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Croup is a viral illness that causes irritation of the trachea (the main airway leading to the lungs). Its audible symptoms include a characteristic barking cough, various degrees of difficulty breathing, and a squeaky sound on inhalation called “stridor.”

Croup occurs in kids from three months to almost six years, and it tends to strike in winter. It often starts like a flu, with a fever as high as 102° or 103°F but may appear suddenly, usually at night, without any prior signs of cold or flu. Croup can sound quite impressive, especially when Jimmy barks like a seal and breathes like a train whistle. Despite these dramatic aural features, croup is usually mild and resolves after a couple of days. Some cases can be more severe, however, with significant respiratory distress.

In mild cases of croup, you’ll only hear the stridor when Jimmy breathes rapidly or coughs. In moderate croup, Jimmy has to work hard to breathe, and the stridor is audible even when he’s at rest. With severe croup, his breathing is constantly labored.

When to worry

If Jimmy gulps for air, despite relief treatment (see below).

If his breathing difficulty is constant

If he seems to pull in air with his neck or belly muscles

If his skin is pale or his lips are blue

If you suspect he has inhaled an object into his lungs (He may manifest the above croup-like symptoms in this case.)

Any of the above will require a trip to the hospital.

When not to worry

When Jimmy has a barking cough or difficulty breathing but is able to sleep, drink, or cough

If his breathing improves markedly with the moist-air treatment described below

What to do

During croup, the trachea swells up and airflow is reduced. The faster and more intensely Jimmy breathes, the more difficult breathing becomes. The goal is to help break the nerve-wracking cycle and induce deeper, slower respiration.

First, try not to panic; this will only increase Jimmy’s anxiety and rate of respiration. Then you can help him ease his breathing.

Have Jimmy breathe the steam of a running shower. You may also want to open the windows or take him out for a short stroller ride. Both activities improve airflow by encouraging slower breathing.

Lower his fever (if he has any) with acetaminophen or ibuprofen. A high temperature speeds up the respiratory rate, which makes breathing even more difficult [See: Fever].

If the episode occurs at night, put him back to sleep when he’s calmed down, and place a vaporizer or humidifier turned on at full strength by his bed.

If there is no relief and his breathing is still labored, you may need to take him to the hospital.

While mild croup requires no further treatment and subsides within a couple of days, your doctor will treat moderate forms by prescribing a short course of oral steroid medication, which is safe and efficient. Severe cases of croup are treated in the hospital.

Some kids will experience periodic recurrences of croup, especially the type that manifests no flu symptoms. One minute Jimmy’s fine; the next he has that distinctive cough and labored breathing again. This could happen a few times a year until the end of childhood (ten years old or so), and if it does, you’ll become an expert at treating the condition.