By Dr. Loretta Lanphier, ND, CN, HHP, CH

There are few things more alarming than to be awakened in the middle of the night by a hideous cough coming from your child’s bedroom that sounds similar to a dog choking on a bone. A new mom or dad may already be grabbing the phone to call 911, whereas a veteran will most likely recognize the awful sounds as a case of croup. As frightening as croup can be to both child and  parent, most of the time it sounds a whole lot worse than it actually is. What causes this common childhood disease and how should we best respond when it makes an appearance? Let’s take a look at the basics.

What is Croup?

Croup is an infection that causes the tissues around the vocal chords (larynx) and windpipe (trachea) to become swollen and inflamed, thereby narrowing the passageways. It is most often found in young children from the ages of six months to under six years, primarily because their airways are quite small to begin with. Adults with the same type of infection typically develop laryngitis because their larger throat passages are not as obstructed. Approximately 5% of all children will experience at least one case of croup, with about 1% of these cases being serious enough to require emergency treatment or hospitalization.

The majority of croup is the result of a viral infection, but it can also develop from an allergic reaction or, in rare cases, from a bacterial infection. It most often occurs during the night, and typically will come on very unexpectedly without warning. When a child breaks out with the harsh coughing associated with croup, and feels like he can’t get enough air, it can be very frightening. The good news is that most croup cases can be arrested by calming the child and applying some simple home remedies.

What Are the Symptoms of Croup?

The traditional sound associated with croup, often described as the sound of a seal barking, is caused by the cough reflex forcing air through the child’s swollen, narrowed airways. The vocal chords vibrate and cause this characteristic and unnerving sound. Other symptoms of croup vary depending on the degree of severity of the condition. Typical ones may include:

  • Labored breathing that causes a rasping sound, especially when inhaling. This is officially known as stridor.
  • A feeling that you cannot get enough air to breathe.
  • In some cases, especially with bacterial croup, a fever may be present.
  • Hoarseness when speaking.

What Causes Croup?

All forms of croup are triggered by swollen, inflamed respiratory passages. This is the result of the immune system response to either infection or an allergic reaction in the area. Mucous and fluid build up, and the irritation process continues until normal inhaling and exhaling become impossible in the child’s small airways.

Most croup manifests itself after a cold or influenza infection. Other viruses that are sometimes responsible for croup include the respiratory syncytial virus, adenovirus, and measles virus. If your child has a cold, the flu, or the measles, be aware that croup may occur. One clue that parents should watch out for is the presence of hoarseness during the day. If you notice your child is hoarse, it is possible that he or she may have a croup attack during the night.

Most cases of croup occur at night while a child is sleeping, and during the “cold and flu” season of autumn and winter. They typically last anywhere from five to seven days. You can protect your child from developing croup by taking the same common sense measures one takes to avoid colds and the flu:

  • Keep them away from other children who are sick, whenever possible.
  • Teach them to always wash their hands after playing with or spending time around other kids, especially when colds or flu are present.
  • Most cold and flu germs are spread when the virus is present on the child’s hand and he touches his eyes, nose, or mouth; or when he breathes in the germs from the coughs of other kids.
  • Keep your child’s immune system strong by feeding them a wholesome diet that is high in natural, nutritious foods such as fruits and vegetables and whole grains.
  • Keep them hydrated too, with plenty of pure water. Start kids on the water habit early so they develop a love for this life-giving beverage that so many people, kids and adults, don’t get enough of.
  • Avoid sugar in their diets. Sugar, especially refined white sugar, is one of the worst compromisers of our immune systems.
  • Supplementation with such immune system boosters as vitamin C or zinc, especially at the first signs of a cold, can also be a great deterrent to an infection that could lead to croup.

Are There Any Complications That Can Occur With Croup?

