Hark, is that a bark? Yes, it's croup

Amy Wang | By Amy Wang | The Oregonian
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on January 17, 2009 at 12:22 PM, updated January 17, 2009 at 5:50 PM

Every child is affected by cold viruses differently. When it came to my firstborn, I always envied those parents whose kids gave them ample warning of an impending cold by getting the sniffles for a day or two first. Mine would seem totally fine right up until the moment he started throwing up. And he couldn't 'just bend over and barf discreetly, either. No, it had to be like something out of The Exorcist: He'd projectile-vomit onto everything and everyone within 2 feet. Good times.

Then there was the wheezing. For the first three years of his life, every cold meant wheezing so bad that we became well acquainted with Albuterol, Qvar and nebulizers.

Kid No. 2 takes a totally different approach to colds. First there's the sneezing. Then he starts coughing. Along the way he may or may not barf. But almost inevitably, there comes the sound we dread: the deep, raspy bark that signals the croup. As I'm typing this, I'm completely doped up on caffeine because I was up all last night with my secondborn's latest case of croup.

Croup is one of those illnesses that parents often struggle with: Do we call the advice nurse or not? Does he need medication or not? And at night, when the croup is at its worst, do we take him to the ER or not?

Here are some tips, based on personal experience and one of my favorite reference guides, "The Baby Book" by Dr. Sears:

• Croup is a viral infection (which means it won't respond to antibiotics) that attacks the upper respiratory passages. In severe cases, it can cause swelling of those passages, which can hinder the child's breathing. That's what you want to watch out for.

• Croup has a day-night cycle, meaning the symptoms are mildest during the day and worst at night (of course). Your child may improve notably during the day, but come bedtime, regress right back to where she was the night before.

• In addition to that barking cough, croup can include the following symptoms: a hoarse voice, a fever, raspy breathing (especially at night) and a sore throat. Acetaminophen can help with the fever and sore throat.

• If your child seems to be acting normally except for the cough, he has a mild case of croup. If, however, he's refusing to lie down or sleep, is upset, is laboring to breathe (watch the little indent in his neck right above his breastbone) or is breathing very raspily, he has a more serious case that could require medical attention.

• There are several home treatments you can try to ease the croup's symptoms.
-The classic treatment is steam: Take the child into the bathroom, close the door and run the shower at its hottest setting until the room is full of steam, which will relax the child's breathing passages. When you take the child back to bed, have her sleep in an upright position if possible to keep the breathing passages as open as possible. It also helps to have a humidifier running next to the child's bed to keep the air moist.
- Another tactic is to go to the other extreme and expose the child to very cold moist air. I've actually stood with the child right in front of our open freezer for several minutes. It did help.
- At night, you can also try taking the child outside for a drive with the windows down. The cool air often eases the coughing.

• Push fluids. Avoid solid foods during a coughing attack, however, because of the risk of choking.

• You can generally expect croup to last around five days; the cough may go from barky to congested and linger a few more days.

• When to make that call to the advice nurse or doctor:
- The rasping changes to a whistling sound.
- The child is losing color.
- The child can't speak or cry because of lack of breath.
- The child is struggling harder to breathe, but the sound of breathing is decreasing.

Of course, if you are in any doubt about your child's situation, seek help from a medical professional. The above is general advice only and is not meant to subsitute for professional medical advice.

Good luck!

-- Amy Wang;