Learn the warning signs of pediatric croup

The heavy breather on the other end of the phone line was a sleeping 3-year-old. Her father had paged me to ask for advice after a rough evening listening to his little girl's barking cough. He had finally settled her down to bed, but was still worried.

Dad offered to put the phone by his child's mouth so I could hear what he was hearing. I listened for a minute to get the rhythm of her breathing. She was taking quick breaths and was noisy while breathing in, not out. This "stridorous" breathing and dad's comment about the barky cough gave me the diagnosis of croup. The little girl sounded sick enough to be seen, but comfortable enough for a ride in dad's car, so I quickly recommended a night visit to the nearest emergency room.

Croup, also known as laryngotracheobronchitis, is a respiratory disease that comes on suddenly and seems to worsen after bedtime. Croup is a common pediatric condition, generally affecting kids under 5 years of age. Many parents already know its warning signs, but don't know why the illness progresses as it does.

Experts at the American Academy of Pediatrics describe croup as a swelling of the larynx and trachea (voice box and windpipe). This swelling below the vocal cords narrows the child's airway, resulting in that recognizable barky or seal-like cough.

Croup peaks in the fall and winter months and is most often triggered by human parainfluenza viruses. Other respiratory viruses, including influenza viruses (another good reason to have your child vaccinated against the flu) and RSV (respiratory syncytial virus, more notorious for causing bronchiolitis or infant wheezing), are also known causes of croup.

Since the vast majority of croup cases are viral, antibiotics don't help. With mild croup, children simply need close observation and supportive care. If your child is alert, drinking, not highly feverish and not labored in his breathing, simply encourage good fluid intake and keep him as humidified as possible.

Sit with him in a steamy bathroom for 10 to 15 minutes, and then place a cool mist vaporizer or humidifier in his bedroom. This exposure to extra moisture can help diminish the tight cough and make breathing more comfortable. If he still seems uncomfortable, try bundling your child up and bringing him outside on a cold winter's night. Some parents find that, after their child breaths the cold night air during the ride to the emergency room, he is so much better that they turn around and head back home.

If at-home treatment doesn't work and your child looks like she's increasingly stridorous and working harder to inhale, a visit to your child's doctor or the emergency room is in order. If you have any qualms about transporting your sick child yourself, or if your child looks like she's experiencing a severe case of croup with very labored breathing or color changes (cyanosis or blueness), call 911 for emergency assistance.

Once under medical care, kids with croup often respond to treatment with steroids (oral, injected or inhaled) as well as a nebulized or machine-generated misted medication called racemic epinephrine. In severe cases -- when the child appears to be tiring from ongoing stridorous breathing, or when she needs supplemental oxygen -- hospitalization is required.