• There is a distinctive cough that occurs with infections of the voice box (larynx).
• The cough is tight, low-pitched, and barky (like a barking seal).
• The voice is usually hoarse.

Description of Stridor:

• A harsh, raspy, vibrating sound (stridor) is heard when your child breathes in.
• Breathing in becomes very difficult.
• Stridor only occurs with severe croup.
• Stridor is usually only present with crying or coughing.
• As the disease becomes worse, stridor also occurs when a child is sleeping or relaxed.

Cause:

Croup is a viral infection of the vocal cords, voice box (larynx), and windpipe (trachea). It is usually part of a cold. The hoarseness is due to swelling of the vocal cords.

Stridor occurs as the opening between the cords becomes more narrow.

Expected Course:

Croup usually lasts for 5 to 6 days and generally gets worse at night. During this time, it can change from mild to severe many times. The worst symptoms are seen in children under 3 years of age.

FIRST AID FOR ATTACKS OF STRIDOR WITH CROUP:

If your child suddenly develops stridor or tight breathing, do the following:

Inhalation of warm mist - Warm, moist air seems to work best to relax the vocal cords and break the stridor. The simplest way to provide this is to have your child breath through a warm, wet washcloth placed loosely over her nose and mouth. Another good way, if you have a humidifier (not a hot vaporizer), is to fill it with warm water and have your child breath deeply from the stream of humidity.

The Foggy Bathroom -In the meantime, have the warm shower running with the bathroom door closed. Once the room is all fogged up, take your child into the humidified bathroom for at least 10 minutes. Allay fears by cuddling her.

Results of First Aid - Most children settle down after the above treatments and then sleep peacefully through the night.

Note: If the stridor continues in your child, call our office immediately. If your child turns blue, passes out, or stops breathing, call the rescue squad (911).

HOME CARE FOR A CROUPY COUGH:

Humidifier - Dry air usually makes coughs worse. Keep the child's bedroom humidified. Use a cool mist humidifier if you have one. Run it 24 hours daily. Otherwise, hang wet sheets or towels in your child's room.

Warm, Clear Fluids for Coughing Spasms - Coughing spasms are often due to sticky mucus caught on the vocal cords. Warm apple juice, lemonade, or herbal tea may help relax the vocal cords and loosen the sticky mucus.

Cough Medicines - Medicines are less helpful than either mist or swallowing warm fluids. Older children (over age 4) can be given cough drops for the cough, and younger children can be given 1/2 to I teaspoon of corn syrup. If your child has a fever (over 102oF [38.9oC]), you may give her acetaminophen or ibuprofen.

Avoid Smoke Exposure - By all means, don't let anyone smoke around your child. Smoke can make croup worse.

Close Observation - While your child is croupy, sleep in the same room with her. Croup can be a dangerous disease.

Contagiousness - The viruses that cause croup are quite contagious until the fever is gone or at least until 3 days into the illness. Since spread of this infection can't be prevented, your child can return to school or child care once she feels better.

CALL OUR OFFICE

IMMEDIATELY and begin first aid for stridor if:

• Breathing becomes difficult (when your child is not coughing).
• Your child develops drooling, spitting, or great difficulty in swallowing.
• Your child develops retractions (tugging in) between the ribs.
• The warm mist fails to clear up the stridor in 20 minutes.
• Your child starts acting very sick.

During regular hours if:

• A fever lasts more than 3 days
• Croup lasts more than 10 days.
• You have other concerns or questions.

Adapted from Instructions for Pediatric Patients by Barton Schmitt (2nd edition, 1999) with permission from the author.

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