PEDIATRICIAN DR.PAUL Answers: Croup is caused by an inflammation (swelling) of the upper airway (larynx or voice box and the trachea or windpipe). The inflammation is usually due to a viral infection, and is a common condition in young children. Typically, viral croup begins with a cold that slowly develops into a characteristic "seal-like" barking cough and a high-pitched, raspy noise when breathing in, known as "stridor". The stridor often gets worse with physical activity. Most children with viral croup have a low-grade fever. The potential problems of croup depend on how much the upper airway is blocked by the swelling.

The more the airway is blocked, the more the child's breathing is labored and in general the less active the child becomes. Additionally, an important sign of difficulty breathing is that he may stop eating or drinking. Croup usually worsens at night, lasts for three to four days and usually subsides on its own.

In children with mild croup, the treatment approach is simple: exposure to cold, humid air. You can do this in two ways: open up a window or simply bundle the child up and take him outside. Another way is to let the shower run, preferably with cold water, and to let the child sit in the bathroom to breath in the cold humid mist. Usually, children start to breathe more easily within 15 minutes of exposure to cold, humid air. During the rest of the croup illness a cold-water humidifier or vaporizer in the room during the night can also help.

The cough and stridor of croup may be quite scary, but fortunately most cases are mild, and need no other treatment or medical intervention. However, in the most serious cases, a child may have so much difficulty breathing that he is not getting enough oxygen into the blood. In this situation, the child will need to go to the hospital.

Signs that a child needs immediate medical attention include: stridor that is getting louder with each breath, inability to speak because of lack of breath, labored breathing, pale or bluish mouth or fingernails, stridor at rest, and/or drooling. At the hospital, the child will be evaluated and given oxygen if necessary. Although there are no specific medications for croup, steroid injections and adrenaline-like inhaled preparations are used to help children with severe croup. These medications act to decrease the swelling of the upper airway.

Another type of croup is called "spasmodic croup". In this case, the child gets a cold, rarely with fever, and then the typical "croup" begins. In some cases spasmodic croup may begin suddenly without any preceding cold symptoms. Unlike viral croup, spasmodic croup usually recurs, can occur in older children and is thought to be related to allergies. Viral croup is more common in children less than five years of age. Croup is very rarely seen in adults.

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