Croup Treatment: The Dreaded Barking Cough

Croup treatment is all about getting that child into a steamy bathroom; using a cool mist humidifier; or taking the child out into the cool night air. These are all effective ways to ease the dreaded barking cough of croup. Other than that, acetaminophen (or ibuprofen for older children) can make the child more comfortable, especially if there’s fever.

Croup Treatment: What is Croup?

Croup is an infection in a child’s upper airway. The infection causes swelling. The swelling makes it hard to breathe. The swelling of the airway also causes the barking cough.

Croup affects children between the ages of 3 months and 5 years. The most common age for a case of croup is at around 24 months. Croup occurs more often in the fall and in early winter. Boys are more likely to get croup than girls. Croup stays contagious for a few days or until the fever is gone.

Croup Treatment: The Barking Cough

Croup is caused by a virus. The virus causes the vocal cords (larynx), windpipe (trachea), and bronchial tubes (bronchi) to swell. It is the swelling of these parts of the upper airway that causes the barking cough, scratchy voice, and high, squeaky, breathing sounds. When the child coughs, air is pushed through passageways narrowed by swelling. The results are a cough that sounds like a seal barking, and breathing that sounds like a whistle (stridor).

Croup is frightening to parents and their children. The good news is that croup usually sounds worse than it is. Most of the time, croup is not serious. Croup can usually be managed at home. Kids with croup tend to recover within 3-5 days.

Croup Treatment: How Croup Begins

We parents know it’s croup when we’re awaked by that dreaded barking cough in the middle of the night. But when we look back on how it all began, a parent may recall that the child already had symptoms of a cold, for instance a stuffed-up or runny nose, and maybe some fever. Once the airways begin to swell, the child’s breathing becomes more difficult. In addition to the whistling noise made when the child breathes in (stridor), you might also see the child’s skin pulling in between the ribs (retractions). In more serious cases of croup, the child may seem pale or blue around the lips, which suggests the child may not be getting enough oxygen.

Croup Treatment: Symptoms of Croup

Croup symptoms tend to worsen at night. The symptoms also worsen when a child is crying and upset. Of course, when your cough sounds like a seal or a dog; you have a fever; and it’s hard to breathe, it’s natural to feel upset and to cry, which only makes things worse. This is why it’s important to appear calm to your child and to make an effort to calm the child down. If your child sees you are calm, he has less reason to be afraid or nervous.

Here are common symptoms of croup:

  • Barking cough (sounds like a seal or a dog)
  • High-pitched breathing (like a whistle)
  • Hoarse, raspy voice
  • Breathing fast
  • Labored breathing
  • Noisy breathing
  • Stuffy nose
  • Runny nose
  • Fever

Children under the age of 3 years have smaller airways. That means their symptoms are likely to be more severe. You can expect your child to have symptoms of croup for three to five days.

Croup Treatment: Causes of Croup

Croup comes in two varieties: viral croup and spasmodic croup. The symptoms of both are the same. Croup is caused by the same sort of viruses that bring on the common cold. The most common virus behind croup is the parainfluenza virus.

There seems to be a seasonal component to croup, since children are more likely to have croup in fall and early winter. Age and gender also play a factor in a bout of croup. Boys get croup more than girls. The peak age for a bout of croup is 24 months. Kids generally don’t get croup after the age of 5 years.

Croup is contagious. Your child may catch a virus by breathing near someone who sneezes. Sneezing can release droplets of virus into the air. That’s why it’s smart to sneeze into a tissue, instead of into the air.

Child sneezes into elbow
Sneezing into an elbow can help prevent others from getting sick.

When someone sneezes into air, the droplets of virus can fall onto toys or other surfaces that children handle. The virus can live on such surfaces for quite a while. If another child should touch a contaminated item or surface, and then touch his eyes, nose, or mouth, a virus may set in.

Even when children use tissues, some droplets of virus can escape. These droplets can end up on the hands or clothes. Teaching children to wash their hands after sneezing is one way to prevent the spread of viruses.

Croup Treatment: Diagnosing Croup

The doctor diagnoses croup by listening to the child’s barking cough, and the high whistling sound of the child’s breathing (stridor). You may be asked whether the child has had any recent cold symptoms such as a stuffy or runny nose, and/or a fever. The doctor may also want to know if the child has had past problems with croup or health issues of the upper airway.Doctor applies stethoscope to child's back.

If symptoms of croup are severe, and don’t respond quickly to treatment, the doctor may order a neck x-ray. If the child has croup, the x-ray will show the “steeple sign” in which the top of the airway narrows to a point.

Croup Treatment: Treating Croup

Croup sounds scary but children tend to quickly get better with home treatment. The main thing is to keep the child calm, since crying and being upset worsens the symptoms of croup. If the child has a fever, acetaminophen can help the child feel better. If the child is older than 6 months, you can offer ibuprofen. Your doctor can give you instructions on dosing: how much, how, and when to give acetaminophen, or for the older child, ibuprofen.

Children with croup feel better when they breathe moist air. You can offer moist air to your child through any of these methods:

  • Run a cool-mist humidifier in the child’s bedroom
  • Run a hot shower in the bathroom (with door closed) until the room fills with steam. Sit there with your child for ten minutes
  • Take your child outside in cooler weather
  • Go for a ride in the car with the windows open a bit to let in the cool breeze
  • Sit with the child near an open window

Make sure your child is drinking lots of liquids. Kids tend to dry out from the coughing, difficulty breathing, and fever. If your child resists drinking, try using a spoon, or even a medicine dropper to offer fluids. Your child should also rest as much as possible.

Some children need stronger measures to combat the symptoms of croup. These children may need to go to the hospital for more intensive croup treatment. Croup treatment in these cases may include a breathing treatment, or steroid medication to lessen the swelling in the upper airway. Sometimes kids with croup will need to spend a short stay in the hospital until their breathing improves.

Croup Treatment: When to Get Help

For most children, croup goes away quickly and everything is once again fine. Some children, however, are prone to complications from croup. Children who were born prematurely, or who have asthma or other lung problems, for example, are more susceptible to complications of croup and may need further croup treatment. Even so, only around 5 percent of children who go to the emergency room for croup need to be hospitalized.

If your child has any of the following symptoms with croup, call the doctor or get immediate medical attention:

  • Makes loud, high-pitched whistling sounds (stridor) both when breathing in and breathing out
  • Breathing sounds are becoming noisier
  • Has trouble swallowing, drools
  • Seems nervous and hyper
  • Is listless, lacks energy, hard to awaken
  • Child’s breathing is faster than usual
  • Child is struggling to breathe
  • The skin around the nose, mouth, or fingernails looks blue or gray (cyanosis)
  • The child is too short of breath to walk or talk
  • You can see the neck and chest muscles pulling in as the child breathes
  • The child is dehydrated (not peeing enough, pee is dark, eyes look sunken, few or no tears when child cries, dry or sticky mouth)

Croup Treatment: Preventing Croup

Defending your child against the viruses that cause croup means staying away from people with colds. It also means washing hands often and well. Teach your child to stay away from people who are sick. Have your child learn to sneeze into the elbow, when tissue is not available.

Has your child had croup?

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About Varda Epstein

Varda Meyers Epstein serves as editor in chief of Smarter Parenting. A native of Pittsburgh, Pennsylvania, Varda is the mother of 12 children and is also a grandmother of 12. Her work has been published in The Washington Post, The Huffington Post, The Learning Site, The eLearning Site, and Internet4Classrooms.

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