Wellness Medical Care

Once you hear a croup cough, you will never forget it. The cough is harsh and dry, sudden and dramatic — often described as sounding like a barking seal. However, some children with croup have congestion, a runny nose, or even a wet cough. The hallmark of croup is that, wet or dry, the cough is harsh.

Inexplicably, croup almost always begins as the sun goes down and gets worse through the night. By the time the sun comes up the next morning, it is usually getting better.

Its duration varies, sometimes lasting one night, sometimes five. It tends to be at its worst on the second night. Occasionally, the cough continues through the daytime, predicting a rough night to come.

The sound of a croupy cough tends to alarm the child who is producing it. In fact, the cough can be so loud and barky that it may cause your child to cry, which then exacerbates the cough.

It is important to remember that croup is always caused by a viral infection, and therefore it does not improve with antibiotics (antibiotics treat only bacteria). There are at least five or six dif­ferent viruses that may lead to this classic cough. Therefore, to call a cough “croup” does not diagnose the cause of the cough. Instead, “croup” is a description, not unlike calling the sky “blue.”

Stridor is a low-pitched or squeaky sound produced when your child inhales. Stridor results when the part of the airway right around the vocal cords narrows. This narrowing can be caused by infection, allergy, inflammation, a congenital problem, or even a foreign body (such as food or a small piece of a toy) lodged in that area. Unlike the croup sound, which is audible only with coughing, stridor is heard with each breath.

When infection causes stridor, it can be difficult to say whether the infection is viral or bacterial. The most dangerous type of infection associated with stridor is epiglottitis. This is a bacterial infection that causes swelling of the epiglottis, the piece of carti­lage located at the base of the tongue.

Epiglottitis causes sudden-onset respiratory distress that can escalate quickly. There can be so much swelling that air cannot get in or out of the lungs, result­ing in complete obstruction of the airway, a medical emergency. A child with epiglottitis will look very sick and may be seated in a tripod position (sitting on his bottom, leaning forward onto his hands) to make himself comfortable.

The most common cause of epiglottitis is a bacterium called Haemophilus influenzae type B (HiB). Fortunately, this bacterium is now very rare because chil­dren are vaccinated against it. It is important to recognize that an under-vaccinated or un-vaccinated child is still at grave risk for epiglottitis from HiB.

Allergy can cause stridor if the tissue in the airway swells in response to an allergen. Severe allergy in the airway is called anaphylaxis. It is accompanied by swelling of the lips or tongue and hives on the skin. In the case of an allergic reaction, swelling on the outside of the body (skin, lips) may signal swelling on the inside (airway, lungs).