My nephew seems to get croup a lot. He is 4.5 years old and has had it 4 times that I can count. I worry about him.  I did some reading and it seems like croup is less common after age 5. Oh, that 5th birthday of his couldn’t come soon enough. I know it is scary for my sister when she sits up with him at night and has to listen to that horrible cough. I thought the information on symptoms, warning signs, treatment and concerns of croup would be helpful for everyone.

This is helpful information from the bbc.co.uk website.

Croup is inflammation and narrowing of the larynx and trachea (the
main airways to the lung) more formally known as laryngotracheitis. The
mucosa lining the airway becomes inflamed and there are increased
secretions. Most hazardous is the swelling of a part of the
trachea known as the subglottic area. Although croup is usually mild,
it occasionally causes severe breathing problems that may need
emergency treatment. More than 95 per cent of cases of croup are because of a viral
infection, usually a type known as parainfluenza, although other
viruses, such as RSV or influenza, may also cause it. In a small number
of cases a bacterial infection is to blame. Croup typically occurs between the ages of six months and six years,
but the peak age is two and it’s less common after three. Children with
asthma may get repeated episodes. Croup starts like a cold with snuffly nose and mild fever. But within a day or two, a characteristic barking cough develops. There is also harsh stridor (a rasping sound heard when the
child breaths in), shortness of breath and a hoarse voice. Symptoms are
usually worse at night. Signs of more serious croup include
drawing in of the chest wall below and between the ribs, fast difficult
breathing, agitation (or drowsiness as the child gets tired) and a blue
tinge to the lips. In bacterial croup, the child may seem more ill, with a high fever and rapid deterioration. If your child has these symptoms, call your doctor for advice. Never
try to look in the child’s throat because you may trigger spasm of the
airways if they’ve a condition called epiglottitis. Mild viral
croup can often be treated at home with a moist environment (use a
vaporiser, or place a damp towel near the radiator, or sit them in the
bathroom as you run a hot bath), paracetamol syrup for fever and
discomfort, and plenty of drinks to avoid dehydration. In more
severe croup, hospital treatment may be needed. This includes steroids
(tablets or through a nebuliser) and humidified oxygen. Occasionally,
the child will need to be intubated (a tube is put in to the trachea
through the nose or mouth) to help with breathing. Most children recover from croup within a few days. If you’re worried,
call your doctor, or an ambulance if the child is not breathing
properly, blue or very drowsy.

And more help from Dr. Sears:

Croup usually lasts 5-6 days and is worse at night.  The symptoms tend to peak
on the second or third night.  Croup may begin without warning when child
suddenly sits up in bed with a barking cough.  Or it may begin as a cold that
gradually escalates into a croupy cough. Often will be fever, but usually below 104.he main concern for parents is to
recognize when croup is serious and when it is not.
Is Croup contagious?  Yes, it is about as contagious as the common
cold.  Good hand washing is important to prevent spread.
The features to observe are the behavior of your baby and how the croup is
progressing.  If your child is smiling, happy, playful, looking around,
interested in the environment, and not obviously bothered by the croup, these
are good signs.  He may have a barky cough, but is not having stridor
(see above). As a final reassurance, if your barking child is able to lie down
and sleep without repeated interruption, his breathing is not jeopardized. (Stridor: This is the most concerning symptom of croup.  Stridor is a harsh,
raspy, whooping, gasping sound when your child breathes in.) Here’s when to be concerned but not to panic.  The child whose airway
is obstructed and who is unable to get enough air has a worried look on his face
and is not interested in any play or interaction, as if concentrating all his
energy on getting air.  Child won’t lie down; he just sits up and barks, and he
can’t sleep.  When you watch the little dent in child’s neck just above the
breastbone, it caves in with each labored breath.  This sign is called
indrawing.  Stridor (see above) is another sign to watch for.  The
stridor will sound worse when you child is agitated or crying.  When the child
is resting calmly, the stridor usually lessens or goes away.  If your child is
calm, but still has stridor, this is a sign that the croup is worsening and
requires immediate treatment, see below.

Calm your child.  Croup can be frightening for your child.  Crying
will make the stridor sound much worse.  It is important to keep your child
relaxed by cuddling and staying calm yourself.  Sit baby upright in your lap,
play soft music, sing lullabies, read a story.  If breastfeeding, offer the
great pacifier.
Steam up the bathroom.  Humidity helps clear child’s breathing
passages. Turn on the hot shower in your bathroom and close the door.  While
keeping your child calm, sit with them on your lap in the steamy bathroom.  You
should see some improvement in about ten minutes.
Inhalation of cool mist.  If you have a cool mist humidifier or
vaporizer, let your child breathe directly in front of the stream of mist.  Once
the child improves, keep the mist flowing near the bed for the rest of the
night.  If you only have a hot mist vaporizer, you can still use it but don’t
get too close, as child can get burned.
Cool night air.  If necessary, bundle-up your child and take him
outside into the cool night air for 10-20 minutes, or take a slow car ride with
the windows open.  The misty night air is why babies with croup often improve en
route to the ER.
Treat the fever. Using Acetaminophen or Ibuprofen. Click on each for
dosing help.

The above suggestions usually work well within about twenty minutes (an hour
for the fever), and the child is able to settle back to sleep.  You should
observe your child closely by sleeping in the same room the rest of the night,
as another croup attack is likely, and the above treatments will need to be
repeated.
After trying the preceding treatment, assess in which direction your
child is going. If indrawing and stridor is lessening, color is
returning to child’s pale cheeks, or he initiates some interaction or
wants to drift off to sleep (though still breathing noisily), continue
with the steam and a watchful eye and ear. If you feel your child is
getting worse despite the above treatments go straight to the Emergency
Room. Your doctor won�t be able to treat this over the phone, so it may
be best to go to the ER instead of paging your doctor and waiting for a
call back.

Watch for the following emergency signs, and if any of them occur take baby directly to the nearest Emergency Room.

• The indrawing is becoming more labored and your child’s inhaling changes from a low-pitch stridor to a whistling sound.
• Your child becomes paler.
• Child can’t speak or cry from lack of breath.
• Child is struggling more to get each breath.
• Your child begins drooling excessively, or has difficulty swallowing.
• The indrawing is increasing, but the sound of breathing is decreasing.

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