Croup What is That Barky Cough?

If any parent reading this article has experienced croup, they know how distinctive and terrifying that barky cough can be. A child with croup is usually crying from the pain of the cough, drinking less, and running fever, so usually looks miserable. Most of the time, this starts suddenly in the middle of the night – which can paint a scary picture for a parent. So what causes all this to occur, and what can you do as a parent when this happens?
Most cases of croup are caused by a virus. There are a few viruses that can be blamed, including adenovirus, RSV, and influenza virus. However, parainfluenza virus (a virus completely different from the flu) is the most common cause of croup. Usually there is not a quick test for this virus like there is for RSV and flu, but from previous research studies, we know that parainfluenza types 1-4 are the culprits.

Parainfluenza typically causes more severe cases of croup and interestingly occur in the fall of odd-number years. We have already started to see a large number of croup cases this fall of 2015 which are likely due to this strain of virus. Parainfluenza type 2 virus can cause a less severe form of croup and usually occurs each fall. Parainfluenza type 3 virus is also milder and can occur in the spring and summer seasons, and parainfluenza type 4 can occur any season of the year. Croup caused by RSV, influenza, or adenovirus usually occur in the winter time.
When a child is infected by one of these viruses, it usually starts out as a common cold, causing a runny nose, cough and often times a fever. After 1-3 days, the virus travels to the upper airway in the throat (the larynx and trachea) and causes swelling. This swelling is what causes the barky cough and sometimes stridor. Stridor sounds like wheezing and sometimes is indiscernible to parents. The difference is that wheezing is a high-pitched noise from the bronchi in the lungs/chest whereas stridor is a high-pitched noise usually during inspiration that occurs in the throat – and these are both treated differently.
An adult and older children may be infected with one of these viruses and may have just a pesky cold and maybe a sore throat, but children younger than 3 years old are at higher risk of this developing into croup. The reason for this is because their airway is much more narrow. The virus typically causes swelling of the larynx and trachea, which in some cases can be a pretty substantial amount of swelling. This causes the hoarseness, high-pitched cry and cough, and sometimes refusal to eat or drink because it hurts to swallow.
Most cases of croup can be treated at home. If it is cold outside (especially with our humid environment), you can take your child outside and the cool misty air helps open and relax the airway, which will improve the cough. You can also use a cool-mist humidifier or take your child into the bathroom and have a hot, steamy shower running for the same effect. Sometimes the throat swelling from croup can become too much and needs treatment with steroids and on the most severe occasions, breathing treatments with racemic epinephrine and sometimes hospitalization.
Unfortunately, croup is worse at night – many times with no signs that previous day to indicate it will be so bad later. If this happens, try the home treatment options and try to make an appointment with your pediatrician for the next day. If you try the home remedies and things are not improving any, then call your pediatrician or go to the Emergency Room.

Jennifer Adair M.D.

Jennifer Adair, M.D., was born and raised in Mobile. She graduated from Davidson High School in 2002 and received her Bachelor of Science in Chemistry at The University of Alabama in 2006. She completed her medical training at the University of South Alabama College of Medicine, and pediatric residency at the University of Nevada College of Medicine – Las Vegas and the University of South Alabama. She joined Children’s Medical Group in July 2013 and currently practices at their Airport office. Jennifer and her husband, Cory, reside in Mobile with their dogs, Fitz and Barkley.