Croup is an acute viral respiratory infection involving the upper airway passages. It results in swelling of the vocal cords and narrowing of the upper airway to produce the symptoms of croup: hoarse voice, barky cough, labored breathing and low-grade fever. Croup may be preceded by a mild cold, or may occur unexpectedly. Typically, the symptoms of croup have an abrupt onset between 10 p.m. and 2 a.m. Croup generally improves during the day and worsens each night for 3-4 days.

With the acute onset of croup in the evening, the child’s breathing difficulty will generally improve 15-20 minutes. In order to hasten improvement, try the following:

1. Wrap the child warmly and take him outside into the cool air. The humid, cool air will help the breathing and the distraction of outdoors will help calm the child.

2. If the breathing difficulty persists, run hot water through the showerhead for five minutes to steam up the bathroom. Then take the child into the steamy air for five minutes.

3. Repeat step one, if needed.

4. If significant breathing difficulty persists, contact a physician.

When the breathing has improved, the child may be returned to his bed and a cool-mist humidifier set up to blow directly over the bed. A cough suppressant may be given as well.

Severe breathing difficulty not responding to steam or cool air, high fever, excessive drooling or undue apprehension are danger signs which call for immediate physician notification. In addition to these, a child who has had more than mild breathing difficulty should be examined in the office the following day.