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You are sleeping peacefully when you suddenly are shocked to hear a barking dog (and you don’t own one) or you think you are dreaming about a visit to the seal show at Sea World. It’s neither, but it is your own child with the illness croup.

Croup is a fairly common problem, around all year but hitting hardest in the fall and winter. It is caused by a variety of respiratory germs (almost all viruses, not bacteria) but they all attack the sufferer at the larynx and vocal cords. The distinctive barking cough is caused by airway swelling in that area. When air is forced against the narrower than normal airway during a cough, it makes the sound.

In some cases the swelling can get bad enough to cause significant, even life threatening compromise but that is really unusual. If that happens, emergency room treatments can turn it around quickly. Most often though it’s just a cough that sounds strange, with perhaps a raspy laryngitic voice.

Croupy sounds can be made by any airway obstruction, including stuck objects in the throat or in the past a rare, severe illness called Epiglotitis, this post is about the much more common viral etiology.

We sometimes will use a course of steroids (anti inflammatory, not anabolic ) to ease the swelling and make breathing easier if there is moderate difficulty. The type of sound made by the swelling when children are breathing is called stridor. It is different from wheezing in that it coarse is made on inspiration, wheezing is an expiratory sound and has a high pitched, almost whistling character. This is also the illness that responds to either steam in the bathroom or cold night air. The reason they both can work is that there are two kinds of croup, spasmodic croup resolves with cold, regular resolves with steam. It is unclear why but it’s always worse at night.

The illness goes away in 4-5 days and is frequently accompanied by fever and nasal congestion as well.  Unless complicated by an ear or sinus infection, antibiotics are generally not prescribed. The cough will become less “croupy” but can last for up to two weeks.  Other than steroids there is not much else that can be or needs to be done for it.

Croup is not to be confused with Whooping Cough, a much rarer disease characterized by coughing fits.

We are always happy to evaluate children with croup but it can be managed well at home in most cases with rest, time an a little TLC. So don’t panic if you hear that sound, you are not hallucinating. Just go check on your child.