What is It, When to Worry?
What is Croup?
Croup is a variety of a cold that presents the greatest worry and perhaps the greatest risk of all forms of a cold.
The word croup is actually derived from ancient root words that mean "to call out, to cry, to shout hoarsely"
Like all colds, croup is an infection of the respiratory system by a virus. What makes this respiratory infection croup is not the germ as much as the geography.
When a virus causes a cold or respiratory flu, what happens physically is that the virus burns the lining it attacks. If the virus attacks the nose, the lining of your nose gets burned and you develop a sore, runny nose. If the virus attacks the throat, you get a sore throat, and if it burns the lining of the lungs you get the all too familiar cough of a cold.
Croup happens only when the virus attacks a very specific area of the respiratory tree- the vocal cords and voice box. What is so special about this area? Think about narrowing and where narrowing counts. If your nose gets very swollen and clogged with mucus, you can always get around that by breathing through your mouth. And if some part of the lungs gets swollen and filled with mucus, you can always get around that by having the air go in and out of other parts of the lung.
But, if the vocal cords get badly swollen, so swollen that the gap between them is closed, then no air can flow, and that is very bad.
So, croup is a cold that has landed on the vocal cords, and caused enough swelling there to create some problem with air flowing, usually a barking cough.
When to Worry
As with all infections, the amount of irritation, swelling, and mucus production varies from mild to severe.
The sequence of severity for croup is as follows:
1. Croup always starts off as a barking cough with no trouble breathing when not coughing.
2. The next stage, if it gets more severe, is some difficulty breathing noted by a whooping sort of sound on breathing in. This is called stridor. It is a sharp, moaning sound on breathing in.
3. If croup gets even worse, then not only is there a barking cough, and stridor, but now you can see your child tugging and pulling air hard to get it into their chest.
4. At the most severe, it becomes truly challenging for the child to get air in their chest.
Fortunately, the vast majority of cases of croup we see never go beyond the mildest stage, simply having a barking cough. If your child has a barking cough, but breathes easily and without that sound we call stridor, there is no danger, this croup is too mild to cause any harm.
A small number of children we see go on to have stridor, but not many go beyond that.
So, when looking at your child with a cold, if you hear a barking cough but hear no stridor and see that he or she is breathing comfortably, no reason for worry.
And, of course, if you hear stridor or see any difficulty getting air in and out of the chest, that is when to be concerned and contact us.
In very, very instances, breathing is really very hard for the child and there is a great deal of struggle. This is the situation that truly is emergent and indicates the need to call 9-1-1.
What to Do?
If your child's croup is mild, only the barking cough, there is not much to do. As with other colds and coughs, there is no medication that will actually change the cough. Comfort measures may help, such as sipping comfort foods and drinks.
If the cough goes on to stridor, give us a call. While at home, you can sit in a steamed-up bathroom which will dissolve some mucus around the vocal cords and ease breathing. And/or, you can step outside which will allow cold air to shrink some of the swelling around the vocal cords.
If the stridor is mild, we can start a prescription of oral steroid for a short time which will shrink the swelling around the vocal cords and restore easy breathing.
Again, if trouble breathing is pronounced, the right course of action is to call 9-1-1.
Croup is a cold with a specific location, the vocal cords. We see croup every cold and flu season.
It tends to be mild, with only a barking cough, but can be more severe.
If it is mild with only a barking cough, not much to do.
If it starts to make breathing difficult, then you need to call.
Here is to a happy and healthy holiday season,