Many parents are horrified when awakened in the middle of the night by a strange barking sound coming from their baby's crib. While it may sound bad, the distinctive barking cough that is associated with croup usually isn't serious and in most cases can be treated at home.
Croup is a viral infection usually brought on by the parainfluenza virus which affects a baby's upper respiratory tract, causing the trachea and larynx (windpipe and voice box) to swell. The same virus that causes croup in a baby causes laryngitis in adults, but babies' airways are much narrower than adults, so when the croup virus strikes it turns a normal cough into a bark when it passes through the tightened airway.
Croup usually affects children between ages six months and three years; however, it can strike children up to five years old. Croup is usually strongest at nighttime and occurs most often in the fall, winter, or early spring. Because the parainfluenza virus, also known as the common cold, is usually the initial cause of croup, your child may have a cold for several days and then one night suddenly develop the distinctive loud, barking cough. However, viruses aren't the only culprits; seasonal allergies can also bring on recurrent and spasmodic bouts of croup during allergy season.
Many children will develop a low fever with croup, while some will reach temperatures as high as 104 degrees F. Because it is usually viral, antibiotics are ineffective for treating croup, and it usually clears up on its own in three to five days. The best way to ease your baby's coughing is to take him or her into a steamy bathroom or out into the cold night air for 15 to 20 minutes. Doctors believe that the moist or cold air helps reduce swelling in the airways (although it won't eliminate the cough completely). Cough medicine is also ineffective against croup, and can actually make coughing up mucus harder. If the steamy bathroom or cold air doesn't help your baby, or the swelling is severe, he or she may need a prescription for oral steroids.
While most cases of croup are mild and not cause for serious concern, it can be dangerous, especially in younger infants whose airways are very small, so at the first sign of croup, call your doctor to get an accurate diagnosis and to check for signs of dangerous swelling. If your baby's airways become too swollen, he or she can have problems breathing. In addition, a child can stop breathing during a severe coughing attach, so if your baby seems to be struggling for breath or his lips or skin turn blue, call 911 immediately.
Your doctor will have you listen to your baby's breathing to determine if he or she has stridor: noisy, labored, or even musical or whistling breathing. Displaying stridor after a coughing or crying fit is common and harmless; however, if your baby has stridor when he's resting or sleeping, take him to the ER immediately. Stridor in a resting baby can indicate significant swelling of the airways, which could be life-threatening.
Croup is contagious as long as your baby continues to cough, so keep him or her out of playgroups and/or school until fully recovered. Your child may get croup more than once. Some children are anatomically predisposed to get it repeatedly until their airways grow bigger, and children who develop croup due to allergies may continue to get it into their elementary school years.