So, your little angel (?) goes to bed happy as can be, then at the lovely hour of 3:00 a.m. wakes up out of the blue breathing harder than Darth Vader and barking like a trained seal. What's this all about?
Croup. It's back and raging right now. Croup is caused by several respiratory viruses (most commonly parainfluenza virus, but also RSV, influenza A, and other cold viruses). It is most common among children ages 2-4 years of age. For some reason, children with these viruses can have a significant amount of swelling in the larynx (voicebox) region. This gives them a constricted, whistly breathing pattern called STRIDOR that you will notice more with breathing in than breathing out, and more when they are breathing fast (crying or physically active). They may also get very hoarse or lose their breath altogether. In severe cases, the children can develop significant respiratory distress, with loud breathing both in and out, trouble swallowing, and retractions (the skin of the neck or under the ribs pulling in with breathing).
Typically kids will have tight breathing and croupy cough for the first 3-4 days (nights!) of the infection, then their cough will loosen up and become more productive, like a regular cold. It may take another week for their cold to go away.
You can usually treat croup at home unless it is severe. We recommend the following home treatments for your croupy child:
-- Run a cool mist humidifier or a steam vaporizer near their bed when they sleep. (If you use the vaporizer, be careful that they don't burn their fingers on the steam.)
-- If your child wakes up with stridor or severe cough, take him/her into the bathroom and run the shower on hot with the door closed. Sit with your child in the steam for twenty minutes or so, until the tight breathing starts to improve.
-- Another treatment for stridor that works well is to take your child outside in the cold night air. Be sure to bundle up, because you will need to stay outside from 15-30 minutes until the stridor improves.
-- If these things don't work, take your child to an emergency room for a special breathing treatment with racemic epinephrine. This will open up their throat, but it will require several hours of observation afterwards.
We can see your child in the office if he or she has stridor. Treatment with a steroid called dexamethasone (Decadron) will often help open up the airway.
Croup typically does not have fever with it, but the past week we have been seeing a lot of fevers (102-103) with croup. We should check your child if he or she has croup with a fever that lasts more than a day or two.