A croupy cough is very distinct; many parents say it sounds like a barking seal. Along with the cough, children often breathe very noisily, or may experience stridor. And because croup causes the throat and windpipe to become inflamed and swollen, little ones with croup often get scared and panicky. In the middle of her coughing attacks, our daughter Catherine would tell us “I can’t breathe!” or “I can’t swallow!” Sometimes, the coughing was so violent, she would throw up.

Catherine is nine years old now, but dealt with repeated nighttime croup attacks as a young child. We’ve dealt with croup in our other children to varying degrees.

Croup is caused by inflammation and swelling of the vocal cords (larynx), windpipe (trachea) and bronchial tubes (bronchi). It often follows the common cold, and nearly always manifests itself in the middle of the night, when your child (and you!) are suddenly awakened by noisy, strangling coughing fits. Sometimes, there are multiple croup attacks in the night. Most children usually feel better the next day, with only a mild cough or the sniffles. The next night, croup may strike again!

Here are some good things to know when it comes to treating mild to moderate cases of croup at home:

Hot steam from the shower is good, but cool moist air is best. If possible, warmly dress your child and take him/her outside to breathe the night air. If it’s a baby, just bundle him in a blanket. Many croupy children being rushed to the doctor’s office in the middle of the night feel much better before they ever arrive. The night air is very soothing to the airways and helps reduce the inflammation. If it’s not possible to take your child outside, the next best thing is to close the bathroom door, turn on a hot shower and let the room fill with steam to breathe in.

Stay calm and give comfort and encouragement. A child can really get scared during a croup attack. Very sensitive children might feel they are choking to death or running out of air completely. Stay very close to your child and talk in a soothing and sympathetic voice. Try to stay busy so there will be a diversion. Some suggestions: tell a story, look at a book or sing a song as they breathe in steam from the shower, do gentle pats or “percussions” on their chest during coughing fits, give them a Kleenex to hold and use, or a warm washcloth to hold against their throat. If your child is sobbing or screaming and cannot seem to calm down, you might just have to sit and hold them for a long while. Trying asking yes/no questions, so your child isn’t overwhelmed, and only has to nod or shake the head to communicate.

Cold and allergy medications will not help croup. There’s always the temptation to administer some type of medicine, but croup won’t respond to typical cold medications, and antihistamines like Benedryl are not recommended. They will dry up the narrowing airways. Besides albuterol for very bad attacks, there probably isn’t anything in your home medicine cabinet that is indicated for a croup infection. Fever medication will help a febrile child, but again, this is not going to actually treat the croup attack, and a mild fever will be the least of your child’s worries anyway.

Make them comfortable for sleep. When the attack has subsided, your child might be more comfortable with his head slightly elevated in bed. A humidifier or vaporizer next to the bed helps tremendously. Offer something to drink before they go back to sleep.

Be on the lookout for danger signs. It’s time to call the doctor and start heading for the car if you notice any of these things:

• Your child is using all his energy and focus on just trying to breathe. That means it’s difficult for you to even make eye contact, or have them respond to a simple command. If the little dent in their neck just above the breastbone is caving in every time they breathe, this is called indrawing and means the croup is worsening. Likewise, if they are having stridor while calm and at rest, that’s also a concerning sign.
• Your child is barely able to get a breath between coughing attacks, or you are worried they may have aspirated something if a coughing spell led to throwing up.
• Your child’s coloring looks bad (pale, blue, purple, etc.)
• Your child cannot speak or cry because breathing is so difficult
• Your child is so distraught/hysterical that you cannot calm him down and/or he refuses any assistance. Be sure to take a helper, if at all possible, for the car trip.

Most children outgrow croup by the adolescent years, but for some it continues on even as they get older. I noticed that Catherine’s croup attacks and strep infections vanished after her tonsils and adenoids were removed at age 6, so there was likely a connection.

Have you dealt with croup in your family?