The vast majority of croup cases are mild, and can be effectively managed with self-care remedies we will describe below. However, be aware of a couple of things regarding croup:

  • Children under the age of three, especially infants, tend to have the hardest time with croup. When croup strikes this age group, be especially alert to breathing difficulties your child may experience.
  • Kids who are born premature seem to have croup more often and more severe cases of it. This may be due to respiratory passages that are unusually small.
  • Sometimes croup infections can migrate from the respiratory passages and cause pneumonia and ear infections, although this occurrence is relatively rare.
  • Severe cases of croup may require a trip to the emergency room. Here are some signs to watch out for:

ü       If your child begins to drool or has trouble swallowing, their respiratory passages may be dangerously swollen.

ü       Difficulty breathing that does not diminish when you attempt to calm your child.

ü       A child that seems panicked, agitated, or unable to settle down. This may indicate that he cannot breathe sufficiently.

ü       A blue or gray tint to the skin, especially near the nose, mouth, and/or fingernails. This is a sign that he cannot get enough oxygen.

Any of the above conditions would necessitate immediate emergency care. Physicians may employ several methods to intervene in the crisis:

  • Intubation: This procedure involves the temporary insertion of a tube into the child’s airway to restore proper breathing. There is a risk of damage to your child’s internal organs if this tube is not placed and removed properly.
  • Humidified Oxygen Tent: The child is placed in an artificial environment in order to restore oxygen levels and clear the airways. Some kids find this terribly frightening, and if they panic it can make matters even worse. You know your child better than the hospital staff, so use good judgment.
  • Medications: Corticosteroids and adrenaline are often used as emergency measures to lessen the swelling of the respiratory passages and help to restore breathing. Be aware that some children (and adults) can have severe allergic reactions to these drugs. They are potentially dangerous, so only allow their use as a last resort, life-saving measure. You should also know that adrenaline is very short-acting, and it often has a rebound effect that can make the breathing difficulties worse in the short-term.

What is the Best Way to Treat Croup?

As I stated above, most cases of croup are mild, despite the frightening sounds your child may produce. The most important thing to remember is to remain calm. If your child sees you panic, it will be very difficult for him or her to stay calm. Here are some practical suggestions that may be of help:

  • Cuddle and comfort your child to calm his fears and to stop him from crying. Fear only makes the situation worse, as does crying.
  • Calmly take him or her into a warm, damp atmosphere. This can be accomplished through the use of a humidifier. However, a quick and handy response is to take the child into the bathroom, shut the door, and turn on the hot water in the shower. The heat and moisture will help clear the air passages. By the way, a very interesting study released recently has deduced that moisture does little to  help clear up a case of croup, contrary to the advice given for many years. What researchers discovered is that a much bigger factor is the calming effect of the parent nurturing, holding, singing, and/or gently talking to the youngster. However, the warm moist air may be helpful by providing additional comfort for the child.
  • Some children respond well to cool, damp air as well. Experiment a bit and see what works best. Try taking a walk with your child for a few minutes in the cool night air, if the opportunity affords itself.
  • Fluids can help too. Either warm or cold may be effective. Just about any choice will work, including breast milk, water, juice, or even soup. Popsicles may also help to soothe your child and his throat.
  • An upright position is also helpful. Again, you can combine a practical step that can help clear the symptoms with comfort. Try putting your child on your lap, in a favorite chair, or even in a car seat that is familiar to him.
  • If you suspect croup may develop during the night, try sleeping in or near your kid’s room so that you can respond quickly with a prepared plan of action. This will take a lot of stress off of you and the child.

If sore throat or fever is a problem, give him or her over-the-counter pain medications such as acetaminophen. Most of the time croup will run it’s course in several days. After the first attack, it should get better and begin to dissipate. Once he or she has had a couple of nights with no symptoms, you can begin to relax. You have survived a bout with croup. Congratulations!

Choosing a lifestyle of wellness in your home will always cut down on the number of infections that lead to croup and other illnesses. These long-term habits will keep the whole family healthy, and establish patterns of wellness that your kids can carry on into the next generation.

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