Waking up suddenly to your child coughing and struggling to breath can be one of the most frightening situations you will have as a parent. If you have ever experienced this, you will never forget the sound of a barking, seal-like croup cough and the stridor that comes with it. My goal is to help you recognize the illness and have a plan to help your child get through it with as little anxiety as possible. Croup is caused by a virus and children can have fever, runny nose, cough, and a hoarse voice – until they wake up suddenly with difficulty breathing. These symptoms are caused by swelling in the vocal cords and the high-pitched wheezing noise with inspiration (breathing in) is called stridor. Croup can be mild with a barky cough alone or severe with cough, stridor and difficulty breathing. With mild symptoms, supportive care with nasal saline, honey, humidified air and ibuprofen or acetaminophen is appropriate. If your child wakes up with sudden difficulty breathing, take these steps:

1) Remain calm and calm your child! Anxiety will make your child worse (I know, easy for me to say).

2) Turn your shower on to the hottest setting in your smallest bathroom

3) While steam is filling up the bathroom, take your child outside in the cold air

4) If it is not cold outside, hold your child in front of the freezer

5) Sit with your child in the steam-filled bathroom for 10-20 minutes

6) If stridor continues after these steps, or your child appears blue, is drooling or struggling to breath, seek medical care – urgent care or emergency department is appropriate. There, your child will receive a dose of steroids and possibly a breathing treatment. Rarely, children need to stay in the hospital for humidified oxygen and frequent breathing treatments.

If your child goes back to sleep, without stridor or difficulty breathing after these steps, then call your pediatrician the next day. A dose of steroids can help decrease the severity and length of symptoms. Typically, croup lasts 3-5 days and the worse symptoms are nights 2 and 3, so a trip to your pediatrician can help you and your child get a better night’s sleep.

Click here to listen to an example of stridor.

Heather Joyce, MD

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