"The Curious Incident of the Dog in the Night" is a wonderful book by Mark Haddon but it is exactly what it feels like when your child gets the croup virus.  It is a sudden occurrence of a barky cough, usually in the middle of the night that makes a parent sit bolt upright.

Croup affects about 15-20% of young children.  It typically starts as a cold with nasal congestion and a low grade fever with the evolution of a strange, harsh cough and stridor, which is noisy breathing from turbulent airflow.  Croup is also called laryngotracheobronchitis because there is inflammation of the voice box (larynx), the windpipe (trachea) and the upper airways (bronchi).  Below is an xray of the neck, showing narrowing at the top of the airway which is called a steeplechase sign.  This type of narrowing occurs with severe croup.  

Click the link to hear the sound  stridor:

The most common causes of croup today are viruses.  Before the DTaP vaccine was available, diptheria was the most common cause of croup caused by the bacteria, Corynebacterium diphtheriae.  The "D" part of the DTaP vaccine provides protection against diptheria.  Croup caused by diphtheria often caused death.  Today, with widespread vaccination, viruses such as parainfluenza, influenza A & B, adenovirus and RSV are the culprits with parainfluenza being the most common.  Croup primarily occurs in the fall but can occur throughout the year, especially with a prolonged influenza season such as we are experiencing in 2018.

Advice is often given to use humidified air or cold air to reduce symptoms of croup.  Although these treatments seem to be effective anecdotally, the scientific literature, in multiple studies, shows no effect of humidified air on symptoms.  Cold air treatments have not been as well studied.  The use of warm or cold air is harmless and if effective, will make the child more comfortable. 
For more moderate to severe symptoms, one oral dose of steroids such as dexamethasone or prednisone can be remarkably effective. 
Seek care in the Emergency Department if stridor is noted on inhalation (common) and exhalation (less common), sucking in of chest muscles or increasing difficulty breathing. 

Croup is a self-limited illness that will resolve in 5-7 days with the worst of the barky cough occurring for 1-2 nights and the prognosis for recovery is excellent.

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