and raspy voice (laryngitis). Runny nose and fever (especially in infants) are also common. Fussing and crying make the barky sounds and raspy breathing louder. Many cases of croup worsen at night, then calm down during the day. The characteristic cough and raspy breathing usually last about 3 days, then the cough turns junky and can last as long as any other cold virus – 7 to 10 days. Most parents worry this junky turn indicates something has gotten worse, but that’s not generally the case. Croup is contagious for the same time as any cold (7 to 10 days). Croup is not treated with antibiotics (unless fever lasts more than 5 days or a child appears to have a bacterial complication). Giving ibuprofen (click here for dosing) to treat the fever and sore throat pain may calm down fussing and croupy breathing. Taking your child outside in the cold night air for 20 minutes will usually relieve the labored breathing temporarily. Running a hot shower in a small bathroom and letting baby breathe the concentrated steam for 20 minutes can also stabilize the breathing difficulty. Sleeping with the windows open and running a hot steam humidifier all night usually keeps the room humid enough to stabilize the breathing. Most cases don’t need emergency care as the above measures usually work well enough. Doctors can prescribe an oral steroid medication to shrink the swelling in the vocal cords so an infant can breathe more easily (these take several hours to kick in though).
IS THIS AN EMERGENCY? Most cases of croup start at night, but don’t require emergency care. Here’s how to tell: If your child looks like she can’t get enough air, looks panicked, and the raspy breathing is very loud, take your child outside immediately in warm clothes (if you live where it is cold and humid at night). If the outside air is too dry (such as living in the mountains), then make your smallest full bathroom hot and steamy by running a hot shower and let your child breathe the steam. If you can calm your baby with nursing or feeding, this should also help (crying makes croupy breathing worse). Alternatively, you can put your baby in the car in warm clothes and start driving toward the nearest emergency room with the windows rolled down. This cold night air is likely to improve the breathing en route, and if you feel your baby has stabilized you can return home without going into the ER.
DO YOU NEED TO SEE A DOCTOR? Usually not. Most kids will be croupy for a few nights (seemingly better during the daytime), seem much better during the day, then have a junkier cough for a week or more and get over it like any other cold. The main reason to see a doctor is if your baby’s first night of croup is fairly rough (but you didn’t go to the ER because the cold night air/steam and maybe ibuprofen got baby through OK), you can see the doctor the next day to consider a prescription of oral steroids to take for the next 2 days to minimize the severity during the worst few days of croupy breathing. This is especially true if your child stays severely croupy during the day (which predicts that this upcoming night and the next are likely to be rough). It’s also useful to have the medication on hand for the next croupy illness (a recurrence with subsequent cold viruses can trigger croupy breathing again) IF your child needed steroids the first time.
WHEN YOU DON’T NEED A DOCTOR. If your child’s breathing is stable enough with cold air/steam/ibuprofen, then you likely don’t need to see a doctor. Some raspy breathing while asleep is expected, and croupy sounds and louder rasping is normal during crying or when excited. But if your child’s breathing seems fine when relaxed, and the first night was manageable with cold air/steam and maybe ibuprofen, then you likely don’t need steroids or a doctor’s visit.
CROUP IS NOT WHOOPING COUGH. These two illnesses are very different, although they both will have a whooping sound when breathing in. Whooping cough, however, only has the whooping sounds when gasping for air during the coughing fits, and the coughing fits are very long and separated by hours of appearing quite well. Croup, on the other hand, will have a whooping sound with EVERY breathe when crying, have a seal-barky sound when coughing out, causes a raspy laryngitis voice, can have raspy breathing sounds with every breathe even when not coughing, and your child will look and feel sick all day. Click here to review whooping cough if needed.