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Croup is a viral infection which can cause swelling of the larynx (voice box) and the sudden onset of a barky cough (like a seal or puppy). Other symptoms may include a runny nose, fever and raspy breathing. Symptoms are often worse at night or in the early morning and may improve throughout the day. Typically, a child wakes up with a barky cough just a few hours after going to sleep for the night.

A child may experience 2 or 3 difficult nights with these symptoms, which usually resolve within 3 to 5 days. Croup may occur at any age, but is more problematic for children under age three, because of their smaller airways. In older children or adults, the same virus may simply cause the common cold.

If your child wakes with a barky cough, first, try a steam shower. Bring the child into the bathroom, shut the door, turn on the hot water and let the room fill with steam. Sit with your child for 10-15 minutes while he breathes in the steam, being careful not to let him near the hot running water. This often helps to quiet the cough and noisy breathing associated with croup. You may have to repeat this more than once during the night. It is important for parents to remain calm and to try to keep your child calm. If he becomes frightened or upset, the symptoms may become more severe.

If there is no improvement with steam, open a window or go outside and have the child breathe the cold night air for a few minutes. You may also give a dose of Tylenol or Motrin to reduce fever or relieve the sore throat which can accompany croup.

If the steam shower or exposure to cold air relieves the symptoms, and the child is breathing more comfortably, try to settle him back to sleep, while keeping the head somewhat elevated. In the morning, call the office and make an appointment to see the doctor. Although the child may improve by morning, he may still require medication to prevent the symptoms from recurring the following night.

If the child does not improve with steam or cold air, and continues to have difficulty breathing (i.e., fast or noisy breathing, pulling in of the neck area above the breastbone or between the ribs, or flaring of the nose), call the on-call physician at (203) 755-2999. The doctor will advise you about what other measures to take, including whether or not to go to the emergency room.