About a week ago I started to see the first cases of croup for the season. Croup is an illness with a characteristic barky, seal-like cough that is dramatically worse at night and much milder during the day. Often the first sign of illness is a horrible cough at 2 a.m. and often there’s enough airway swelling to cause some visible difficulty breathing.
Croup is typically caused by a virus (parainfluenza, RSV, and adenovirus are the main ones) and when the virus strikes, it settles in the vocal cord area and just below. The younger you are, the smaller and narrower the airway is and as such when the virus causes swelling in the area it’s suddenly like having to breathe through a straw. If that weren’t bad enough, the swollen area hurts too, a lot.
As as result, the toddlers are up at night, breathing through a painful small airway and they end up getting more and more agitated. This agitation makes it even more difficult. Croup can also be accompanied by fever that causes the toddler to breathe faster, which complicates things further.
At 2 a.m. when you are awoken by your child with a seal-barking cough, first try to calm her down. The agitation will worsen all of her symptoms and will make it hard to assess whether she needs to be seen during the night. Your child will look as though she is struggling to breathe but if you can remain calm and soothe her, chances are she will improve.
Second, take her into a steamy bathroom to moisturize her airway. The swelling causes her to mouth-breathe, which dries the airway out and makes it that much more uncomfortable.
Third, consider giving some pain reliever like acetominophen or ibuprofen. By reducing pain you will help your child breathe more calmly.
If after an hour or so of trying to calm your child he is still gasping for air with every breath, heading to the ER makes sense.
It is rarely necessary to hospitalize a croupy infant, but steroids and specialized breathing treatments can relieve some of the airway swelling and allow the child to relax.
If you are able to calm your child down and his breathing at home improves enough that he falls asleep again, it may still be worth it to go to the office the next day to see if steroids are warranted to prevent another rough night.