Description of Stridor (seen with severe croup)

• When your child breathes in, you hear a harsh, raspy, vibrating sound.
• Breathing is very difficult.
• Your child has severe croup (stridor only occurs with severe croup).
• Stridor is usually present only with crying or coughing.
• As the disease becomes worse, stridor also occurs when a child is sleeping or relaxed.

Cause

Croup is a viral infection of the vocal cords, voice box, (larynx), and windpipe (trachea). It is usually part of a cold. Swelling of the vocal cords causes hoarseness.

Stridor occurs as the opening between the vocal cords becomes more narrow.

Expected Course

Croup usually lasts for 5 to 6 days and generally gets worse at night. During this time, it can change from mild to severe many times. The worse symptoms are seen in children under 3 years of age.

First Aid for Attacks of Stridor with Croup

If your child suddenly develops stridor or tight breathing, do the following:

• Inhalation of warm mist
• Warm moist air seems to work best to relax the vocal cords and break the stridor. The simplest way to provide this is to have your child breathe through a warm, wet washcloth placed loosely over his nose and mouth. Another good way, if you have a humidifier (not a hot vaporizer), is to fill it with warm water and have your child breathe deeply from the stream of humidity.
• The foggy bathroom : In the meantime, have a hot shower running with the bathroom door closed. Once the room is all fogged up, take him in there for at least 10 minutes. Try to help your child not be afraid by cuddling or reading a story.

Results of first aid

Most children settle down with the above treatments and then sleep peacefully through the night. If your child continues to have stridor, call your child's physician IMMEDIATELY. If your child turns blue, passes out, or stops breathing, call the rescue squad (911).

Home Care for a Croupy Cough without Stridor

• Humidifier : Dry air usually makes coughs worse. Keep the child's bedroom humidified. Use a cool mist humidifier if you have one. Run it 24 hours a day. Otherwise, hang wet sheets or towels in your child's room.
• Warm fluids for coughing spasms : Coughing spasms are often due to sticky mucus caught on the vocal cords. Warm fluids may help relax the vocal cords and loosen up the mucus. Use clear fluids (ones you can see through) such as apple juice, lemonade or herbal tea. Give warm fluids only to children over 4 months old.
• Cough medicines: Medicines are less helpful than either mist or drinking warm, clear fluids. Children over 4 years old can be given cough drops for the cough. Younger children can be given 1/2 to 1 teaspoon of corn syrup as needed to thin the secretions. If your child has a fever (over 102°F, or 38.9°C), you may give him acetaminophen or ibuprofen.
• Close observation : While your child is croupy, sleep in the same room with him. Croup can be a dangerous disease.
• Smoke exposure: By all means, don't let anyone smoke around your child. Smoke can make croup worse.

Contagiousness

The viruses that cause croup are quite contagious until the fever is gone or at least during the first 3 days of illness. Since spread of this infection can't be prevented, your child can return to school or child care once he feels better.

Call Your Child's Physician Immediately If:

• Breathing becomes difficult (when your child is not coughing).
• Your child starts drooling or spitting, or starts having great difficulty swallowing.
• The warm mist fails to clear up the stridor in 20 minutes.
• Your child starts acting very sick.

Call Your Child's Physician within 24 Hours If:

• The attacks of stridor occur more than three times.
• A fever lasts more than 3 days.
• Croup lasts more than 10 days.
• You have other concerns or questions.

Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.  Copyright 1999 Clinical Reference Systems